Which lens should you choose for cataract surgery?

One of the questions patients ask most often before cataract surgery is: “Which lens is best?” There is no single lens that suits every eye and every lifestyle. A more useful starting point is to think about how you use your vision. Do you spend most of your time indoors or outdoors? Do you read a lot or spend many hours driving? What would you like your vision to help you do? [1]

For one person, reducing their reliance on glasses is a priority. Another may be happy to wear glasses for small print if their main concern is clear distance vision after dark.

Choosing a lens should therefore be a shared decision between you and your ophthalmologist, based on a thorough examination, your everyday needs, and a discussion of the benefits and limitations of each option. [1], [2]

What does an intraocular lens replace?

During cataract surgery, the cloudy natural lens is removed and replaced with an artificial intraocular lens, or IOL. Its power is calculated using measurements of your eye, and it is intended to stay in place permanently. Occasionally, a lens may need to be repositioned or exchanged, but this involves another procedure and additional risks. [1], [2], [3]

Several separate decisions go into choosing a lens:

• the lens power, calculated from measurements of the eye and cornea;
• the range of vision provided by the lens design—for example, a standard monofocal, enhanced monofocal, extended depth of focus (EDOF) or multifocal lens;
• whether a toric lens is needed to correct astigmatism;
• the target refraction—the distance at which we aim to give you the clearest vision without glasses;
• the plan for both eyes, because the final result also depends on how they work together. [2], [4]

Will I still need glasses after surgery?

No lens can guarantee complete freedom from glasses. Careful planning can improve the chances of achieving your visual goals, but a small amount of refractive error may remain even after successful surgery. [1], [2]

Whether you need glasses afterwards depends on several factors. These include the lens type, the intended focus, any astigmatism, the accuracy and consistency of the measurements, the health of the eye’s surface, and any conditions affecting the cornea, retina or optic nerve. The operation, healing and the way your eyes work together also play a part. [2]

Monofocal lenses

A monofocal lens provides clear vision mainly at one distance. Most often, the aim is good distance vision without glasses. Reading glasses are usually needed with this approach. It is also possible to aim for clear near vision, which may appeal to people who are used to being short-sighted. In that case, glasses will be needed for distance vision. [1], [4]

Enhanced monofocal lenses (Monofocal Plus)

These lenses are still classed as monofocal, but they can provide a slightly wider range of useful vision than a standard monofocal lens, particularly at intermediate distances. This may make activities such as using a computer or looking at a car dashboard easier. [1], [5]

They are not designed to provide a full range of near vision. Glasses are usually still needed for reading, especially small print. Unwanted visual effects are generally less likely than with multifocal lenses, although the risk depends on the particular lens design and cannot be ruled out completely. [1], [5]

Extended depth of focus (EDOF) lenses

EDOF lenses provide an extended, more continuous range of vision from distance to intermediate. They may make computer work and other tasks at around 60–80 cm more comfortable. Reading glasses are still usually needed for small print. [1], [2]

Halos, glare and starbursts are less common than with multifocal lenses, but they are not eliminated entirely. How often they occur and how noticeable they are also depend on the technology used in the particular lens. [1], [2], [6]

Trifocal lenses

Multifocal lenses, including trifocal lenses, offer the greatest chance of reducing your need for glasses across distance, intermediate and near vision. They still cannot guarantee that you will never need glasses. [1], [2], [6]

These lenses require a particularly careful assessment of your eye health, lifestyle and expectations. Halos around lights, glare and starbursts are more common than with monofocal lenses. Some designs may also reduce contrast sensitivity—the ability to distinguish objects from their background. [2], [4]

These effects may become less noticeable as the brain adapts, a process called neuroadaptation, but they do not always disappear completely. This is particularly relevant if you often drive at night or work in dim lighting. [1], [7]

Toric lenses for astigmatism

The lens types described above may also be available in toric versions, designed to correct astigmatism at the same time. Toric lenses are mainly considered for regular corneal astigmatism. [2], [4]

ESCRS guidelines recommend considering a toric lens when regular corneal astigmatism is around 1 dioptre or more. The benefits are particularly well established when astigmatism exceeds 2 dioptres. With trifocal lenses, the usual aim is to leave no more than around 0.5 dioptres of residual astigmatism, because even a small amount can affect the quality of vision. For this reason, correcting lower levels of astigmatism may also be considered. [2], [8]

The decision is not based on a single measurement. A toric lens can reduce astigmatism, but it cannot guarantee that all of it will be corrected or that you will no longer need glasses. [2]

Why is the right lens more important than the most expensive one?

Before recommending a lens, your ophthalmologist assesses much more than the cataract itself, including:

• the macula and the rest of the retina;
• the optic nerve, including any signs of glaucoma;
• the cornea and the surface of the eye, including dry eye disease;
• the type and regularity of any astigmatism;
• previous laser vision correction or other eye surgery;
• the health of the other eye and how well the two eyes work together;
• your expectations and willingness to accept possible visual effects and a period of adaptation. [2], [4]

If you are considering a presbyopia-correcting lens—a lens designed to reduce your need for reading glasses—a more detailed assessment may be needed. This can include checks of the eye’s surface, corneal topography or tomography, an OCT scan of the macula, pupil assessment and tests of how your eyes work together. [2], [4]

Dry eye disease should be treated before the final measurements are taken, because an unstable tear film can make the results less consistent. [9]

If you have previously had laser vision correction, special methods are needed to calculate the lens power. There may also be a greater risk of some refractive error remaining after surgery. [2]

Having another eye condition does not automatically rule out a particular lens. It may, however, limit the result, increase the chance of disappointment or make a simpler lens design a safer choice. [2], [4]

The best lens is not necessarily the most expensive one. It is the one that best suits your eye and your everyday needs.

How does your lifestyle affect the choice?

Before your assessment, it can help to think about these questions:

• Do I often drive after dark?
• How much time do I spend at a computer, and how far away is the screen?
• Do I often read small print or use my phone?
• Is good vision in dim light important for my work or hobbies?
• Would I be comfortable wearing glasses for some activities?
• Which matters more to me: the best possible image quality with fewer unwanted visual effects, or a greater chance of managing without glasses?
• How well does my other eye see, and will it also need surgery?

There are no answers that suit everyone. This information helps you choose a lens whose strengths are useful in your daily life and whose limitations you feel comfortable accepting.

What should I ask at my assessment?

• Which type of lens would suit my eye, and why?
• Do I have astigmatism that would benefit from a toric lens?
• At what distance are we aiming for the clearest vision without glasses in each eye?
• Which activities am I likely to need glasses for afterwards?
• Do any conditions affecting my cornea, retina, macula or optic nerve limit the lens options or the result I can expect?
• What unwanted visual effects might I notice with this lens?
• How will the lens chosen for my first eye affect the plan for my second eye?
• What can be done if a small amount of refractive error remains after surgery?

Choosing well is not about finding a lens with no limitations—there is no such lens. It is about finding an option that meets your needs, with trade-offs you understand and are comfortable with.

Lens availability depends on the clinic where you have surgery and how your treatment is funded. This article is for educational purposes and does not replace an individual consultation with an ophthalmologist.

References

1. Polish Ophthalmological Society. Patient information on lens surgery [in Polish]. Appendix 2 to the guidelines on refractive lens exchange. 2021. Patient information, including the section “Artificial intraocular lenses”. Source

2. European Society of Cataract and Refractive Surgeons. ESCRS Recommendations for Cataract Surgery. Clinical guidelines, online version; accessed 28 September 2026. Source

3. Patel V et al. Intraocular Lens Exchange: Indications, Comparative Outcomes by Technique, and Complications. Clin Ophthalmol. 2023;17:941–951. DOI: 10.2147/OPTH.S399857. Source

4. Polish Ophthalmological Society. Guidelines on refractive lens exchange [in Polish]. 2021. Clinical guidelines. Source

5. Auffarth GU et al. Clinical evaluation of a new monofocal IOL with enhanced intermediate function in patients with cataract. J Cataract Refract Surg. 2021;47(2):184–191. DOI: 10.1097/j.jcrs.0000000000000399. Source

6. Tavassoli S et al. Trifocal versus extended depth of focus (EDOF) intraocular lenses after cataract extraction. Cochrane Database Syst Rev. 2024;7:CD014891. DOI: 10.1002/14651858.CD014891.pub2. Source

7. Zhang et al. Comparison of Visual Neuroadaptations After Multifocal and Monofocal Intraocular Lens Implantation. Front Neurosci. 2021;15:648863. DOI: 10.3389/fnins.2021.648863. Source

8. Zhang L et al. Effect of postoperative residual astigmatism on visual outcomes after trifocal intraocular lens implantation. Front Med (Lausanne). 2023;10:1202793. DOI: 10.3389/fmed.2023.1202793. Source

9. Polish Ophthalmological Society. Guidelines for perioperative care in cataract surgery in Poland [in Polish]. Section on preoperative care. Source