Key takeaways:
Cataract surgery involves removing the eye’s clouded natural lens and replacing it with a clear artificial lens called an intraocular lens (IOL).
There are several different types of IOLs available.
Standard IOLs are covered by insurance, and are safe and effective.
Premium IOLs often cost thousands more but can offer more independence from glasses.
A cataract is a clouding of the eye’s natural lens. The lens is a structure tucked deep inside the eye that helps you focus your vision on objects near and far. Natural lenses start out clear when you’re young, but they can cloud over as you get older.
Cataract removal involves removing the eye’s clouded natural lens and replacing it with a clear artificial lens called an intraocular lens (IOL). Below, we review some of the options you may have when selecting an IOL.
What are intraocular lenses (IOLs)?
During cataract surgery, your clouded natural lens is removed. It is then replaced with a clear artificial lens — called an intraocular lens — to help your eye see its best. Once an IOL is placed in your eye, it can’t be changed without additional surgery.
Before IOLs were available, people would need to wear thick glasses after removal of their cataracts.
In 1949, Sir Harold Ridley implanted the first IOL, made from a material called polymethylmethacrylate. In the 1980s, more flexible IOLs made from silicone were developed.
IOLs look like a small, clear lens with attached legs called haptics. Haptics hold the lens in place inside your eye.
What types of intraocular lenses (IOLs) are available?
As you prepare for cataract surgery, you’ll discuss IOL options with your eye surgeon. There are several different types of IOLs available.
Standard IOL
Standard IOLs are included in the cost of cataract surgery with most medical insurance plans. They’re high-quality lenses that come in different strengths. Your surgeon will work with you to determine what strength you need.
These lenses are monofocal (also called single-focus) IOLs. They give the sharpest focus at one particular distance — usually a far distance, which is helpful for driving. To see up close for reading or at a middle range for using a computer, you’ll still need to wear glasses. People with astigmatism are likely to need glasses all the time after cataract surgery if they choose standard IOLs.
Activities to avoid after cataract surgery: Recovery takes time. Learn what to avoid — like heavy lifting and swimming — for a smoother healing process.
Does Medicare cover cataract surgery? Medicare covers basic cataract surgery, but not all lens types. Here’s what’s included and what you’ll likely pay.
Eye drops after cataract surgery: Post-surgery drops help prevent infection and ease inflammation. Here are the ones you may need after surgery.
Premium IOL
Premium IOLs are designed to offer some freedom from glasses after cataract surgery. They use advanced technology to correct certain eye irregularities that standard monofocal lenses can’t.
There are several different types of premium IOLs, including:
Toric IOLs: Toric IOLs are single-focus lenses designed for people who have astigmatism. Astigmatism is an irregularity in the shape of your cornea, lens, or both. It makes your eyeball more “football-shaped” instead of “basketball-shaped.”
Accommodating IOLs: These lenses use your eye’s own muscles to adjust focus, allowing you to see clearly at closer distances. While they often work well at first, they can sometimes become less effective over time and have been linked to other problems like tilting or clouding, which could require additional procedures.
Multifocal IOLs: Multifocal IOLs contain more than one focusing power in each lens (similar to bifocal glasses, but without any line or distortion). They’re designed to help you to see far away, at middle range (for a computer), and up close (for reading) without glasses. Multifocal IOLs work well in daylight. In the dark, they can make you see halos around lights. This can cause glare and interfere with night vision.
Extended depth of focus IOLs: Extended depth of focus (EDOF) IOLs are similar to multifocal IOLs but with less focusing power and fewer side effects. Glare and halos aren’t as big of a problem with EDOF lenses, but their focusing power isn’t as strong, either. In addition to giving you good distance vision, EDOF lenses can help you focus at a middle distance (to see a computer screen), but you’ll still need glasses for reading.
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Light adjustable lenses
These are the newest types of IOLs on the market. Light adjustable lenses are customizable and allow your ophthalmologist to fine tune your lens prescription after cataract surgery using ultraviolet (UV) light.
Choosing between standard and premium IOLs for cataract surgery
You’ll want to work closely with your eye surgeon to select your IOLs. There are many factors to consider.
Why choose a standard IOL?
Standard IOLs are less expensive, reliable, and don’t come with many side effects. Most people will still need glasses to see clearly at closer distances.
People choose standard IOLs when they:
Want the least expensive option
Prefer to avoid side effects like glare or halos around lights
Don’t mind wearing glasses
Have other eye conditions, like dry eye, glaucoma, or macular degeneration, which could interfere with the precise technology used in premium IOLs
Why choose a premium IOL?
Premium IOLs offer the possibility of freedom from glasses, but they’re more expensive and come with a higher risk of side effects.
People choose premium IOLs when they:
Don’t have other eye problems
Don’t mind the extra out-of-pocket cost
Strongly dislike wearing glasses
Monovision is another option to consider
Keep in mind, premium lenses aren’t the only way to see both near and far. If you need cataract surgery in both eyes and choose standard lenses, it’s sometimes possible to correct one eye to see better at a distance and the other eye to see better up close. This inexpensive solution is called monovision.
While monovision can work well for some people, others find it difficult to get used to. If you’re considering monovision, you’ll want to try it out with contacts first.
What are the risks of intraocular lens implants?
All eye surgeries carry some risks, including bleeding, infection, or loss of vision. These are rare with cataract surgery, but they can happen.
More common complications include:
Glare: You may notice glare after intraocular lens implantation. This may make driving at night or seeing when light conditions are low more difficult.
Lens dislocation: The lens can become dislocated. This will affect your vision and needs to be corrected with surgery.
Eye swelling: The lens can cause swelling (edema) in your eye and affect vision. It may go away on its own. You may need medication or surgery to relieve this swelling.
How do you know if your IOL is working correctly?
Once your eye has healed from cataract surgery, you’ll begin to use your new lens. You’ll figure out how much glasses can help you focus on objects near and far. No matter which type of lens you choose, it could take some time to adjust to the change.
It’s important to remember that even with the most advanced, premium IOLs, many people still need to use glasses to see their sharpest — especially at very close distances.
Frequently asked questions
Removal and replacement of an IOL is called an IOL exchange surgery. It may be performed if the lens becomes dislocated or if you develop severe glare or other side effects.
Yes, Medicare covers cataract surgery if your cataracts impair your vision. Medicare also covers standard monofocal IOLs.
Some IOLs — both standard and premium — are designed to block blue light as it enters your eye. The idea is that they can protect the back of your eye (the retina and macula) from the effects of blue light. Although this sounds like a good idea, studies show that blue-light-blocking IOLs don’t make much difference for eye health.
Because blue-light-blocking lenses are slightly yellow-tinted, you might want to avoid them if precise color vision is important to you (for example, if you’re an artist).
Removal and replacement of an IOL is called an IOL exchange surgery. It may be performed if the lens becomes dislocated or if you develop severe glare or other side effects.
Yes, Medicare covers cataract surgery if your cataracts impair your vision. Medicare also covers standard monofocal IOLs.
Some IOLs — both standard and premium — are designed to block blue light as it enters your eye. The idea is that they can protect the back of your eye (the retina and macula) from the effects of blue light. Although this sounds like a good idea, studies show that blue-light-blocking IOLs don’t make much difference for eye health.
Because blue-light-blocking lenses are slightly yellow-tinted, you might want to avoid them if precise color vision is important to you (for example, if you’re an artist).
The bottom line
When you have cataract surgery, you’ll need to choose an IOL. Standard IOLs are high quality and covered by insurance. Premium IOLs can make you less reliant on glasses but come at an additional out-of-pocket cost.
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References
Boyd, K. (2023). What is monovision (or blended vision)? American Academy of Ophthalmology.
Briceno, C.A. (2024). What are cataracts? American Academy of Ophthalmology.
de Silva, S. R., et al. (2016). Multifocal versus monofocal intraocular lenses after cataract extraction. Cochrane Database of Systematic Reviews.
Downie, L. E., et al. (2018). Blue-light filtering intraocular lenses (IOLs) for protecting macular health. Cochrane Database of Systematic Reviews.
Kretz, F., et al. (2014). A brief history of IOL materials. The Opthamologist.
Mayo Clinic. (2023). Fine-tuning cataract surgery: Light adjustable lens.
National Eye Institute. (2025). Glaucoma. National Institutes of Health.
Ong, H. S., et al. (2014). Accommodative intraocular lens versus standard monofocal intraocular lens implantation in cataract surgery. Cochrane Database of Systematic Reviews.
Puente, M. A. (2024). What is dry eye? Symptoms, causes, and treatment. American Academy of Ophthalmology.
Vemulakonda, G. A. (2024). Understanding macular degeneration. American Academy of Ophthalmology.
