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Cataract Lens Options


 

When you decide to have cataract surgery, you need to choose which type of intraocular lens (IOL) will be implanted in your eye, and whether you want a high-performance implant that can reduce or eliminate your need for glasses.

No single IOL is best for everyone. To choose the right one for you, we evaluate four key factors:

  • Desired range of vision

  • Whether astigmatism correction is required

  • Cost

  • Presence of any ocular diseases


Reviewing these factors will help us decide on a standard monofocal lens, or a premium presbyopia-correcting lens, of which there are several types.

Standard monofocal lens implants correct for one vision range only, near or far. Patients will need glasses for the range not chosen. Presbyopia-correcting lens implants can correct for distance, intermediate, and/or near ranges. Currently, the  three leading lens technologies are multifocal (e.g., the Panoptix Trifocal Intraocular lens), extended depth-of-focus (the Symphony EDOF lens), and accommodative (the Crystalens Accommodative lens). If you have astigmatism, you’d require a special toric version of one of these lenses.

IOL Categories: single vision vs. presbyopia-correcting

As described above, presbyopia causes a loss of lens flexibility and a resulting inability to shift our visual focus from, say, the tv across the room to a book on our lap. 

A standard monofocal IOL is designed to provide the best possible vision without glasses at one of those distances– the tv or the book. Most monofocal lens patients opt for glasses-free distance vision, understanding that they’ll still need glasses to see up close after surgery. Should you have astigmatism, you’ll likely require glasses for both distance and near.

By contrast, specialized presbyopia-correcting IOLs enable the patient to see clearly at multiple distances: far (driving, watching television), mid-range (computer, tablet), and/or close up (reading). They can also correct for astigmatism. 

Four Factors in Choosing a Lens

No single lens is best for everyone. There are multiple presbyopia-correcting IOL technologies, and they have significant differences. To choose the right one, you need to consider four important factors: 

  • desired range of vision

  • whether astigmatism correction is required

  • cost

  • presence of any ocular diseases

  1. Desired range of vision. When selecting which IOL meets your needs, I discuss with patients their goal for which ranges of vision they want to maximize: far distance, mid-range, and/or close up vision. We discuss possibilities for eliminating the need for glasses.

Think about the lifestyle activities that are most important to you. Are you an avid surfer, birdwatcher, theater lover? These activities rely upon the ability to see clearly from afar, so distance vision is important to you. Does your work require spending hours in front of a computer or tablet each day?  This means that enhanced mid-range vision is a priority. Are you a tattoo artist, voracious reader, jewelry maker?  If so, you need to see clearly close up and you’ll want to maximize your near-range vision.

  Is astigmatism a factor?

    Astigmatism is an ophthalmic condition in which the cornea is somewhat oval-shaped rather than round. Astigmatism requires a specific type of IOL called a toric lens in order to see clearly without glasses or contact lenses after surgery.  

If you have astigmatism, a monofocal toric lens will correct for one vision range only – you can choose near or far, but you’ll still need glasses for the other range.

Conversely, a presbyopia toric lens can correct for both near and far vision, enabling you to see both ranges clearly without glasses. It will also correct for your astigmatism. All the presbyopia-correcting specialty lenses described below are available in toric versions.

 

  1. Consider cost. Monofocal (single-focus) lenses come standard with cataract surgery - they are covered by insurance.

Toric, multifocal and accommodative lenses, on the other hand, are high-performance upgrades. Most insurance companies will not cover the cost of a specialty lens. However, it’s worth considering that a pair of prescription glasses can cost anywhere from $300 to $1000. A multifocal implant costs more up front, but may be more cost-effective over time – they are designed to last for the rest of your life.

  1. Do I have any ocular diseases? Some lenses may be contraindicated if you have certain ocular conditions, such as diabetic retinopathy or macular degeneration. This is something we would discuss thoroughly preoperatively and account for in your plan.  

High-performance IOLs

The three leading presbyopia-correcting lenses are:

- Panoptix Trifocal Intraocular Lens (Alcon)

- Symphony Extended Depth-of-Focus Lens (Johnson & Johnson)

- Crystalens Accommodative lens (Bausch & Lomb)

In 2019, the FDA approved Alcon’s Panoptix Trifocal Intraocular Lens, which provides clear vision at all three visual ranges: distance, middle, and close-up. Patients who opt for this lens usually enjoy full independence from glasses post-surgery, though they may need a slightly brighter light when reading at night. Occasionally, a patient may require glasses for reading very small print. Some patients have reported seeing a small amount of glare or haloing around nighttime lights; most patients become accustomed to this shortly after surgery and tolerate the lens very well. 

The Panoptix Trifocal can also correct for astigmatism. Note that in certain eye diseases like macular degeneration, these lenses are contraindicated.

Johnson & Johnson’s Symphony Lens is another multifocal technology, extended depth of focus (EDOF), that works very nicely. It provides excellent field of vision in the far-distance (e.g. watching television, driving) and intermediate (computers, tablets) ranges. As with the Panoptix IOL, patients occasionally report a certain amount of glare or haloing around lights at night, with most patients becoming accustomed to this shortly after surgery and tolerating the lens very well. Patients who opt for this lens occasionally need glasses for reading up close. A Symphony toric lens can also correct for astigmatism. Contraindications for this lens are similar to those of the Panoptix lens. 

Bausch & Lomb’s CrystaLens represents a third type of lens technology, called an accommodative intraocular lens, which allows you to see distance and intermediate (computer/tablet) range. Patients who opt for this lens may require glasses for reading closer objects, as it offers a more narrow range of near vision. However, for certain eye diseases such as macular degeneration, the Crystalens can sometimes be a better option than other multifocal lenses. Crystalens implants are also free of any haloing or glare effects.

All three specialty IOLs – the Panoptix, Symphony, and Crystalens – are available in toric versions. 

To learn more or schedule a consultation to find out if you’re a candidate for cataract surgery, contact our offices today.

310-838-0202

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Eduardo Besser, MD
9808 Venice Boulevard, Suite 400
Culver City, CA 90232
Phone: 310-838-0202
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