What is the best lens for cataract surgery? Your guide to making the right decision

The type of lens is chosen on the basis of two main points: the material the lens is made of, and the optical and functional design of the lens. These are two completely different things that many patients confuse. In this article we explain these details so that it can serve as a comprehensive guide for our patients.

In this guide:

• Material: hydrophilic acrylic lenses
• Material: hydrophobic acrylic lenses
• Monofocal lenses
• Enhanced monofocal (monofocal plus) lenses
• Extended depth of focus (EDOF) lenses
• Multifocal and trifocal lenses
• Toric lenses for astigmatism
• Accommodating and light adjustable lenses
• Phakic and add-on lenses
• Detailed lens articles

First: comparing lenses by material

Modern intraocular lenses are made of advanced medical-grade acrylic, which falls scientifically into two main types. The type determines how long vision stays clear and how often late complications appear.

An accurate medical choice depends on the following essential differences between the materials:

Hydrophilic acrylic lenses

These lenses are made of a material with a high water content. The material is of acceptable quality, but the main drawback is that these lenses carry a high likelihood of clouding of the posterior capsule behind the lens (PCO), which means the patient may need a laser session in the future to clear the posterior capsule (Li et al., 2013; Ursell et al., 2018). In addition, these lenses carry a risk of long-term calcium phosphate deposits inside and on the surface of the lens, leading to severe clouding of the lens, which may require an operation to exchange the lens in a small proportion of patients (Darcy et al., 2019; Kanclerz et al., 2021).

Hydrophobic acrylic lenses

These lenses are made of a material with a low water content, unlike the previous type. This makes hydrophobic lenses the better choice in terms of material and quality, because it reduces the likelihood of clouding of the posterior capsule behind the lens (Li et al., 2013; Chang and Kugelberg, 2017) and prevents calcium phosphate deposits inside or on the surface of the lens, which keeps vision clear over time.

With technological progress, newer generations of hydrophobic lenses have appeared to overcome the phenomenon of "glistenings". The American company Alcon developed the Clareon lens family, and the Japanese company HOYA produced the Vivinex lens family, to provide materials that resist glistenings (Auffarth et al., 2023; Miyata et al., 2025). These modern materials therefore keep their full transparency and clear vision for life.

In detail: Hydrophobic or hydrophilic lens in cataract surgery and Can an implanted lens become cloudy years later?

Second: comparing lenses by optical design

Choosing the optical design of the implanted lens is the most important decision before cataract surgery, because it determines the nature and range of vision for years to come. The choice depends on a precise examination of the eye's tissues to identify the suitable lenses, and it also takes into account the patient's expectations and daily needs.

Monofocal lenses

These lenses are designed to give very sharp, clear vision at one viewing distance, usually set mainly to correct distance vision. They allow the patient to drive, follow the road or watch television clearly without glasses. They require glasses for reading or using a mobile phone (de Silva et al., 2016). They are the most suitable choice for patients who want flawless clarity with no night halos at all and do not mind partly depending on glasses, or for patients with advanced retinal disease. Advanced generations use aspheric technology to offset the cornea's positive spherical aberration, which improves vision in dim light (Schuster et al., 2013).

In detail: Choosing a lens for cataract surgery and Spherical or aspheric lens

Enhanced monofocal (monofocal plus) lenses

These represent an advanced generation that combines clear distance vision with a noticeable extension of intermediate vision (Wan et al., 2022; Auffarth et al., 2021). This technology lets the patient see the car dashboard and computer screens clearly without affecting the quality of distance vision. These lenses reduce daily dependence on glasses compared with the conventional type, while the patient keeps glasses for fine reading only (Hayashi et al., 2025). They do not rely on diffractive rings and therefore do not cause any glare or light scatter during night driving, which makes them ideal for driving (Wan et al., 2022; Hayashi et al., 2025). Leading examples are the TECNIS Eyhance, SIFI Evolux and RayOne EMV lenses, which use positive spherical aberration to increase the depth of field.

In detail: Enhanced monofocal lenses such as Eyhance

Extended depth of focus (EDOF) lenses

Extended depth of focus technology creates a continuous, smooth focal range that covers distance through to intermediate vision without visual gaps or sharp transitions (Cho et al., 2022). It gives the patient full freedom for most daily tasks, such as shopping, using a computer and driving. EDOF technology avoids the night halo problem associated with traditional multifocal lenses, and comes in diffractive designs (such as Symfony) or advanced refractive designs that stretch the light wave (such as Vivity and PureSee). It is an ideal clinical choice for people who are always on the move and drive at night. A careful subjective refraction is preferred, because automated refraction (autorefraction) readings may be false and suggest myopia that is not real, because of the optical design of the lens.

In detail: Choosing a lens for cataract surgery

Multifocal and trifocal lenses

This optical technology aims to provide near-complete independence from glasses, reaching 95% in all daily activities. These lenses contain graduated refractive/diffractive circles and rings that split the light and serve distance, intermediate (computer screens) and near (reading and the phone) vision together (de Silva et al., 2016). These lenses require a careful clinical assessment of the macula to make sure they fully suit the health of the retina and that it is free of any disease. They offer the greatest comfort to patients who want to be rid of glasses, with a possibility of some mild halos to which the brain gradually adapts through neuroadaptation (de Silva et al., 2016).

In detail: Choosing a lens for cataract surgery, Cataract surgery in diabetes and 20/20 (6/6) after cataract surgery, so why don't I see comfortably?

Toric lenses for astigmatism

A precise surgical option that is combined with any of the previous lens technologies (monofocal, EDOF or trifocal) to treat irregular corneal curvature (astigmatism). This technology ensures that astigmatism is corrected during cataract surgery in a single surgical step (Kessel et al., 2016; European Society of Cataract and Refractive Surgeons, 2024). Implanting it requires advanced biometric and topographic measurements to map the cornea, and strict axis alignment inside the eye to keep the lens stable at the exact anatomical angle, because rotational stability is the cornerstone of its success (Haripriya et al., 2021).

In detail: Choosing a lens for cataract surgery and The more expensive lens in cataract surgery: what are you actually paying for?

Accommodating lenses and light adjustable lenses (LAL)

Accommodating lenses change their position inside the eye in response to the effort of the eye's internal muscles, to imitate the natural lens. Clinically, we make clear that the visual benefit they add at near distances remains very limited and less effective than other technologies, and most of these lenses are not commercially available; many are still under study and development. Light adjustable lenses are a technology that adjusts the refractive power of the lens after surgery by exposing it to ultraviolet (UV) light. This procedure requires strict commitment to wearing special protective glasses for weeks to prevent random changes in the lens. We emphasize to our patients that these lenses and their medical precautions make them unsuitable for a large group of patients, and they are not currently available in Egypt.

Phakic and add-on lenses

For patients with severe refractive errors or thin corneas that rule out LASIK, lenses can be implanted in front of the natural lens (phakic IOLs), such as ICL lenses made of Collamer, Artisan/Artiflex lenses fixed to the iris, or IPCL lenses. Add-on lens technology (Sulcoflex or AddOn) is also available: these lenses are implanted over a previous cataract lens to correct refractive surprises. For loss of the iris from congenital defects or injuries, custom artificial iris implants are available; they are handmade in Germany and match the color of the healthy eye to reduce severe glare.

Detailed lens articles

• Choosing a lens for cataract surgery: monofocal, multifocal or toric?
• Hydrophobic or hydrophilic lens in cataract surgery: does the lens material matter?
• Spherical or aspheric lens in cataract surgery: does it make a difference at night?
• Enhanced monofocal lenses such as Eyhance: what do they add after cataract surgery, and what can they not do?
• American, European or Indian lens: does vision differ after cataract surgery?
• The more expensive lens in cataract surgery: what are you actually paying for?
• Can an implanted lens become cloudy years later? Capsule clouding, calcification and glistenings
• 20/20 (6/6) after cataract surgery, so why don't I see comfortably?
• Dislocated intraocular lens: why it moves years later, and how we fix it in place again

From the cataract section:

• Cataract surgery: what happens before, during and after the operation?
• Cataract surgery in diabetes: when to operate, and how to protect the retina before and after
• Cataract after vitrectomy or silicone oil

This information is for health education and does not replace a medical examination.