Posted by: Philadelphia Eye Associates in Eye Health on July 7, 2025
Written by Abigeal Olantuji and edited by Brad Feldman, MD
The eye’s crystalline lens is an optically clear structure that helps us focus images on our retina to see clearly. A cataract is what we term a cloudy or discolored lens. Most people develop age-related cataracts before the age of 70 and conditions such as diabetes can lead to the development of cataracts at younger ages.
Currently, the only option for improving vision from cataract-related vision loss is to surgically remove the cataract and replace it with an artificial lens.
Artificial lens implants, termed intraocular lenses (IOLs), were first widely adopted in the 1980’s. In fact, Joseph Markoff MD/PhD, the founder of our practice Philadelphia Eye Associates, was one of the first surgeons in the region to successfully place IOLs during cataract surgery. Our practice has remained leaders in IOL technology since the 1980’s, participating in multiple clinical trials for new IOLs.
IOL implant technology has steadily evolved and we are in the enviable position of having many options of high quality IOLs. Because of the wide array of options, deciding on what IOL to have placed in your eye can be overwhelming. The right lens for you will depend on several factors and it is important to acknowledge that some of these considerations are beyond our control. Factors like the natural shape of your eye, pre-existing ocular conditions, and even the financial aspect of treatment can all impact your options since certain lenses may not be fully covered by insurance.
Here is a general overview of IOL implant options.
Monofocal IOLs are implants that help correct vision at a single focal point – either distance, intermediate or near. Monofocal IOLs can give the highest quality vision of any type of implant since they allow for all light energy to be focussed to a single point rather than split or spread into multiple focal points.
Most patients who receive monofocal IOLs will need glasses for either distance or near, or even full time glasses. Before surgery, patients need to choose whether they’d rather see better at distance or near without glasses. A common choice with monofocal IOLs has been to have both eyes set for distance vision and to use reading glasses as needed.
There are 3 different types of monofocal implants:
Multifocal lens technologies aim to improve your ability to see clearly at multiple distances so that you have less of a need for glasses for distance, intermediate, or near. We are on our eighth iteration of multifocal lens technology, and the current generation of lenses are truly delivering remarkable results. However, it is important to note that there are some compromises being made when multifocal lenses divide focus into multiple zones for near, intermediate, and far vision. These lenses do not replicate the natural change in focus for different distances that you may have had when you were younger. Instead, these lenses use concentric rings to split light.
It’s normal to need some adjustment time with multifocal lenses. Initially, you might notice halos or rings around lights, especially at night. For most, these effects typically lessen over time, but a small number of patients may find them bothersome in the long term. Patients will still need glasses at times, especially while try to read in low light. Over time, most patients brains adapt, allowing them to perform tasks like reading, computer work, and driving without constantly needing glasses.
Toric versions of multifocal lenses are available to correct astigmatism.
The two most popular multifocal implants are:
Extended Depth of Focus (EDOF) lenses offer a wider range of focus than monofocal lenses but not as wide of a range as multifocal lenses. This trade off means that patients need glasses less often than they would with monofocal lenses but more often than they would with multifocal lenses. Conversely, patients with EDOF lenses are less likely to experience halos, glare, or other visual disturbances seen with multifocal lenses and may require less time to adapt to their new vision.
As you explore your options, it can be helpful to reflect on what matters most to you. Do you want to live your life without needing glasses all the time? Are you frequently driving at night? Do you rely heavily on close-up vision for your work or hobbies? How would reducing your dependence on glasses make a meaningful difference in your life?
It’s also wise to start budgeting for your cataract surgery since not all lenses may be covered by insurance. There are few investments as critical as your health and your vision. Creating a list of your vision priorities—both essential and optional—can guide you when discussing options with your ophthalmologist. Being informed and prepared allows for a more productive conversation, ensuring that your surgeon recommends the IOL that aligns with your needs. By making thoughtful decisions now, you set yourself up for both a smooth recovery and the best possible vision after surgery.
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