viewpoint
No "Best" IOL

Whenever I am on a panel discussing premium intraocular lenses, I am inevitably asked which lens I would like to have put in my own eye if I were the patient having cataract surgery. In order to decide I have to ask myself a few questions:

Q. Why are you having surgery?

A. I don't see clearly.

Q. What do you want to accomplish?

A. I want to see clearly again.

Q. Would you like to see distance and near without eyeglasses?

A. Of course.

Q. Would you like to see very clearly, even if you had to wear eyeglasses?

A. Of course, but I'd rather not wear eyeglasses.

Q. Considering your lifestyle, what is more important to you, quality of vision or range of focus?

A. This is where it gets tricky. Of course I'd like to have both, but read on.

As we know, all lenses have some compromises. The ringed multifocal lenses can reduce the quality of how you see, but do offer a wide range of focus. The aspheric lenses give you sharper vision, but they do not have a wide range of focus.

I have spent my entire life racing sailboats. This sport requires me to see many subtle changes in conditions, like light shadows on the sails or wind-induced ripples on the water. I need excellent quality of vision if I am to remain competitive. Range of focus doesn't matter in sailing because we don't look at anything up close. This being the case, quality of vision is more important to me than quantity. I would want an aspheric lens, either neutral or, because of my previous RK, negative in design.

Different Patient, Different Lens

Other people have different priorities and may prefer it the other way around. They'd rather have a wide range of focus, even if there were a modest reduction in quality of vision. Still others might decide to compromise and pick a middle course. They would split the difference between quality and range and select a monofocal optic on an accommodating platform. 

Each one of us would approach this decision from our unique points of view. For the first time ever, we have a lot of different lenses to pick from. Our challenge is figuring out which one to pick for each patient.