As you have seen on previous pages, when your natural lens becomes cloudy you have a cataract. When cataract surgery removes this cloudy lens, a new crystal-clear intraocular lens (IOL) is almost always placed in order to refocus images.

 Before discussing these replacement IOLs, you must learn about something called presbyopia. Presbyopia is a natural age-related part of life, and usually starts to affect people at about age 40-50. It results from the lens slowly losing its elasticity as the lens thickens over the years. When we are younger, we have a muscle inside of our eye that contracts as we attempt to focus on a close object like a book. After the muscle contracts, the lens “fattens” and increases its refractive power, which allows us to see the near object clearly. With the decrease in lens elasticity that occurs with increasing age, the eye has a hard time focusing on near objects. This is why you see people wearing reading glasses or “cheaters” while reading restaurant menus, threading a needle, or tying a fishing lure – they are suffering from presbyopia. 

Now you may be wondering which IOL is more beneficial for you and how do you choose the right one? The first step in determining this is to answer a few common questions prior to your pre-operative consultation with your surgeon. What do you do every day? Do you hunt, shoot, or golf? Do you work on a computer? Do you read a newspaper? Paper books? Read on a device? Do you text message a ton? Do you drive at night? What are your hobbies? What sports do you play? Ride a motorcycle? A bicycle? Paint? These are all important for us to know so we can decide what would work best for YOU!

Standard IOLs

Standard IOLs have been used for over 40 years in cataract surgery. They can provide excellent distance vision (such as seeing street signs or watching a golf ball) for patients without astigmatism. You will still need glasses to help get intermediate (such as a computer screen) and near (such as reading the newspaper) objects in focus Watch a video about Standard Monofocal IOLs.

Premium IOLs

Premium IOLs have been used for approximately 20 years. There have been several different designs over the years. The newest generation of premium IOLS have had excellent results, and their popularity is exploding. Another name for these lenses could be “presbyopia-correcting” or “astigmatism-correcting” IOLs because the goal is to minimize the need for glasses.

Toric IOL

Toric IOLs are specifically shaped IOLs designed to offset the imbalance created by the irregular shape of the cornea (astigmatism). Once implanted during surgery, they stay fixed in place thereby eliminating or decreasing pre-existing astigmatism. This can be used to treat low, moderate, and high levels of astigmatism. They can help provide both improved clarity as well as increased independence from glasses.

Multifocal/ Extended Depth of Focus (EDOF) IOLs

The purpose of this category of lens implants is to help treat or correct presbyopia. For several years, people that have astigmatism could not choose a multifocal IOL, unless the astigmatism was mild and could be treated with laser corneal incisions. Now, however, many of the multifocal and EDOF IOLs also come in toric versions, which treat astigmatism at the same time.

EDOF IOLs are great for people that want crystal clear distance vision and great depth of focus, such as for golfing or hunting. This lens extends the focus from distance vision all the way to about computer distance without having to create multiple focal points. The EDOF technology allows for very crisp vision without “dead zones” in the vision. Interestingly, quite a few patients like to have an EDOF in one eye and a trifocal or multifocal in the other eye – this allows the patient to benefit from the strengths of both types of lenses as the brain adapts over a few weeks.

Alcon Vivity IOL

The Vivity IOL is a type of extended depth of focus IOL. This lens provides excellent far and mid-range vision as well as functional near vision with a continuous range of vision. Reading glasses are usually needed for sharp near vision. Patients have minimal night halos because the lens is not diffractive (does not divide light), it functions with “X-wave technology” (a central, smooth, plateau in the center of the lens that extends the clear distance focus).

Tecnis Symfony IOL

The Symfony IOL is also designed to improve the range of vision provided with cataract surgery. Slightly different than a multifocal IOL, this lens uses small eschelettes to extend the depth (EDOF) or range of focus. Most studies show that EDOF lenses like a Symfony IOL have less glare than a traditional multifocal IOL, but also provide “slightly weaker” near vision than a traditional multifocal as well, as its near focal point is at approximately 23 inches. The beauty of the Symfony lens is the excellent range of vision from distance to intermediate.

Alcon PanOptix IOL

The only trifocal approved for use in the United States is the Panoptix trifocal IOL. This IOL is designed to give clear vision at distance, intermediate (computer), and near (reading).  The actual intermediate and near focal points are at approximately 16 and 23.5 inches away. Over 99 percent of patients implanted with this IOL in their approval study said that they would have the same lens implanted again!

Tecnis Synergy IOL

The Synergy IOL provides the widest range of continuous vision, with the best near vision of any presbyopia-correcting IOL. This lens allows for better contrast, especially in low or dim lighting. Johnson and Johnson created a novel hybrid design that features EDOF (extended depth of focus) and diffractive multifocal optics to provide a broad range of vision. They also incorporated violet-filtering technology to improve night symptoms.

Lenstec Clearview3 IOL

In March 2023, Dr. Rhodes implanted the first Lenstec Clearview3 lens in Central Texas. The Clearview3 is the latest FDA approved multifocal IOL, and is the first of its kind in the US because of the segmented optic (works like a progressive bifocal).  The lens is designed to improve contrast sensitivity, minimize glare and halos, and provide superior near/intermediate/far vision compared to other multifocal IOLs.

Light Adjustable Lens (LAL)

The Light Adjustable Lens (LAL) from RxSight is made of a photosensitive silicone. This lens is implanted during cataract surgery or refractive lens exchange surgery just like any other lens implant. The big difference is that the lens power is customizable after surgery once you are stable.  The IOL is exposed to UV light from a “light delivery device”, which changes the lens shape and power.  Once the desired vision is achieved, the lens power is “locked-in,” with a different light treatment.  This treatment allows for a level of precision and customization never seen before with cataract and lens surgery, and results in the highest percentages of ridiculously sharp vision compared to other IOLs. We are so privileged at Lake Travis Eye and Laser Center to be one of the first eye clinics in Central Texas to offer this technology!

At our clinic, we strive to always offer the newest and most- advanced IOLs on the market. We offer a variety of brands in order to accommodate to each patient’s needs and are always willing to compare options and alternatives with you. Our goal is to make sure you love your new vision, no matter which type of IOL you choose. We look forward to helping you see better!