Standard IOL: These implant lenses are fully covered by medical insurance, but do not address astigmatism or presbyopia. They are safe and optically excellent, but generally patients will likely need glasses for all three distances (distance, intermediate and near) to get the best vision.
Standard Toric IOL: These implant lenses have an astigmatism correction built into the lens, so when placed in the eye and aligned with the patient’s pre-existing astigmatism, can allow for quite good vision at one distance (distance, intermediate or near). It is more than likely that glasses may be required for better vision at other distances. There are additional fees for toric lenses.
Crystalens and Trulign IOL: These implant lenses are the only FDA approved accommodating intraocular implant lenses. The Trulign is the toric version (fixes larger amounts of astigmatism) of the Crystalens; they both work the same way. These lenses are able to move a little bit inside the eye, allowing patients to have a bigger range of vision without glasses compared to standard or standard toric lenses. They are not, however, good enough to go all the way from perfect distance to perfect reading vision, but are generally quite good at giving two out of three distances without glasses. As a result, after both eyes are done, we are generally able to get quite good distance and intermediate vision, and 50% of patients do not need reading glasses. These lenses are also less prone than most standard lenses to optical aberrations including edge glare and night time optical aberrations. There are additional fees for the Trulign and Crystalens, and those additional fees include a LASIK or PRK touch up within the first year if the target of good distance vision is not achieved. It is impossible to achieve excellent distance vision in all cases because of the biology of human variation, so missing the intended target is possible with all types of implant lenses, and can be fixed with glasses, contact lenses, or laser vision correction with LASIK or PRK.
Vivity and Vivity Toric IOL: These are FDA approved extended depth of focus implant lenses. These lenses, much like the Trulign and Crystalens, can reduce astigmatism and increase the range of vision without glasses, but are also not good enough to go all the way from perfect distance to perfect reading. In comparison to the Trulign and Crystalens, because the optics of the Vivity are not dependent upon movement of the lens (which is less predictable), the range of vision is more predictable, and only 35% of patients still need reading glasses. There are additional fees for the Vivity lenses, and that additional fee also includes a LASIK or PRK touch up if the distance target is not achieved acceptably.
Symfony and Symfony Toric IOL: These are also FDA approved extended depth of focus implant lenses. These lenses, much like the Vivity lenses, can reduce astigmatism and increase the range of vision without glasses, but are also not good enough to go all the way from perfect distance to perfect reading. In comparison to the Vivity the range of vision is a bit more predictable, and only 25% of patients still need reading glasses. The tradeoff for less dependence on reading glasses with the Symfony lens is that 15% of patients have a spider web visual effect around lights at night. There are additional fees for the Symfony lenses, and that additional fee also includes a LASIK or PRK touch up if the distance target is not achieved acceptably.
PanOptix and Synergy - Multifocal IOL: These lenses actually have multiple lens powers built into the lens, so most patients (over 90%) do not need intermediate or reading glasses. These are not good lenses if you have other medical ocular problems such as macular degeneration, or other retinal problems or certain corneal problems. The other issue with these lenses is that 30% of people have halos or rings around lights at night. These lenses also have an additional fee that also includes a LASIK or PRK touch up if the distance target is not acceptably achieved.
Mix and Match option This has become the most popular option for implant lenses. With this option, we have the possibility of limiting side effects while maximizing the possibility of being less dependent on reading glasses. There are three distances in the real world where we want to see.
Distance- driving, watching television, walking around everything further than 4 feet away
Intermediate- computer, dashboard, playing cards, grocery store, interpersonal distance, essentially 18 inches to two feet
Reading- up close reading, generally about 12-18 inches
The two lenses in use for the mix and match option are the Vivity extended depth of focus (EDOF) lens and the Panoptix trifocal lens.
The Vivity lens generally gives very good distance vision and intermediate vision, and when placed in both eyes, over 65% of people do not need reading glasses, and 35% still need a weak +1.25 pair of reading glasses. The Vivity has no extra risk for glare or halo over and above a standard lens, about 1%.
The Panoptix lens generally gives good distance, intermediate and reading vision without glasses, over 90% do not need glasses to read comfortably, but this lens has a much higher percentage of halo around lights at night (headlights, streetlights, traffic lights).
People have to decide which is more important for themselves, to limit dependence on reading glasses and accept the possibility of some halo effects around lights at night, or to limit the risk of night halos and accept the possibility of needing weak reading glasses.
If someone is very motivated to be glasses independent and believes that they can handle the halo, we start with the non-dominant eye and put a Panoptix in that eye. When the person comes back after a week, on the pre-op visit for the second eye, they should have gone out the night before to evaluate the presence and level of halo. If the halo is minimal or not bothersome, we put the same lens in the second eye. If the halo is more than the person thinks they can handle if it were in both eyes, we can put a Vivity in the second dominant eye. In this result, both eyes can have good distance vision (assuming we hit our optical target), both eyes can have good intermediate, and with both eyes together because of the Panoptix lens in the first eye, the reading is usually acceptable, and the dominant eye does not have the halo so with both eyes open it is typically not too bothersome.
If someone is more motivated to minimize the risk of halo and can accept the possibility of needing some weak reading glasses, we start with the dominant eye and put in a Vivity lens. When the person comes back after a week on the pre-op visit for the second eye, we evaluate how happy they are with their reading vision. If the reading vision is good, we put a Vivity in the second eye. If the reading vision is not good, we decide together whether or not to put a Panoptix in the second non dominant eye and accept the possibility of halo in that eye, or put in a Vivity and accept the possibility of needed some weak reading glasses.
This mix and match option engages the patient to participate fully in the decision about the best lens option for their lifestyle.
