Many patients have been wearing glasses all their life and glasses have become part of their identity. They do not mind wearing glasses at all after surgery.
In this case, I typically recommend a monofocal lens as this will give the patient the best possible vision for distance. The patient will still need to wear glasses for intermediate and near vision. With glasses, the patient will achieve high quality vision and will be happy with the result.
If the patient wants to reduce their dependence on glasses, they may benefit from extended depth of focus lens (EDOF) or a multifocal lens.
Extended depth of focus lenses give patients good vision for distance and intermediate work but patients will still need to wear glasses for near tasks such as reading.
Multifocal lenses give patients good vision for distance, intermediate and near tasks.
Generally, patients will not need to wear glasses after having multifocal lenses but they may get glare and halos particularly when driving at night.
Multifocal lenses give patients greater independence from glasses after surgery. However, they can be associated with glare and halos particularly when driving at night.
For patients who really want to avoid the risk of glare and halos when driving at night, an EDOF lens is a good option as it reduces the need for glasses for intermediate work but presents less risk of glare and halos when driving at night.
There are some patients who should not have a multifocal lens. These include those with:
Ocular disease:
Patient factors:
Eye trauma or surgery:
Neurological disease, e.g. multiple sclerosis, Parkinson disease or stroke
For patients with contraindications, extended depth of focus (EDOF) IOLs may be better choices, offering fewer visual disturbances while still providing some range of vision.
Toric lenses correct for corneal astigmatism. They are generally very effective and don’t really have much of a downside other than a small risk of rotation which may require further surgery to correct. All types of lenses [monofocal, EDOF and multifocal lenses] are available in toric versions. It is a good idea to use a toric lens when a patient has significant corneal astigmatism. This reduces the need for glasses in someone who has a monofocal lens. With EDOF or multifocal lenses it is important to treat corneal astigmatism with a toric lens to achieve the full benefit of reduced glasses dependence in these patients.
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