Which IOL should I choose for my cataract surgery?
Dr Rajeev Raut Eye Clinic Raut Eye Care

This blog informs about different kinds of intraocular lenses (IOLs) for cataract surgery.

Reviewed by
Dr. Chaitanya Bhargav M.B.B.S D.OM.S
Updated on Jun 08  •  2 mins read
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How will vision improve after cataract surgery?

Cataract is a condition in which the clear and transparent natural lens located inside the eye becomes cloudy or opaque.
At the time of cataract surgery this cloudy natural lens is removed and replaced with an artificial IntraOcular Lens or IOL.
Cataract surgery not only improves the vision but also opens up the possibility of reducing dependency on glasses.
There are various types of IOLs available with different properties.

There are 2 basic types if IOLs :

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what are monofocal IOLs?

Monofocal IOLs have been the standard of care since the very 1st intraocular lens implants up until last few years.
These lenses have a single focal point and allow for good vision without glasses at one distance only. Therefore monofocal IOLs will give good distance vision or good near vision but not both. Depending upon a person’s needs or lifestyle one may opt to have a monofocal IOL for distance vision or for near vision. For the other distance glasses need to be worn.
For example if a person opts to have monofocal IOL for distance vision, he will be able to see far such as driving or recognising faces far away without glasses but will need glasses for near vision such as to read newspaper or the menu in a restaurant or work on mobile or laptop.
Advantages of monofocal IOLs : Cheaper than other lenses
No photic phenomenon
Disadvantages of monofocal IOLs : Dependency on glasses.
In order to have better near vision with a monofocal IOL one could opt for Smart surgery.

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Smart surgery

Here, a monofocal IOL is implanted but with specialised advanced software some curvature adjustments are made on the eye during the surgery to allow for a degree of better near vision in addition to distance vision without glasses. This may allow one to have good distance vision as well as read off the mobile screen or larger prints without glasses. For reading smaller size print such as newsprint glasses may be needed.
Some people may even have good distance and reading vision without glasses after undergoing smart incision surgery.
This may be a good option for people in whom multifocal IOLs are not suitable.

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What is monovision?

Sometimes monofocal IOLs are implanted in both eyes wherein one eye is adjusted for far by bringing the number to zero or as close to zero as possible and the other eye is adjusted with some degree of minus number for distance. This allows good distance vision with one eye as well as a fair degree of near vision with the other without spectacles.
This is in effect a sort of compromise which usually works well to reduce spectacle dependency where one eye is used for far and the other for near vision.
Disadvantages of mono vision : Some loss of depth perception.
Some decrease in overall
distance vision
Unsuitable for detail-focussed
persons or people with
squint or macular diseases

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multifocal IOLs

To get greatest freedom from spectacles after cataract surgery Multifocal IOLs may be considered.
Multifocal IOLs give good distance as well as good near vision.
Some people might still need to use a small number for prolonged reading or for fine print but unlike monofocal IOLs these (multifocal or trifocal) allow most patients to have freedom from glasses. They would allow people to perform tasks like watching movies, driving, reading newsprint or mobile without glasses.
Best results are obtained with multifocal IOL in each eye.
These IOLs are designed with rings on the surface which improve near vision by dividing light into different foci.
However multifocal IOLs are not suitable for everyone. Whether this IOL can be implanted will depend on the preoperative measurements of the person’s eye.
Disadvantages of multifocal IOLs :
More expensive than monofocals.
Because of the way these lenses are designed some rare individuals may experience photic phenomenon like haloes, glare from lights or loss of contrast sensitivity. In most patients these would resolve over days to weeks by neuroadaptation.
Possibility of these photic phenomenon is avoided or reduced with Custom designed multifocal IOLs.
However, if a person does a lot of night driving or has active evening social life this lens might not be a good option.

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Extended depth of focus (EDOF)

New technology lenses which improve the range of vision without splitting light rays. As opposed to 2 or 3 distinct foci for multifocal IOLs EDOF IOL creates one elongated focal point
These IOLs allow people to carry out most daily activities without spectacles. These are thought to be associated with less haloes or glare compared to multifocals and give normal contrast sensitivity.
However although they may give good distance and intermediate vision, fine near vision may not be as good.

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Toric IOLs

Some people have a condition called Astigmatism or ‘cylindrical number’ which means that the front surface of the eye is not evenly spherical but irregular in shape. If this cylindrical number is not corrected during cataract surgery the person may need to wear glasses for most activities.
Toric IOLs have different powers in different meridia to negate this irregularity. Thus these lenses reduce dependency on spectacles after cataract surgery giving optimal vision correction in astigmatism for one distance usually far.

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Aspheric IOLs

With age, the optical system (mainly the natural lens) of the human eye develops some aberrations. Unfortunately standard spherical IOLs can increase the positive spherical aberration of the eye.
Aspheric lenses are designed to avoid adding spherical aberrations to any optical system and are widely used in cameras, telescopes, in equipment in eye clinics and operating theatres.
Implanting an 'aspheric' IOL avoids increasing this positive spherical aberration. Several studies have shown better contrast sensitivity and night driving simulation improvement.
These IOLs would give better quality of vision and would work well for everybody especially younger people in low light conditions for example while driving at night or in people with active evening social life. It would also be a good choice of IOL for people undergoing lens implant surgery with purpose of reducing dependency on glasses.

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Article Reviewed by Dr. Chaitanya Bhargav M.B.B.S D.OM.S General ophthalmologist, chalazion and endoscopic naso lacrimal duct specialist

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