In modern cataract surgery, the clouded crystalline lens is removed and replaced by an artificial intraocular lens (IOL). Intraocular lenses represent a highly innovative technology – both in terms of corrective power and the quality of vision provided. Different types of intraocular lenses are available today, enabling good vision at one, two or all three distances:
- Near: Approx. 40 cm (Reading).
- Intermediate: Approx. 80 cm (Computer work).
- Far: Beyond 100 cm (Spatial orientation).
IOLs can simulate the refractive properties of the natural lens, however they do not have the ability to accommodate. Advanced intraocular lenses are designed to meet additional, individual patient's vision requirements. Depending on the design, the advanced IOLs can offer further benefits, such as improved contrast perception.
Intraocular lenses are usually made of a soft, synthetic, and biocompatible material. A typical IOL measures approximately between 11 and 13 mm in diameter. The thickness of the lens can vary, depending on its refractive power. The corrective power of the lens is individually calculated and may differ for each eye. An IOL is transparent and neither visible nor perceptible in the eye.
There are different types of intraocular lenses available today. Generally, there is a distinction made between standard and advanced intraocular lenses, also known as premium intraocular lenses.
Standard intraocular lenses are the most commonly used implants in cataract treatment. They have one focal point and can improve sight at one distance: far or near. These lenses are called monofocal lenses. For the remaining distances, the patient may still need to use glasses.
Advanced versions offer additional advantages on top of treating the cataract. They provide the possibility of being less dependent on glasses for different activities. Advanced products include so-called multifocal, EDoF (Extended Depth of Focus) and aspheric or toric lenses.
Multifocal intraocular lenses have two or three focal points and restore vision at more than one distance, giving the patient a chance of being more independent of glasses. Multifocal lenses include bifocal and trifocal IOLs, with the latter representing the most advanced technology. Trifocal options allow the highest level of independence from glasses, enabling patients to see clearly at all three distances without them.
EDoF Intraocular lenses also provide a high extent of spectacle independence while inducing less visual side effects at night, compared to multifocal versions.
Added capabilities in advanced IOLs, such as aspheric or toric functions, offer additional advantages for the patients: Toric IOLs allow the correction of pre-existing astigmatism, while aspheric IOLs can improve contrast sensitivity general image quality.
Advanced IOLs allow patients to become less dependent on glasses, and are a good option for patients with active lifestyles and for those wanting more freedom from glasses. Since what they offer are additional benefits for patients, cataract treatment with premium lenses is – depending on in which country you live – not covered by health insurance.
This is the most common type of intraocular lens used in cataract surgery. When light enters the eye through a monofocal lens, it is bent to a single focus point on the retina.
Light cannot be focused from both distant and near objects at the same time, so it means that a monofocal lens can correct vision at one distance, providing good visual perception for either near, or far distance.
Most patients choosing this option want to be able to see at a distance, allowing them to perform activities such as driving and watching TV. They usually need to use glasses to help with near vision tasks, such as reading, cooking and working on the computer.
While most surgeons implant the monofocal option with distant focus to correct far vision, it is also possible to choose a monofocal lens with near correction to enable good vision up close. For all other distances, the patient needs to wear glasses.
The decision about whether distant or near sight should be corrected depends on the patient's lifestyle and visual needs. The decision should be made in agreement with the surgeon after a close consultation with the patient.
Standard types of monofocal IOLs have a spherical optic, which is equally rounded on both sides. It is normally paid for by your health insurance.
However, the natural crystalline lens of the eye has a slightly aspherical (not completely round) shape at the front, and is not equally curved on both sides. This shape enables it to precisely focus light rays entering the eye onto one point on the retina. The result is a clear, crisp image.
Advanced monofocal IOLs are available with an aspherical optic very similar to the original shape of the crystalline lens. The special design of the aspheric versions enable an enhanced image quality.
Additionally, if you have an irregularly shaped cornea, a monofocal lens in a toric version can improve your quality of eyesight considerably. Consult with your ophthalmologist to find which type of monofocal option is right for you.
1. IOL with aspheric surface
2. Light rays focusing exactly onto one point on the retina
Bifocal intraocular lenses have two focal points, providing clear vision at two distances, far and near. Patients choose this option over a monofocal IOL when they wish to see clearly at additional distance, and become less dependent on visual aids. Bifocal IOLs allow you to see clearly and perform tasks such as reading and driving without glasses. However, you may still need to wear glasses for certain tasks in the intermediate-range (approx. 80 cm), such as computer work and cooking.
- Glare in certain low lighting situations
- Halos around light sources at night
Most people with multifocal lenses find these phenomena only mildly disturbing and get used to them over time. However, there is also a small group of patients who do not adapt to the lenses well or are very bothered by the glare and halos that may occur.
EDoF (Extended Depth of Focus) intraocular lenses use an advanced optical technology that allows to increase the range of focus compared to standard monofocal types.
In this way, EDoF solutions enable clear eyesight ranging from far up to intermediate distances, like a computer monitor. For close-up activities such as reading fine print and precision work, patients treated with EDoF lenses may need to wear reading glasses. However, they will experience less visual disturbances at night, which are sometimes caused by bright light sources with multifocal IOLs.
- Working on the computer
- Driving a car
- Watching TV
- Other typical home and garden tasks
Daily tasks become easier and more enjoyable. Most activities can be fulfilled without needing to wear prescription glasses, however, reading glasses may be necessary for small print.
EDoF lenses combine the advantages of both monofocal and multifocal IOLs, providing the perfect balance between increased freedom from glasses and reduced visual side effects typically associated with the multifocal types. Some patients are more, others less sensitive to these light phenomena, which may be experienced as halos or glare around light sources, especially at night.
Patients with EDoF lenses generally enjoy good night vision, which is particularly important for driving after sunset, for example. The undisturbed and reliable visual performance that EDoF lenses provide gives patients a feeling of added comfort and safety.
EDoF IOLs are an ideal fit for individuals wishing to maintain an active lifestyle.
EDoF lenses offer a high degree of spectacle independence. However, the achieved vision quality is very individual and may differ from patient to patient.
It also offers a good fit for individuals interested in an IOL that combines greater freedom from glasses with high vision comfort day and night. Consult your doctor to see if an EDoF IOL might also be right for you.
These are the most advanced intraocular lenses (IOLs) available today, providing clear vision for near, intermediate and far distances. They are designed to enable a high degree of independence from glasses for patients leading an active life and wishing to do without visual aids.
Unlike monofocal and bifocal options, trifocal lenses also provide comfortable intermediate vision, which is important for various daily activities, such as computer work.
It allows you to perform a range of activities in everyday life without glasses. This includes daily tasks such as:
- Cooking, cleaning, ironing
- Working at the computer
- Watching TV
- Working in the garden
- Playing sport or doing exercise
The biggest advantage of trifocal IOLs is the possibility to see clearly at all distances without glasses. As a result, you may no longer need to wear glasses when pursuing your daily activities.
Moreover, trifocal solutions allow for the treatment of pre-existing vision disorders, such as myopia or hyperopia. With a toric version of the trifocal lens, pre-existing astigmatism can be corrected as well.
Trifocal intraocular lenses are also effective for treating age-related vision changes such as presbyopia, which affects nearly everyone after the age of 40. When you treat your cataract with a trifocal IOL you can take care of your presbyopia at the same time.
In short,trifocal IOLs offer a high chance to become independent from glasses or contact lenses.
- Glare in certain low lighting situations.
- Halos around light sources at night.
Most people with multifocal lenses find these phenomena only mildly disturbing and get used to them over time. However, there is also a small group of patients who do not adapt well or are very bothered by the side effects that may occur. Simulations of potential halo and glare perceived after the surgery help the patient prepare for the possible side effects.
Ask your doctor about the light disturbances during your consultation to check if you are the right candidate for a trifocal IOL.
In addition to the advantages offered by multifocal and EDoF IOLs, advanced solutions offer some more functions for a better vision. For instance, aspheric lenses correct certain light phenomena and improve contrast, providing an optimized image quality.
Toric intraocular lenses enable the treatment of astigmatism, a common vision disorder affecting roughly one third of the global population and causing distorted vision.
Both IOL types: the aspheric and toric IOLs have special characteristics to enable clear, crisp images. These additional functions are not always covered by the national health care system. Please check with your doctor if an aspheric and/or toric IOL is recommended in your case and discuss the potential extra costs of the lens.
The special, not uniformly curved, design of the aspheric IOLs enables the correction of spherical aberrations.
What is a spherical aberration?
A spherical aberration is a visual defect that occurs when light rays passing into the eye are not precisely focused at one single focal point. When we are young, the cornea and lens of the eye work together to focus the entering light rays at exactly one point on the retina, optimizing image contrast.
As we grow older, that interaction deteriorates, causing reduced vision quality. This means:
- Vision gets blurry.
- Contrast perception is decreased, leading to difficulty seeing in low-light conditions.
With aspheric IOLs, light rays entering the eye are once again sharply focused at a single point on the retina. The result is improved contrast sensitivity and an enhanced image quality, especially during activities such as driving at night or reading in dim lighting conditions.
If you are already suffering from spherical aberration or you want to prevent this visual change, an aspherical IOL may be a suitable option for you. Discuss this option with your ophthalmologist.
Visual acuity is an important factor for patients. The possibility of correcting astigmatism using toric intraocular lenses during a cataract procedure is a great option for patients suffering from both conditions. Astigmatism is a refractive error like near- or farsightedness. This error is usually the result of an irregularly shaped cornea, which leads to light not being properly focused on the retina. It causes objects at different distances to appear skewed or distorted.
- Depending on the type of lens, just prior to cataract surgery, temporary markings may need to be placed on your cornea that identify the location of the most curved meridian.
- During surgery, the toric IOL is implanted in your eye.
- Once implanted, each toric lens is rotated until the markings are aligned with the markings on your cornea.
If you have astigmatism and would like to correct it during cataract surgery, consult your doctor to discuss the implantation of toric IOLs.