Correcting presbyopia and choosing an intraocular lens to suit you

Cataract surgery is the most commonly performed procedures in the UK. There are various types of intraocular lenses (IOLs) available to correct your vision and they work in different ways. London based Consultant Ophthalmic Surgeon, Sharmina Khan explains how.

Monofocal IOL and monovison

The most commonly used standard IOL is typically used on the NHS to correct vision for distance and you would require glasses for near vision reading.

This type of IOL can be used for presbyopia blended mini-monovision which means correcting your dominant eye for distance and the non-dominant eye for near. without losing binocularity. This will allow you to visualise a bus number in the distance, read a menu at arm’s length but you will not be able to read the label on the back of a tin of beans. You will need glasses to read “War and Peace” and legal documents at speed.

Toric IOL and monovision

This premium IOL is like a monofocal IOL but with a built-in element that corrects astigmatism that pre-exists in the cornea (the clear window of your eye).

What is astigmatism?

The cornea is less like a football and more akin to a rugby ball in shape.

Correcting your vision with a toric lens means glasses worn post-operatively will be less expensive. Again both eyes can be corrected for distance or mini-monovision as explained above.

New generation “Multifocal” IOL

There are currently two most advanced types available:

1. Trifocal
2. Extended depth of focus (EDOF)

A Trifocal IOL is able to achieve greater spectacle independence than an EDOF IOL by correcting your vision for distance, intermediate and near. EDOF IOLs preferentially correct for distance and intermediate vision with a requirement for reading glasses for near vision. 

Following a detailed assessment and discussion, your surgeon will guide you based on experience and outcomes towards a preferred multifocal IOL.

Who is not suitable for a multifocal IOL?

These should be avoided in long-distance HGV drivers those who drive long distances for work/leisure as they can experience glare; tennis players may notice difficulty tracking the ball at speed and other lifestyle factors should be discussed.

Monofocal “Plus” IOL

This recent addition to the market improves distance and intermediate vision on a monofocal platform without the glare effects of a multifocal IOL and may replace the EDOFs out of the market.

Femtosecond laser-assisted cataract surgery and intraoperative digital image guidance

Employment of both these technologies further enhances your premium cataract surgical service by the more predictable placement of your corneal incisions, optimum centration of your trifocal IOL and optimum alignment of your toric IOL.

In summary:

Cataract surgery is an opportunity to become (i) spectacle independent or less dependent 

(ii) correct myopia (short-sightedness) and (iii) correct astigmatism. 

Sharmina Khan embraces innovative changes in delivering eye healthcare with the aim of changing people’s lives for the better by 

• adopting proven technologies that are safe
• proven track record in auditing cataract surgical outcomes and patient-reported outcome measures.