Matching Your Lens Implant to Your Life: A Guide for Cataract Surgery Patients

This article is for educational purposes only and is not medical advice. Please see the full disclaimer at the end.

During cataract surgery, the cloudy natural lens is removed and an artificial lens implant takes its place permanently. Most of the surgery is in your surgeon's hands, but the type of implant is a decision you make together, and it shapes how you see for the rest of your life. Rather than starting with brand names, we suggest starting with two questions. Which distances do you most want to see without glasses? And which compromises can you live with?

Key points

• There is no single lens that suits every person or every eye.
• Lenses that give the widest range without glasses also tend to cause the most halos at night.
• Astigmatism, earlier LASIK and other eye conditions can rule some lenses in or out.
• Medicare and medical insurance pay for surgery with a standard lens. Upgrading to a premium lens is an added out-of-pocket cost.

Your lens options at a glance

All intraocular lenses do the same basic job. What separates them is how they handle focus at different distances.

• Standard (monofocal) lens. Focused for one distance, most often far away, so you wear readers for close tasks. It is covered by insurance, and plenty of patients are delighted with it.
• Extended depth of focus (EDOF): Vivity, TECNIS PureSee. These do not split light. Instead they lengthen the zone of clear vision from far away to roughly arm's length, which covers a car dashboard, a computer monitor or a countertop. Halos at night are usually slight, not far from a standard lens. Fine print typically still calls for readers.
• Full range of vision (diffractive): PanOptix, TECNIS Odyssey, enVista Envy. Microscopic rings on the lens send light to far, middle and near focus at once, giving you the best chance of reading without glasses. In exchange, expect rings around lights after dark and a little less contrast when lighting is poor. See our post on multifocal lenses for more.
• Light Adjustable Lens: RxSight LAL and LAL+. After the eye has healed, its power is refined with brief light treatments in our office and then permanently set. Night vision is similar to a standard lens, and readers are usually still needed up close. You wear UV-protective glasses and come in for extra visits until the lens is set. Our Light Adjustable Lens post explains the process.

Toric models, which also correct astigmatism, exist for most of these lens types. Everything here applies equally to refractive lens exchange, where a clear lens is replaced for vision correction.

Start with your daily routine

Books, phones and computer work

Think about distance. A monitor or a music stand sits at intermediate range, and both EDOF and full-range lenses cover it comfortably. A paperback, a text message or the label on a medicine bottle is near range. If reading those without glasses for most of the day matters to you, a full-range lens gives you the best odds. If screens fill most of your day and an occasional pair of readers for tiny print does not bother you, Vivity or PureSee may be the better fit. Patients who have done well with monovision contact lenses can ask about blended vision, in which one eye is focused slightly nearer than the other.

Driving after dark

This is where lens types differ most. Rings or halos around headlights are common with diffractive full-range lenses. The brain learns to ignore them over a few months in many people, but not everyone adapts. If you do a lot of night driving or glare tends to bother you, an EDOF lens, a standard lens or the Light Adjustable Lens is usually the safer bet. It also helps to know that much of the glare you notice now probably comes from the cataract, so night driving tends to improve after surgery regardless of the lens.

Golf, tennis and time outdoors

Most outdoor activities call for clear distance vision with a bit of middle range, like a golf ball on the ground or a cycling computer on the handlebars. EDOF lenses match that well, and a full-range lens also lets you read the scorecard or check your phone. If what matters most is the sharpest possible distance vision, for example tracking a ball in the air, a standard lens or the Light Adjustable Lens (which Dr. Feiz adjusts once you have healed) may suit you best.

As few glasses as possible

Here a full-range lens is the strongest option, and many people who choose one seldom wear glasses at all. Results are best when:

• the retina, optic nerve and cornea are healthy, with a smooth and regular corneal surface;
• any dry eye is treated before measurements are taken, since an unstable tear film throws off the numbers and softens the final vision;
• very little prescription is left over afterward. Small amounts of astigmatism are more noticeable with these lenses, and a toric model, sometimes followed by a minor touch-up, takes care of most of it;
• expectations are realistic. No implant can promise a life without glasses, and very small print in dim light can still be a struggle.

Sometimes, months or years later, the thin membrane behind the implant becomes cloudy. People with full-range lenses usually notice this earlier than others. A brief in-office laser treatment, YAG capsulotomy, clears it.

Then check what your eyes allow

Astigmatism

An eye with astigmatism has a front surface curved unevenly, like the side of a football rather than a basketball. Standard lenses leave it uncorrected. Toric versions of standard, EDOF and full-range lenses correct it. With a premium lens this is especially important, because uncorrected astigmatism blurs the very range of vision you are paying extra for. The Light Adjustable Lens can also treat astigmatism after surgery. Our post on toric lenses covers this in more detail.

Earlier LASIK, PRK or RK

Prior laser vision correction makes it harder to calculate the right lens power. EDOF lenses are often favored in these eyes because they tolerate a small calculation error, and the corneal changes from laser treatment, better than diffractive lenses do. The Light Adjustable Lens is another good choice, since its power is set after surgery rather than estimated in advance. After a mild, well-centered laser treatment, a diffractive lens may still be reasonable, and your corneal scans guide that decision.

Macular degeneration, glaucoma and other eye diseases

Because diffractive lenses divide incoming light, they cost a small amount of contrast. A healthy eye hardly notices. An eye that is already losing contrast from disease may notice a lot. For that reason we generally avoid full-range lenses in eyes with macular degeneration, glaucoma damage, significant diabetic retinopathy, or a scarred or irregular cornea, such as keratoconus or Fuchs' dystrophy. For those eyes, a standard lens (toric if needed) is often the better decision, and an EDOF lens can sometimes work when the disease is mild. Significant macular disease may also rule out the Light Adjustable Lens. Learning that a premium lens will not benefit your eye is valuable information, not a disappointment.

Costs and insurance

Medicare and medical insurance pay for cataract surgery with a standard lens. Toric, EDOF, full-range and Light Adjustable lenses are upgrades that you pay for yourself, and choosing one does not cost you your insurance coverage for the operation. Refractive lens exchange is an elective procedure and is entirely self-pay. We give you the exact price in writing at your consultation, and CareCredit financing is available.

Getting ready for your consultation

It helps to arrive with a few notes: the activities that fill your day and how far away they are, how often you drive at night, your hobbies, your feelings about reading glasses, and how much small visual flaws bother you. Dr. Feiz works with lenses from Alcon, Johnson & Johnson and Bausch + Lomb, so his recommendation is based on your eyes rather than on a single company's product line.

Quick answers

Is there one best lens?
No. The best choice for you depends on your daily activities, your night driving, astigmatism or past LASIK, and the health of your retina, optic nerve and cornea.

Which lenses let me read without glasses?
Full-range lenses such as PanOptix, TECNIS Odyssey and enVista Envy give the best chance. EDOF lenses usually still need readers for small print. Standard lenses and the Light Adjustable Lens usually need readers for close work.

Which lenses are best for night driving?
Standard lenses, the Light Adjustable Lens and EDOF lenses such as Vivity and TECNIS PureSee cause the fewest halos. Halos from full-range lenses often fade over several months.

Will Medicare cover a premium lens?
Medicare covers the surgery and a standard lens. The premium lens is an out-of-pocket upgrade, and choosing one does not affect coverage of the surgery itself.

Questions?

If you are planning cataract surgery and want help choosing a lens, Dr. Feiz will review your eyes, your measurements and your daily routine with you. Call Eye Care of East Bay at (925) 705-7299 or contact us online to request a cataract evaluation.

Medical Disclaimer

This article provides general educational information only. It is not medical advice, diagnosis or treatment, and reading it does not create a doctor-patient relationship with Eye Care of East Bay or any of its physicians. Every eye is different, and the right choice for you depends on a full eye examination.

Do not delay seeking professional care, or make decisions about surgery or medications, based on what you read here. Talk with a qualified eye care professional about your own situation. If you have sudden vision loss or another emergency, call 911 or seek immediate medical care.