Johns Hopkins Health Alert
The Pros and Cons of Monofocal, Multifocal and Accommodative Lenses
Preparing for cataract surgery? Before your operation, your surgeon will review the intraocular lens (IOL) replacement options. They fall into two basic categories- monofocal (fixed focus) and multifocal or accommodative lenses. A number of factors can affect your lens choices. Here are a few things to consider before you head to surgery.
About monofocal lenses. With monofocal lenses, your vision is typically in focus at only one distance -- near, intermediate or far. Alternatively, you can choose to have an IOL implanted in one eye to improve your distance vision and one implanted in the other eye to improve your near vision. This technique is referred to as monovision.
Advantages of monofocal lenses
- The cost of standard monofocal lenses is fully covered by Medicare and private insurance.
- People with monofocal IOLs who require glasses after surgery often have better vision for driving at night or in low light than those with multifocal IOLs.
- Astigmatism can be corrected with a type of "premium" monofocal lens known as a toric lens. The additional cost of this type of lens is not covered by medical insurance.
Disadvantages of monofocal lenses
- If you choose the IOL for distance vision correction, you will need reading glasses to improve your near vision. Conversely, if you choose an IOL for near vision correction, you will need glasses to improve your distance vision.
- Not everyone adjusts well to monovision as the brain tries to process the differing information it's receiving from both eyes.
- Vision may still be blurry at both distance and near when you are not wearing glasses if you have significant astigmatism and choose a standard monofocal lens.
About multifocal and accommodative lenses. Multifocal IOLs and accommodative lenses are designed to allow you to see more clearly at near, intermediate and far distances. Multifocal IOLs are made up of several concentric rings of varying optical power, each of which refracts, or bends, incoming light, bringing it into focus at different points simultaneously. Accommodative lenses rely on certain muscles in the eye to move the IOL forward and backward, thereby changing the focus. These lenses provide the best results when used in both eyes.
- Approximately 85 percent of people who receive multifocal IOLs find that they do not need glasses for distance or near activities.
- Accommodative lenses typically confer very good distance and intermediate (for example, computer) vision, but reading vision is not as good.
- About 5 to 10 percent of people receiving multifocal implants complain of some glare or halos around lights at night. These symptoms are less common with accommodative implants.
- Multifocal lenses (but not accommodative lenses) are associated with some loss of contrast, typically experienced as a loss of some clarity in low light situations, such as reading a menu in a dark restaurant.
- Neither accommodative nor multifocal lenses correct for astigmatism, although toric versions of both are now under clinical investigation.
- Medicare and private insurers will not pay the costs of the lens and associated services that exceed the charges for a conventional IOL.
Posted in Vision on June 29, 2012
Medical Disclaimer: This information is not intended to substitute for the advice of a physician. Click here for additional information: Johns Hopkins Health Alerts Disclaimer
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