Lens Implant Choices for Cataract Surgery

Distance correction for both eyes

Distance correction for both eyes is by far the most common choice. The implant power for both eyes is chosen to maximize distance vision without glasses. Glasses are needed for close work. The majority, but not all, of patients who choose this option will see well enough to drive without glasses. However, glasses are often still required to achieve their BEST vision even at a distance.

With this option, both eyes work together so depth perception is maximized. Afterward, some patients just carry reading glasses with them but some still prefer to wear bifocals so they are not taking their glasses off and on.

Near correction for both eyes

When you choose near correction for both eyes, the implant power is selected to make the patient near-sighted in order to be able to see at reading distance without glasses. Glasses will be needed for distance vision including driving and TV. This choice is a reasonable option for people who spend significant time reading and like to do so without wearing glasses.

This option is usually for people who have been near-sighted and are already used to this option and like it.

Full monovision

With this option of full monovision, the dominant eye is focused for distance vision and the non-dominant eye is focused for close vision. This allows you to be able to see at both distance and near without glasses.

This approach works fairly well for some but not all are able to adapt to it. There are also some significant long-term disadvantages.

Depth perception is permanently decreased. If for some reason the patient later chooses to wear glasses, this may be difficult because the eyes are too imbalanced. It also requires good vision in each eye to be successful. If the patient later develops poor vision from an eye disorder, it will not work as well. For these reasons, modified monovision is a better long-term option for most patients interested in this. No patient should choose the full monovision option who hasn't already done it with contacts and adapted to it successfully.

Modified monovision

With modified monovision, the dominant eye is again focused at distance but the other eye is focused at an intermediate distance closer to arm's length. This allows good distance vision and fairly good near vision. When you choose modified monovision, you are relatively glasses free but still usually require glasses at least part-time for night driving, reading, and fine print. This still allows for reasonable depth perception and future glasses wear if desired or needed.

Important Note: Lens implant calculations are very good but not perfect. In some patients, the implant power will not turn out exactly as targeted. These patients may need glasses to achieve their best vision and will not be as independent of glasses as desired. Please remember that the primary reason for cataract surgery is to remove the cloudy lens and restore good vision again. Becoming less dependent on glasses is a secondary goal. At the North Idaho Eye Institute, our surgical and lens implant outcomes are carefully tracked and match the best published outcomes in the country but we cannot guarantee your final vision level or that you will be glasses free.

Toric Lens Implants for
Astigmatism Correction

There are two types of premium lens implants available: Toric Lenses that correct astigmatism and Multifocal Lenses that provide both distance and near correction. These lenses work for selected patients but are more expensive than standard monofocal lens implants. The extra charge associated with lenses is not covered by any insurance plan or Medicare and must be paid for out-of-pocket by the patient.

Toric Lenses

Astigmatism is a condition where the surface of the eye is not perfectly shaped and is more steeply curved in one direction than another. This is a refractive problem where the image that the eye sees is out of focus and generally glasses are required to correct this and allow good vision. Standard monofocal lens implants correct for near-sightedness or far-sightedness but not for astigmatism. If a patient with astigmatism has cataract surgery with a standard monofocal lens implant instead of a toric lens, full-time glasses wear will be needed to achieve their best vision at all distances.

Astigmatism can often be corrected during cataract surgery by using a toric lens implant that has astigmatism correction built into it. This works very well and allows the patient significant freedom from glasses. Good distance vision is usually targeted and glasses are still needed for intermediate and near work afterwards. Many patients choosing toric lenses are able to drive and see distance without glasses. However, glasses may still be required to achieve their BEST vision even at distance. Toric lenses are a very good option for most patients with astigmatism but cannot be used in some patients if their astigmatism is severe or irregular. There is no real downside to these lenses other than the added cost.

Extra Cost: $800 per eye ($1600 for two eyes).

Important Note: Lens implant calculations are very good but not perfect. In some patients, the implant power will not turn out exactly as targeted. These patients may need glasses to achieve their best vision and will not be as independent of glasses as desired. Please remember that the primary reason for cataract surgery is to remove the cloudy lens and restore good vision again. Becoming less dependent on glasses is a secondary goal. At the North Idaho Eye Institute, our surgical and lens implant outcomes are carefully tracked and match the best published outcomes in the country but we cannot guarantee your final vision level or that you will be glasses free.

Multifocal Lenses

There are several different lenses available in this category. The most commonly used is the RESTOR lens from Alcon which is the one that we offer. These are complex lenses that separate incoming light into two images, one for distance and one for near. Most, but not all, patients who chose this option will not need glasses for either driving or reading. Glasses are sometimes still needed for computer work or for reading in dim light. This is a good option for patients for whom it is very important not to wear glasses.

Dividing the incoming light into two images decreases visual sharpness slightly. Because of this, multifocal lenses require a perfectly healthy eye to function well. They do not work well if the patient has had previous laser refractive surgery or if the patient has astigmatism, dry eye, macular disease, glaucoma, or other eye disease. Consequently, they are not an appropriate choice for many patients.

There is a period of adaptation with multifocal lenses just as there is for most patients with bifocal glasses. In order for this to occur, multifocal lenses must be placed in both eyes and both eyes must have good visual potential in order to achieve an optimal result.

Because of the slight decrease in visual sharpness and a slight increase in glare associated with these lenses, they are probably not a good choice for people who require particularly sharp vision for detailed work, who do a lot of night driving, or who are significantly bothered by glare.

In order to achieve an optimal result, the calculations for the lens implant power must work out almost perfectly. Although lens implant calculations are very good, they are not perfect. An on target result can be achieved about 80% of the time. If the calculations are off, laser refractive surgery may be needed to touch up the prescription for an optimal result. A discounted laser surgery is available for our patients if needed.

At the North Idaho Eye Institute, our surgical and lens implant outcomes are carefully tracked and match the best published outcomes in the country but we cannot guarantee your final vision level or that you will be glasses free.

Extra Cost: $1500 per eye ($3000 for both eyes) (Both eyes required).
Laser surgery: $850 per eye as needed.