Different Types of Intraocular Lenses: A Simple Guide to Your Cataract Lens Options

If you or a family member has been told about cataract surgery, you may have heard a new word: IOL. It stands for intraocular lens, and choosing one is a big part of planning for surgery. At Soliman Paroli Optical in San Fernando City, La Union, we often hear the same worry: "There are so many choices. Which is right for me?"

This guide explains the main types in plain language so you can have a better conversation with your eye surgeon. It is general education, not medical advice. Your own eyes and needs will decide what suits you.

What is an intraocular lens (IOL)?

Inside a healthy eye, the natural lens bends light so you can see clearly. A cataract is when that lens becomes cloudy, so things look blurry, hazy or less colorful. The American Academy of Ophthalmology (AAO) explains that cataracts can be removed only with surgery.

During cataract surgery, the surgeon removes the cloudy natural lens and replaces it with a clear artificial lens, the IOL. Most IOLs are made of silicone, acrylic or other plastic, and are coated to help protect your eyes from the sun's UV rays. Like eyeglasses, IOLs come in different focusing powers. Your surgeon measures your eye, including its length and the curve of the cornea, to set the right one.

Cataract surgery is done by an ophthalmologist, a medical eye doctor and surgeon. As optometrists, our part is the eye exam, screening and referral, and your glasses afterward.

The main types of IOLs

Monofocal IOLs

This is the most common type. A monofocal lens has one focusing distance. It can be set for near, medium or far, but most people choose clear distance vision and then wear glasses for reading or close work.

Some people set one eye for distance and the other for near, called monovision. The AAO notes this is not for everyone and suggests trying monovision contact lenses before surgery.

Multifocal and trifocal IOLs

Multifocal lenses have zones set at different powers, much like bifocal or trifocal eyeglasses. They give both distance and near focus at the same time, and your brain learns to choose the right focus. Trifocal lenses are one multifocal design, and some multifocals also help with in-between (intermediate) distances, such as a computer screen.

Extended depth-of-focus (EDOF) IOLs

An EDOF lens has just one corrective zone that is "stretched" to cover distance and intermediate vision. The AAO says this may mean less effort to refocus between distances.

Accommodative IOLs

Similar to your natural lens, these are designed to move or change position inside the eye to focus at different distances.

Toric IOLs

With astigmatism, the cornea is shaped more like a football than a basketball, which distorts near and far objects. A toric lens has extra built-in correction for it, and is available in monofocal and some presbyopia-correcting designs. The AAO says people with moderate to high astigmatism are usually happier with toric IOLs.

Light-adjustable and enhanced monofocal lenses

A light-adjustable lens is a newer monofocal that your ophthalmologist can fine-tune after surgery, once the eye has healed, using light treatments in the clinic. "Enhanced monofocal" lenses have small design changes to improve intermediate vision, but eye surgeons say they should not be confused with true EDOF lenses. If you hear a term you do not know, ask your surgeon to explain it.

What about phakic IOLs?

You may also see "phakic IOL" or "ICL" online. These are different: a phakic lens is placed in the eye without removing the natural lens, to reduce the need for glasses or contact lenses. It is not a cataract treatment. The US FDA says all the phakic lenses it has approved are for nearsightedness and are intended to be permanent.

Frequently asked questions

Will I still need glasses after cataract surgery? It depends on the lens and your eyes. With a monofocal set for distance, you will likely need reading glasses. Premium lenses can reduce glasses use, but results vary.

How long until I see clearly? For presbyopia-correcting lenses, the AAO says it can take 6 to 8 weeks to focus fully at all distances. Follow your surgeon's follow-up instructions.

Can vision get hazy again after surgery? Years later, vision can become hazy if the lens capsule holding the IOL turns cloudy. Your ophthalmologist can use a laser to open it and restore clear vision.

Do I need surgery as soon as I have a cataract? Not always. The AAO says to consider surgery when cataracts keep you from doing things you want or need to do. Early on, new glasses or brighter light may help.

Can the right lens be chosen online? No. Only your ophthalmologist can recommend a lens after examining and measuring your eyes.

Book your eye exam

Blurry vision, night glare or faded colors are worth checking. The AAO suggests an eye exam every year if you are older than 65, or every two years if younger. Book an eye exam at Soliman Paroli Optical, San Fernando City, La Union, and bring your questions. If you need a cataract surgeon, we can refer you.

Sources

Mark Paul Paroli