Which Intraocular Lens Should You Choose?
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If you are one of the 4 million Americans each year who requires cataract surgery, then you have an important decision to make. Part of cataract surgery involves surgically replacing the clouded lens with an artificial one, known as an intraocular lens (IOL).
According to the American Academy of Ophthalmology, there are a few different IOLs to choose from, each with its own pros and cons. The two most common choices are:
As the name implies, these lenses are best for seeing well at one distance, typically far or near. Most people who choose monofocal lenses opt for distance vision lenses and use reading glasses for up-close tasks.
These lenses account for both near and far vision in one lens. The newest types of multifocal lenses also account for intermediate vision, which often applies to viewing computer screens or mobile devices.
Both choices have their pros and cons, and it’s an important decision for patients to make prior to cataract surgery. Allister Gibbons, M.D., an ophthalmologist with the Bascom Palmer Eye Institute, helps us weigh the different options.
The choice between lenses is nuanced.
While multifocal lenses at a glance seem like the better choice — you get better vision at all distances instead of just one — Dr. Gibbons says it’s not that simple. Of the many concerns related to multifocal lenses, one of the biggest is the lasting side effects of the procedure that can occur in some patients.
Specifically, some may experience blurry vision or “photic phenomenon” (halos, starbursts, or glare) after the procedure, frequently at night. A 2021 review of the research on multifocal lenses published in the Journal of Cataract and Refractive Surgery found that some patients experienced these side effects. However, many classified them as mild and not disturbing.
To reduce the chances of these side effects, Dr. Gibbons says that only patients with very healthy eyes (other than their cataracts) are selected as good candidates for multifocal lenses. But even then, he says, there is still a chance that these side effects can occur.
“The challenge is that we don’t really know in which patients these effects will be severe,” says Dr. Gibbons. “Most people are fine, but a small set of patients will end up with halos or other vision concerns after the procedure is complete.”
The other prohibitive factor for many patients when it comes to multifocal lenses is the cost.
Dr. Gibbons says that the typical price for multifocal lenses is around $3,500 per eye, and they are not covered by insurance plans. This adds up to a significant out-of-pocket expense for many.
Monofocal lenses, on the other hand, are less expensive and usually covered by most plans.
For these reasons, most patients still choose monofocal lenses for vision correction.
While monofocal lenses are typically only for either far vision or near vision rather than both, most people don’t mind using glasses for up-close tasks. Dr. Gibbons also says that some patients even choose “monovision,” a procedure that involves placing a “near” monofocal lens in one eye and a “far” monofocal lens in the other to correct both vision problems. This procedure may not work for everyone, but the good thing is that patients can do a “monovision trial,” in which they duplicate the effect with contact lenses to see if it will be effective for them.
Ultimately, Dr. Gibbons says that the choice between monofocal and multifocal lenses comes down to cost tolerance and personal preference.
If you do a lot of driving at night, you may not want to risk the potential side effects of multifocal lenses.
On the other hand, if you enjoy reading and don’t like wearing glasses, then multifocal may be your ideal choice. Patients who do a lot of mixed activities in the daytime, such as golfing, tennis, and hiking, as well as reading, might prefer multifocal lenses.
“Everybody feels differently about it, so I usually have patients weigh the decision in their own hearts,” says Dr. Gibbons.
“It often comes down to their like or dislike of glasses. If you don’t mind glasses, then monofocal lenses are probably fine, but if they really bother you, then the multifocal lenses may be worth a closer look.”
Wyatt Myers is a contributor for UHealth’s news service.