How To Consider Your Cataract Lens Options in 2025 - Explained By A Surgeon

0:09 have you just returned from your ophthalmologist office and they told you that you could benefit from cataract surgery now is your head swimming because not only do you need to decide if you want to pursue cataract surgery right now but you also have seemingly a million other decisions to make regarding how you'd like your cataract surgery to be performed as well as what kind of lens implant would you like to have implanted permanently into your eye these are really big questions and really big decisions because the implant will be permanent in your eye and it will impact how you see and how your vision is for the rest of your life but don't worry if your head is spinning we're going to break it down in this video I will discuss all of the main categories of intraocular

0:56 lens implants that you can choose from and how your vision will be in each independent category we will discuss how you can make a decision regarding what kind of lens implant you would like based on your visual goals and your lifestyle whether you just saw your ophthalmologist and your head is reeling because you don't know what to do or you're planning on seeing your ophthalmologist for a cataract consultation appointment this video will be very helpful as we go over the broad categories of the cataract lens intraocular implants that you have to choose from Hi I'm Dr. Roxanne Lee I'm a board-certified ophthalmologist and I specialize in Cataract and refractive surgery I hope that this video empowers you to learn more about your eyes and your upcoming

1:43 surgical decisions if you are at that point and if you find this helpful please go ahead and like the video and subscribe for more there are so many different kinds of lens implants even within each category of lens implant and I'm not planning on going into all of these specifics instead my goal is for you to have a broader knowledge of the categories that you can choose from and this is because every Ophthalmology Clinic and every ophthalmologist surgeon will have a slightly different menu of options that you can choose from and this is based on their personal experience with the lens which one they prefer as well as whichever ones they're most comfortable with there are a lot of really exciting lens options but it's very important to understand that not every eye

2:30 is a good candidate for all the options various factors like your eyeball anatomy and underlying diseases that can be affecting the other ocular structures can really impact your vision after surgery and how good of a candidate you are for certain kinds of lens implants for example if you have uncontrolled diabetes or other cardiovascular issues macular degeneration or macular scars corneal scars from prior trauma or surgery these can all factor into what your vision is going to be like after surgery and what lens implant is a good idea for you so it's really important for you to speak candidly about your ocular and your medical history with your ophthalmologist so that they are all on the same page when you are making this decision together as you might

3:18 already be familiar there are a lot of different lens options and making your way through that decision-making tree to land on the cataract lens implant that you are going to commit to in the end can be overwhelming so let's try to make this simpler let's condense all of those decisions and think about three main burning questions the first question is if you had to pick a single distance from your face to see clearly without glasses what would that be so you only get to pick one as your main priority the three main distances we consider are far distance Visions that's like driving watching a movie looking at across the room seeing street signs and then the second is intermediate

4:04 or middle vision and that is something like a computer screen something around a desk length away from your face and then the third distance is up close near Vision think about handheld devices phones books newspapers magazines burning question number two do you have a stigmatism astigmatism describes an imperfection in the curvature of your cornea which is the very frontmost clear part of your eye so for someone who has no astigmatism if we measured the curvature going up and down on that person's eyeball it would be the same as the curvature going side to side 90° away and you can think of this eye kind of like a basketball if you hold a basketball and you look at it it's a Circle

4:53 and then if you turn it around 90° away it's still a circle it's a sphere so it looks the same however contrast this to a patient who has astigmatism now instead of that eye looking like a basketball think of it more like a football at least an American football so if you look at it in one degree and then turn it around so you're looking at the pointy end it's going to look very different and that's because an eye with astigmatism has a different corneal curvature the steepness of the corneal curvature is different looking up and down compared to looking side by side and the third burning question do you have any other underlying eye abnormalities or disease processes that could be affecting your vision all right for the first of those burning questions you

5:43 can kind of figure that out on your own and I really encourage you to think about that before you've even set foot in your ophthalmologist office so that you can have a very meaningful discussion about what your plans are what your goals are after surgery think about what you do on a daily basis do you see a lot of distance things like do you drive a lot very important question do you drive a lot at night do you work all day on a computer are your hobbies really up close like are you a watch maker are you crocheter do you do very fine Vision tasks but the second and the third of the burning questions will be answered when you are in our office when you are seeing the ophthalmologist for your cataract consultation appointment we will check your vision check your refraction measure your astigmatism if you have any and then I will complete a full

6:32 dilated comprehensive eye exam looking from the front all the way to the back of the eye of course we'll be looking at your cataract but we'll be looking at your cornea all the way back to your retina to see if there is anything else that would answer burning question number three do you have any other Ophthalmic pathology that could be affecting your eyes now let's dive in and talk about the first of the main categories of lens options it's a mono focal implant so think of the word monofocal it means one Focus point so let's go back to burning question number one if you had to pick one of those three distances and remember your options are distance middle or up close which one would you prioritize to see clearly without glasses after surgery because this

7:21 monofocal implant will allow you to optimize your vision for that one distance so for example most of my patients choose a distance Target because your world your general world of what you're looking at is further away from your face than an arms length so most of what you'll be doing is distance vision and so that means that they are aware if you're choosing a monofocal implant and you choose a distance Target that means that your computer vision and your reading Vision like your book phone tablet Vision will require glasses and burning question number two do you have a stigmatism we will let you know if you have a stigmatism of course once you're in the eye clinic

8:07 and if you do not have any astigmatism then you'll be great with the basic what we call a non-toric monofocal implant you will be able to see clearly at your choice of those three distances from your face either distance intermediate or up close one thing that I want you to think about is also consider your starting point so for example if you are a mild myope meaning you have a glasses prescription say it's around a -1 1.5-2 or even a little bit more or less you have what we call Mild nearsightedness or you are a mild my so you might notice if you fall into this category that if you took your glasses off your distance glasses you would be able to read a book just normally

8:57 without any glasses on whereas for distance Vision you would need to put on your distance glasses to see clearly so if you fall into this category you might not be very used to kneading reading glasses so keep this in mind because if you choose a monofocal lens and a distance Target to improve your distance Vision you might subjectively perceive that your near Vision has gotten worse because in order for us to optimize your distance Vision we are fixing your near side and fixing your myopia and so that means that your near vision is going to go away unless you wear those readers in some cases patients will prefer what we call a near Target I would say this is a significant minority of my patients but the classic example is the same kind of patient

9:46 we just talked about who starts out with maybe a minus 2 prescription in their glasses and they are very used to and very comfortable wearing distance glasses to see far away but they really like being able to take those glasses off to read and so this near Target preference would be a really good option for them if they're choosing a monofocal lens now let's talk about a toric lens implant so what does toric mean it just means that you have a stigmatism correction built into the actual cataract lens implant the physical implant that's going to be implanted into your eye so it neutralizes any astigmatism you have in your glasses prescription from the inside so not

10:32 every patient requires a toric lens implant you have to need a significant amount of astigmatism correction to kind of qualify for a toric lens implant so significant amount would be about 1 to 1 and a half diopters of astigmatism depending on the direction that your astigmatism lies on your cornea why do we even need to correct for a stigmatism so like we said before a stigmatism describes an imperfection in the cornea when the light from the outside world enters your eye it hits the cornea first and if you have an abnormality in the curvature of the cornea those aberration will prevent the light rays from coming into Focus properly on your retina and this will

11:19 prevent you from seeing a clear image so patients with more significant amounts of astigmatism will describe their Vision as just being not as clear crystal as as they want it's a little smeared or blurred or distorted instead the thing about a stigmatism is that affects your vision at all distances so we're talking about distance far away intermediate like a computer and even up close like reading a book so patients with more significant degrees of astigmatism will need a toric lens implant otherwise they will need glasses fulltime at all three of those distances because a stigmatism is impacting and degrading your vision at all of those distances what if you want to see more than just one of those three distances clearly without glasses

12:07 is there an option that can get you seeing all of the distances without glasses yes this is where our multifocal implant options come into play so think about the word again multifocal means multiple Focus points these multifocal lens implants will allow you to see clearly for distance Vision intermediate vision and even up close Vision I'd give it about a 90% rating so about 90% of the time the vast majority of the time you will enjoy independence from glasses for both distance and far away but there will always be some instances where you might feel more comfortable having a pair of backup glasses also remember burning question number three do you have any other underlying ocular pathology disease processes or any issues in the eye other than just

12:58 your cataract if you do you need to take note because multifocal intraocular lens implants are not the best option for patients with significant underlying eye disease the other consideration is that the brain takes a little bit longer to get used to multifocal implants compared to other monofocal intraocular implants most patients will see some degree of glare and halo around bright lights especially when you're driving at night so for example example you have that oncoming car headlight like this and you might see a little ring a halo around that light or some people see streaks or Starburst however you'd like to describe glare and Halo as time passes and your

13:43 brain takes time to get used to looking through this new Medium as it looks out into the world the vast majority of patients do not experience the glare in Halo after about a few months I always want you to know the good and the bad of all of these different lens options and the multifocal implant as wonderful as it is is no exception so there are two other considerations that I tell everyone who is considering a multifocal implant the first is that there is a very very slight decrease in contrast sensitivity so the classic example is you're sitting in a restaurant with dim mood lighting the waiter gives you a menu to look at and you'll be able to read the menu because it's at a near distance and you got a multifocal implant so you can read

14:31 without reading glasses but if the light is very dim you might need to take your phone out and shine some more light on it to bring out the contrast of the black Print against the white creamy paper this change in contrast sensitivity is precisely why the multifocal implant is not always the best option for patients who have any other underlying eye diseases that could also be decreasing the contrast sensitivity of that eye classic examples include patients with glaucoma or macular disease like macular degeneration and the last consideration is that a multifocal implant does give you good near Vision without the need for reading glasses but I would describe it as

15:16 functional near Vision meaning if you take your phone out of your pocket and you read your text you'll be fine if you're sitting on a couch in good normal lighting and you're reading a book you'll be fine without readers but it's not super super duper close up x-ray near Vision so my patients who start out nearsighted maybe like a minus three or four know that distance Vision might be blurry but up close you can read really really close to your face without reading glasses and it's very clear because it's magnified being so close to your face a multifocal implant is not meant to give you super near Vision it's meant to give you functional near Vision so if you do any tasks or hobbies that requires Super near Vision including needle work or some electric work with

16:05 with very fine wires some patients will still need reading glasses or a magnifying lens now what's monovision monovision describes a viewing strategy where we target one eye say for example your right eye as your distance seeing eye so that is your far vision eye and then we target your other eye your left eye for either intermediate like a computer or up close near Vision so you've got one eye for distance one eye for up close and this allows patients to have a broader range of focus because you have one eye for each of those distances without needing a multifocal implant this might be an option but monovision is not a one-size fit all Solution by any means it is very

16:56 difficult for the brain to get used to and neuro adapt to having one eye see something completely different from the other eye all the time and for this reason I do not recommend mono Vision as a strategy for patients unless they have experienced it for a long time and given it a good Fair trial using either contact lenses that they've worn for a few years or some patients are naturally monovision where one eye is closer to emmetropic and the other eye is more nearsighted one way to get around this if you don't happen to be naturally monovision or you haven't been wearing it in contact lenses or had it with LASIK before is a contact lens trial so we can give you

17:43 a contact lens set where one eye is corrected to see distance and the other eye is corrected to see up close however if we're thinking about monovision as a cataract surgery complement that means by definition that you have a cataract so your ability to test drive that mono Vision will be limited because you're also looking through a cataract in both eyes about the light adjustable lens the light adjustable lens was approved by the FDA back in 2017 but it's still definitely one of the more exciting Innovations in the world of intraocular lens implants so the cool thing about the light adjustable lens is that it is customizable it's adjustable so that we can change how your vision is after your cataract surgery the light adjustable lens has UV sensitive

18:32 polymers in the center of the implant so if you choose a light adjustable lens the pre-operative measurements are the same the cataract surgery is essentially the same but then we allow your eye to heal for 1 month after surgery before we do any adjustments after 1 month if we check your vision and you do have a refractive error you'd like to get rid of then we can adjust it with our light delivery device and that will shine a UV light on your light adjustable lens and actually change the shape of the polymers inside changing your refraction and changing your vision let's go over an example patient this patient's name is Barbara she has come to me for cataract surgery and is wondering what kind of lens implant would be a good option for her

19:20 with her cataract surgery so to make it easy we go through the three burning questions with her the first which distance of the the three choices near Vision intermediate Vision or far away distance vision would she prioritize and would she like to not need glasses to see clearly after surgery so Barbara tells me she drives a lot and would love to not need driving glasses but she is okay with reading glasses so she prioritizes her distance the second of the burning questions is does Barbara have any astigmatism so after our full eye exam we find out that Barbara is one of those few lucky individuals who has essentially no astigmatism and now burning question number three

20:07 does Barbara have any other ocular pathology on her exam and lucky Barbara she does not have any other eye issues no other eye diseases so given her goal of good distance Vision if she is okay with near reading glasses then she would do very well with a mono focal non-toric intraocular lens remember she doesn't need a toric because she doesn't have any a stigmatism and if Barbara would like to have even more freedom from glasses yes she could also get a multifocal lens implant but for the purposes of this example if she just wants good distance Vision without glasses and she's okay with readers then she would do very well with a monofocal non-toric lens

20:58 implant now let's take Barbara's sister Barbara's sister's name is Susan we will go through the three burning questions again so the first is what would Susan like to see without glasses after surgery so Barbara and Susan Drive together a lot so Susan like her sister would like to prioritize her distance Vision she does not want to see she does not want to have distance glasses but she's okay with readers the second of the burning questions is does Susan have a stigmatism so during the ocular exam we find out that Susan has significant

21:44 astigmatism and it's currently being corrected in her current glasses but it is definitely something we have to watch for as a factor when we're deciding her cataract surgery plan and the third burning question does Susan have any other ocular diseases and lucky Susan she doesn't have any other ocular pathology okay so given Susan's request to have good distance Vision but like her sister Barbara she's okay with readers we can choose a monofocal lens implant but because she has significant astigmatism she would require a toric intraocular lens implant so if she chooses a non-toric intraocular lens implant

22:36 her astigmatism would go uncorrected and so then if she does nontoric IOL she would need fulltime glasses whereas if she chose a toric intraocular lens implant monofocal just requesting the distance to be clear then she would really primarily only need the reading glasses all right now let's take Barbara and Susan's brother his name is Jim and he's also come to me for cataract surgery let's go through those three burning questions so number one what would Jim like to see without glasses after his cataract surgery and for Jim he wants it all he

23:29 wants distance so he can see his golf ball he wants intermediate so he can see his computer screen at work and he also wants near he also wants near because he reads A Lot on his days off all right and option number two or rather burning question number two does he have any astigmatism so Jim lucky Jim does not have any astigmatism just like Barbara but not like Susan and the last burning question does he have any other ocular pathology so Jim actually has significant macular degeneration all right so given the first two burning questions normally for this kind of

24:23 patient we could offer a multifocal implant because this is the kind of implant that will allow him to have good Vision at all of these distances however remember burning question number three is very important especially for patients who are interested in a multifocal implant so if his macular degeneration is very significant it might not be a good idea for Jim to get a multifocal implant and this is something that Jim has to discuss thoroughly with his ophthalmologist so this one is still up in the air really depends on the clinic conversation and Jim and his ophthalmologist should go over his ocular findings his testing and then decide together what the best option is all right and so this is a large family let's say

25:16 they also have another brother and his name is Jerry okay so just like Jim Jerry golfs so he wants to see distance far away without glasses he play plays a lot of computer games and he doesn't like computer glasses so he wants intermediate and he does a lot of electrical work and so he wants to have good near Vision without needing to bother with reading glasses all right Jerry does have a stigmatism when we do his eye exam and lucky Jerry does not have any other ocular diseases all right so the option that would be really good for Jerry given his request

26:01 for full view without glasses he wants a full range of vision for far away all the way up to near he would like a multifocal implant but not just a normal multifocal implant because he has astigmatism he would do very well with a multifocal toric interocular lens implant with this he would have good distance Vision good intermediate vision and good near vision and his astigmatism is being corrected with that toric lens implant and this is all possible because he has no other ocular pathology that would mess with his vision with that multifocal implant I hope you found this information helpful as you progress along your cataract

26:50 journey I want you to feel empowered to speak candidly to your surgeon I want you to ask a lot of questions and ask them what they would think would be the best option for you your career your lifestyle and your hobbies and how you want to see after surgery these are your eyes and it's very important for you to make a very guided informed decision you are the captain of this ship and it's a really exciting journey if you found any of this information helpful please go ahead and give it a thumbs up it is honestly really helpful for me and go ahead and check out this video that I will link here for more helpful information Thanks!