Lens Implants

Choosing the best for your Cataract Surgery
It is important to learn about the options to achieve the best visual results from your cataract surgery with Uday Devgan MD at Devgan Eye Surgery in Los Angeles. Prior to your consultation, you want to review this video which explains basic concepts and the options for lens implants to restore your vision. At your consultation, Dr. Devgan will guide you as to which options will give you the best results in order to meet or exceed your expectations.
The cataract is your human lens which has become cloudy and when we remove it, we need to replace it with a man-made lens implant which we call an IOL (Intra-Ocular Lens). Note that this video covers three primary options and lens implants, but there are dozens of variations and even more different models of lenses available. It is important for all of our patients to watch this video prior to surgery.
For a small number of patients, there are other options such as emphasizing near vision for those who spend many hours per day reading or working on the computer. Some patients also have experience with mono-vision using contact lenses or with prior LASIK laser eye surgery. Mono-vision is where one eye is better for distance and the other eye is better for near vision. This video applies to just a small percent of our patients.
Now that you have learned from these videos, we can review the highlights again with the following pictures and diagrams.
This photo shows the difference between an eye with a cataract and an eye which has restored 20/20 vision after cataract surgery. The cataract is your human lens which has become cloudy: a clear human lens is called a crystalline lens and a cloudy human lens is called a cataract. A cataract is not a film that grows in the eye. And a cataract does not have to be “ripe” before having surgery – the eye is not a banana! If you are having difficulty seeing and performing your day to day activities such as driving, reading, using your cell phone, or even seeing the television, then you should consider cataract surgery. If you feel that your vision is just fine and you passed your driving test (20/40 or better), then there is no need for cataract surgery yet. As the saying goes, “If it’s not broken, then don’t fix it!”

Cataracts cause blurry vision (20/60 in this case) but also darken the vision, induce loss of contrast, and wash out colors. This makes tasks like reading, driving, or even watching television, more difficult. The clear vision after cataract surgery shows a marked improvement in the sharpness of vision (20/20 in this case) as well as the brightness, the colors, and the contrast.

The lens implant which is placed inside the eye is very tiny, only about ¼ of an inch in diameter. It is placed deep inside the eye, behind the blue/green/brown iris and it will last at least 50 years without needing to be replaced. It requires no maintenance and you will not feel its presence. You cannot accidentally remove this lens implant if you rub your eye and you will not see it when you look in the mirror.

The three primary types of lens implants are: mono-focal, EDOF, and tri-focal.

  • Mono-focal IOLs give one optimal focus range without glasses and we usually set this for distance vision which means that things from outstretched fingertips (3 feet) to far away are clear without glasses and then over-the-counter reading glasses (+2.00 or so) are used for near and intermediate work such as computer or cell phone use. With this option, we can typically give an 80-year-old patient the visual function of a 50-year-old.
  • EDOF stands for Extended Depth of Field which uses a central optical zone on the lens to give a little more range of vision without glasses. This means that vision from about 2 feet to far away is good without glasses. This one extra foot of intermediate vision means that computer work would be pretty good without glasses – and that means a desktop computer 24 inches away, not a hunched over a laptop that is one foot from your face. Because of the optical laws of physics, the EDOF lens does cause a modest decrease in contrast compared to the mono-focal lens.
  • Tri-focal IOLs split the light that comes into the eye into three zones: near, intermediate, and far vision. With this lens implant, patients are typically able to navigate their cell phone, read a book, use a computer, watch television, and drive, all without glasses. This is achieved by the concentric rings that you can see on the optic of the IOL. By splitting the light into these three zones, maximum freedom from glasses is achieved. But there is a catch: again, we cannot cheat the physics of optics. This means that contrast is less across the board and there will be glare/halos around lights at night.
This is a graphical way of understanding the range of vision without glasses and the quality of vision achieved with each type of lens implant. Note that the vision of the typical cataract patient is the worst of all (shown in purple), so that any type of lens implant will give significantly better vision. Also remember that there is no fountain of youth and we can never regain the amazing vision that we had at age 25.

So how do you decide?

Study the summary below and then choose the sentence that best matches you. Remember that Dr. Devgan will review the options with you at your consultation and will help to guide you as to what will work best for your needs, your eye anatomy, and your eye measurements. There are dozens of different lens options and other technical subtleties so that we can fine-tune the selection even further.

Monofocal IOL:
  • best quality of vision
  • best night vision
  • great distance vision without glasses
    (3 feet to far away)
  • will need reading glasses for intermediate work
  • will need reading glasses for near work

Extended depth of field IOL:
  • good quality of vision
  • good night vision
  • great distance vision without glasses
    (3 feet to far away)
  • good intermediate vision without glasses
    (2 feet to 3 feet)
  • will need reading glasses for near work

Trifocal / PanOptix IOL:
  • good quality of vision
  • some night glare & halos
  • good distance vision without glasses
    (3 feet to far away)
  • good intermediate vision without glasses
    (2 feet to 3 feet)
  • good near vision without glasses
    (16 inches to 24 inches)
  • will only rarely need reading glasses
    (usually for dim light)

What if I choose the wrong lens? Do not worry – you will be guided in the decision process by Dr. Devgan at the time of your consultation. You are then able to re-watch these videos and then email Dr. Devgan with any additional questions. In the rare case that you do not like the resultant vision from your lens choice (less than 1% of patients), we can do a second surgery to exchange the lens at just about any time in the future, even years later.
Now this is just the start. The next step is a consultation where we will measure your eyes specifically and then determine which lens, along with your desires, will produce the best visual outcome. The PanOptix and the Alcon Vivity are great lens implants, but they are not perfect for every patient. During your consultation and discussion with me and our team at Devgan Eye Surgery, we will help guide you to achieve the best vision.
You can download the official patient brochure provided by Alcon, the manufacturer of the PanOptix and Vivity IOLs. Note that these are marketing materials and are lacking much of the scientific data that Dr. Devgan will review with you in person at your consultation.

Manufacturer’s brochure for the Alcon PanOptix (download link of PDF)

Manufacturer’s brochure for the Alcon Vivity (download link of PDF)

Share This