Intraocular lens implants (IOLs)

• Would you like to be less dependent on glasses after cataract surgery?

  If so, would you prefer to be less dependent on glasses for distance vision, near vision, mid-range vision, or all distances? (in other words – what would you prefer to see with your naked eye?)

• Do you have corneal astigmatism that can be corrected with an IOL? (This will be determined after measurements are obtained of your eyes)

  • Astigmatism means the front of the eye (cornea) is not perfectly round (like a basketball) but is more elliptical (like a football).
  • Astigmatism causes blurring and shadowing/doubling of images.
  • Toric IOLs can correct astigmatism.

• Do you have a history of refractive surgery such as RK, LASIK or PRK?

  Intraocular lens calculations are not quite as accurate if you have had previous refractive surgery. Therefore, the light adjustable lens may be a good option to titrate results as closely as possible, because the focus can be adjusted after the lens is in your eye.

• Are you willing to pay out of pocket fees on top of what your insurance covers?

  • In the US, insurance companies only cover standard monofocal lenses and monofocal “plus” lenses. They do not cover any premium IOLs including toric lenses, multifocal lenses, and extended depth of focus lenses. If you would like a premium IOL, there will be an out of pocket fee.
  • Financing is available through the CareCredit program. See below.

• Have you ever tried monovision (one eye set for near and one eye set for distance)?

  • Monovision can be done with cataract surgery, in which one eye is set for distance vision and the other is set for near/intermediate vision.
  • This option is typically only recommended for patients who have tried monovision previously with contact lenses or previous refractive surgery.
  • The advantage is having good vision at distance and near with decreased dependence on glasses. The disadvantage is decreased depth perception as both eyes are never focused on the same point.

• Do you have other ocular issues?

  If you have retinal or corneal issues, for example, you are likely not a good multifocal or extended depth of focus lens candidate. Your ophthalmologist will help determine which lenses may not be good options for you.

• Standard Monofocal Lenses

  This is the most common type of IOL used in cataract surgery. It has one focusing distance, set either for far, intermediate or near vision. Glasses are then worn for the other distances. Most people have the lens set for good distance vision and then wear glasses for intermediate and near vision. These glasses can often be over-the-counter reading glasses, commonly called “cheaters.” However, some people choose to set the lens for intermediate or near vision and wear glasses for distance vision. Typically, people who choose this second option are those who have been nearsighted most of their life.

  These lenses do not correct for astigmatism and are a good option if you do not have a significant amount of astigmatism or if you are unable or unwilling to pay out of pocket. Insurance companies cover the cost of these lenses.

  Lens	Company	Image	Material	Additional Details
  ZCB00/DCB00	J&J		UV blocking acrylic	Most common one we use
  AR40E	J&J		Acrylic optic, PMMA haptics	3-piece IOL, typically used in special circumstances
  ZA9003	J&J		Acrylic optic, PMMA haptics	3-piece IOL, typically used in special circumstances
  SN60WF	Alcon		UV and blue light filtering Acrylate/ Methacrylate Copolymer	Material can develop glistenings which may degrade vision quality over time
  SA60WF	Alcon		UV absorbing Acrylate/ Methacrylate Copolymer	Material can develop glistenings which may degrade vision quality over time
  MX60E	B&L		UV blocking acrylic	Good for patients with low spherical aberration (optical property of the cornea)

• Monofocal “PLUS” Lenses

  This lens is a monofocal lens, similar to the ZCB00, but its unique shape is designed to extend the depth of focus. It typically provides good distance vision with reasonably good intermediate vision, such as for the car dashboard. Glasses are still typically required for reading at near distances. This type of lens is now commonly used as our monofocal lens of choice for many patients.

  These lenses do not correct for astigmatism and are a good option if you do not have a significant amount of astigmatism or if you are unable or unwilling to pay out of pocket. Insurance companies cover the cost of these lenses.

  Lens	Company	Image	Material	Additional Details
  DIBOO/Eyhance	J&J		UV blocking acrylic	Most common one we use

• Toric Lenses

  The lenses mentioned above have a specific power to correct spherical error (nearsightedness/farsightedness). As described, monofocal lenses are set for one distance, requiring glasses for the others. EDOF and multifocal lenses, described below, decrease dependence on glasses by correcting spherical error at multiple distances. However, most people don’t simply have spherical error; they also have cylindrical error, called astigmatism. Astigmatism is due to irregularity in the shape of the cornea and causes images to appear blurred or slightly distorted. It can be corrected either with glasses/contacts or with a toric IOL. A small degree of astigmatism won’t have much impact on vision and doesn’t need to be corrected. However, if a larger amount of visually significant astigmatism isn’t corrected with a toric IOL during cataract surgery, then glasses will likely be required for all distances to achieve best vision. Almost all IOL types come in a toric version. Your surgeon will discuss astigmatism with you and advise if you would benefit from a toric IOL.

  Insurance companies do NOT cover the cost of astigmatism correction with toric lenses. There is an additional out-of-pocket expense for toric IOLs.

  Lens	Company	Image	Material	Additional Details
  ZCU	J&J		UV blocking acrylic	Toric version of ZCB00
  SN6AT	Alcon		UV and blue light filtering Acrylate/ Methacrylate Copolymer	Toric version of SN60WF
  SA6AT	Alcon		UV absorbing Acrylate/ Methacrylate Copolymer	Toric version of SA60WF
  MX60ET	B&L		UV blocking acrylic	Toric version of MX60E
  DIU/ Eyhance Toric	J&J		UV blocking acrylic	Toric version of DIB00/Eyhance
  ZXT/ Symfony Toric	J&J		UV blocking acrylic	Toric version of ZXR00/ Symfony
  DFT/ Vivity Toric	Alcon		UV and blue light filtering Acrylate/ Methacrylate Copolymer	Toric version of DFT/Vivity
  TFNT/ Panoptix Toric	Alcon		UV and blue light filtering Acrylate/ Methacrylate Copolymer	Toric version of TFNT00/ Panoptix
  DFW/Synergy Toric	J&J		UV and violet light absorbing acrylic	Toric version of DFR00V/ Synergy

• Extended Depth of Focus Lenses

  These lenses work by creating a single elongated focal point to enhance “range of vision” or “depth of focus.” They typically provide good distance vision, good intermediate vision, and functional near vision. Patients may still require glasses correction for small print at near distances. Mild haloing and slight loss of contrast at night are minor downsides of this IOL type.

  These lenses are available in toric versions and can correct for astigmatism. Insurance companies do NOT cover the cost of these lenses. There is an additional out of pocket expense for these premium IOLs.

  Lens	Company	Image	Material	Additional Details
  ZXR00/ Symfony	J&J		UV blocking acrylic	May get halos/glare due to rings on optic. Slight reduction in contrast.
  DFT/ Vivity	Alcon		UV and blue light filtering Acrylate/ Methacrylate Copolymer	Material can develop glistenings which may degrade vision quality over time

• Multifocal Lenses

  These lenses consist of multiple zones of lens power that produce multiple focal points. They typically allow good distance, intermediate and near vision without glasses. The downsides may include nighttime halos and glare due to their design with rings on the optic. They also reduce contrast sensitivity, making images appear slightly washed out and requiring more light to read. So, there is a trade-off for a more spectacle-free life.

  These lenses are available in toric versions and can correct for astigmatism. Insurance companies do NOT cover the cost of these lenses. There is an additional out of pocket expense for these premium IOLs.

  Lens	Company	Image	Material	Additional Details
  TFNT00/ Panoptix	Alcon		UV and blue light filtering Acrylate/ Methacrylate Copolymer	Material can develop glistenings which may degrade vision quality over time
  DFR00V/ Synergy	J&J		UV and violet light absorbing acrylic	Combines elements of Symfony lens with J&J’s previous trifocal lens, giving better near than Symfony

• Light Adjustable Lens

  This IOL is the first and only lens that can be customized after cataract surgery. Although pre-operative measurements are typically very good, there is still slight variation in the entire process, especially in patients who have had previous refractive surgery (RK, PRK, LASIK, etc.). With this lens, we now have the ability to adjust refractive results very closely to the desired outcome. Two to four weeks after cataract surgery, a refraction is performed. That data is then input into a Light Delivery Device, which uses UV light to change the focusing power of the lens. It can be used to treat spherical error (nearsightedness/farsightedness) and cylindrical error (astigmatism). There can be up to three treatment sessions followed by one to two lock-in sessions.

  These lenses have one focusing distance, set either for far, intermediate or near vision. Glasses are then worn for the other distances. Most people have the lens set for distance and then wear glasses for intermediate and near vision. However, many people who get this lens have had previous refractive surgery and therefore have some aberration in their cornea which may give them some ability to focus at intermediate and near. Glasses may still be required for small print at near distance.

  These lenses are a good option if you have had previous refractive surgery. Insurance companies do NOT cover the cost of these lenses. There is an additional out of pocket expense for these premium IOLs.

  Lens	Company	Image	Material	Additional Details
  LAL	RxSight		UV absorbing Silicone optic with PMMA haptics	Patients are required to wear UV protective glasses from the company until all treatments completed.

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