Which Intraocular Lens Should You Choose?
When a cataract is removed from the eye during the surgery, it is always replaced with a new intraocular lens, or IOL. There are 3 different types of IOLs to choose from: a Monofocal IOL, Toric IOL, and Multifocal IOL. We will discuss with you the advantages and disadvantages of each lens option and which one may be the best for you.
Patients can also opt for monovision where one eye is set for distance and other eye is set for near vision. However, not everyone can tolerate monovision as the brain needs to be able to seamlessly transition from the vision from one eye to the other. We only consider targeting monovision with cataract surgery if patients have demonstrated that they like monovision prior to the development of cataracts.
Monofocal Intraocular Lens
A monofocal IOL has the same power throughout the lens. It is the base lens and is fully covered by insurance. It provides excellent vision if you do not mind wearing glasses or contact lenses after surgery.
Prior to surgery, you will specify a target distance that the monofocal IOL will be set for (for example far, intermediate, or near distance). In order to see other distances, you will have to wear glasses. For example, if you choose a monofocal lens with a far distance target, you will have to wear glasses in order to read or see the computer. Even for the distance you target, glasses are sometimes still required to sharpen the vision for that distance, especially if you have astigmatism. In this case, you may opt for progressive glasses after surgery so you can see all distances with one pair of glasses.
Toric Intraocular Lens
A Toric IOL is an intraocular lens that is arranged in the eye in a particular manner to neutralize astigmatism. If you have astigmatism, this lens will allow you to see a specified distance of your choosing (far distance, intermediate, or near) without the aid of glasses. Since a Toric IOL is a type of monofocal, you will still wear glasses for other distances.
During pre-operative testing, we will determine if you have astigmatism that needs to be corrected and if you’re a good candidate for this IOL. Toric IOLs are not covered by insurance and costs $2500 out of pocket. When placing a Toric IOL, we recommend using a femtosecond laser to aid in the precision of placing the lens. The cost of the laser in included in the price of the Toric IOL.
Multifocal IOLs are intraocular lenses that allow you to see more than one distance without the need for glasses. They are the best option for people who want to reduce their dependence on glasses or contacts when doing different tasks. The latest generation of Multifocal IOLs that we place in the eye are the Alcon Panoptix IOL and Vivity IOL.
Alcon Panoptix IOL
The Panoptix IOL was approved by the FDA in 2019. It is a trifocal IOL with concentric rings of different prescriptions to allow you to see distance, intermediate, and near without glasses.
The distance vision with a Panoptix IOL is similar to a monofocal, while the reading is vastly superior. In the FDA trials, 92% of patients with the Panoptix IOL were able to read 20/25 or better at 16 inches away compared to only 9% with a monofocal IOL. We still recommend having a pair of reading glasses handy to use to see fine print on occasion.
There are two important tradeoffs to consider with the Panoptix IOL. First, in low lighting situations, there is lower contrast sensitivity compared to a monofocal. For example in a dark restaurant, you may require additional light to see the small print on a menu.
Secondly, there is a higher rate of glare and halos around lights with the Panoptix IOL. In FDA trials, 5% of patients who received the Panoptix IOL reported these effects as significant.
During pre-operative testing, we will determine if you are a good candidate for this IOL. We only place the Panoptix IOL if there is no other coexisting eye disease. If you also have astigmatism, Panoptix IOL can also correct for astigmatism. This IOL is not covered by insurance and costs $3500 out of pocket. When placing a Panoptix IOL, we recommend using a femtosecond laser to aid in the precision of placing the lens. The cost of the laser in included in the price of the Multifocal IOL.
Alcon Vivity IOL
This IOL was approved by the FDA in 2021. It is an extended depth of focus (EDOF) IOL that will hopefully allow you to see distance and intermediate vision without the aid of glasses. You will, however, need reading glasses to see objects up close. This IOL offer comparable distance compared to a monofocal but extends light to allow good intermediate vision. (such as for the computer).
The advantage of the Vivity IOL over the Panoptix IOL is that it has a lower rate of glare and halos around lights, and similar to rates of a monofocal IOL. In addition, patients who are not candidates due to mild coexisting eye disease (such as mild glaucoma) may be able to get the Vivity IOL.
This IOL still comes with the drawback of decreased contrast sensitivity similar to other Multifocal IOLs. For example in a dark restaurant, you may require additional light to see the small print on a menu.
During pre-operative testing, we will determine if you are a good candidate for this IOL. If you also have astigmatism, the Vivity IOL can also correct for astigmatism. This IOL is not covered by insurance and costs $3500 out of pocket. When placing a Vivity IOL, we recommend using a femtosecond laser to aid in the precision of placing the lens. The cost of the laser in included in the price of the Multifocal IOL.