What intraocular lenses do eye doctors (ophthalmologists and optometrists) choose for themselves?

What have I seen in my own practice?

Having regularly performed cataract surgery on optometrists, ophthalmologists, and their families, I find their personal lens choices revealing. The vast majority still opt for monofocal IOLs, typically targeted for mini-monovision, though some prefer bilateral distance or bilateral mild myopia for reading. Only a small minority select multifocal lenses, but an increasing number now enquire about and choose EDOF designs.

These preferences carry real weight. Eye doctors study optical principles during their training and usually spend years observing the outcomes of different IOLs across thousands of patients, giving them an unvarnished view of real-world trade-offs. As optical designs have matured, their growing willingness to consider modern EDOFs reflects a pragmatic evolution in what practitioners consider an acceptable compromise.

+

What does the published research actually show about what eye doctors choose for themselves?

There is no single IOL choice shared by all ophthalmologists. A US survey published in 2019 analysed 328 responses. For their hypothetical surgery, 61% selected a monofocal IOL: 34% for distance and 27% with monovision. Importantly, surgeons with greater experience implanting multifocal IOLs were more likely to choose a presbyopia-correcting IOL themselves.

A contrasting survey collected in 2019 from 1,209 ophthalmologists in Latin America and Spain found 36% choosing monofocal strategies, 40% bifocal or trifocal IOLs, 15% EDOF and 9% unsure. That paper grouped EDOF under its “multifocal” umbrella. Its often-quoted 60% figure excludes undecided respondents and already includes EDOF; adding another 15% would count EDOF twice.

The dates matter. Responses in 2019 reflect an earlier stage of EDOF adoption, before the broader range of designs familiar today, particularly newer non-diffractive EDOF lenses. 

A Portuguese survey published in 2024, with 121 respondents, found EDOF was the largest category, at 47%. 

The 2025 EuroTimes report adds a Greek conference survey suggesting substantial EDOF interest. The 2024 UK paper it discusses asked about lenses for typical patients, not surgeons’ own eyes. EyeWorld’s 2020 interviews also show a range of personal preferences, from monofocal strategies to multifocals.

Why might an eye doctor prefer a monofocal IOL for their own eyes?

A monofocal IOL provides one main focus and generally offers a favourable balance of image clarity, contrast and fewer unwanted light effects. It can be a sensible choice for someone who values predictable visual quality and is comfortable wearing glasses for some tasks.

+

Contrast sensitivity means distinguishing an object from a similar background: a grey step in dim light, a face in shadow or road markings at dusk. This is different from reading high-contrast black letters on an eye chart. Two people can both achieve 6/6 vision yet describe quite different visual quality.

Multifocal and trifocal IOLs can reduce dependence on glasses, especially for near tasks, but increase the likelihood of haloes or glare compared with monofocal IOLs. A Cochrane review supports this trade-off, although it mainly covers older designs.

For some eye doctors, wearing reading glasses is an acceptable price for protecting the qualities of vision they value most. Others place more value on spectacle independence and make a different, equally considered choice.

Many eye doctors are short-sighted (myopic) and enjoy clear near vision when they take their glasses off. They may be particularly concerned about whether a multifocal or EDOF lens would give them the near clarity and visual quality they value. A wider range of focus does not necessarily reproduce their familiar unaided near vision; the intended prescription and the exact lens design both matter.

+

Higher contrastLower contrast

↔

+

Compare contrast

Does monofocal always mean distance vision and reading glasses?

No. IOL design and the intended focus of each eye are separate decisions. A monofocal IOL can be targeted for distance, intermediate or near vision. A toric version can also correct suitable regular astigmatism; “toric” describes astigmatism correction rather than the number of focal distances.

With monovision, one eye is focused mainly for distance and the other is made more short-sighted for nearer tasks. The brain uses the complementary information from the two eyes. Mini-monovision uses a smaller difference between them, usually favouring intermediate tasks while accepting a greater need for glasses for reading fine print.

In my experience, mini-monovision is significantly more commonly chosen by eye doctors than full monovision. The smaller difference between the eyes can make the compromise more acceptable, although individual tolerance still varies. My article on blended vision and mini-monovision explains this approach in more detail.

Monovision has its own compromises. It can reduce depth perception or binocular visual performance, and some people dislike the imbalance. Glasses may still help for demanding distance work, night driving or close reading. Previous successful contact-lens monovision can be useful information, and a trial may help where appropriate, but it cannot reproduce every feature of the surgical result.

Some people who have always enjoyed reading without glasses prefer to remain short-sighted in both eyes and wear glasses for distance. That is a deliberate visual goal, not necessarily an unsuccessful operation.

Why are EDOF lenses attracting more interest?

EDOF lenses are becoming an increasingly popular option. They aim to extend the useful range of focus, commonly improving intermediate vision for computers, dashboards and household tasks. In my practice, I am seeing more eye doctors ask about them and choosing them for their own eyes.

+

Before today’s broader range of EDOF designs, multifocal IOLs were the main lens option for extending vision beyond the range of a conventional monofocal. Multifocal IOLs work well in selected patients and can give useful near vision with less dependence on glasses. However, a proportion of patients do not tolerate their glare and haloes around lights at night, or dislike the quality of vision even when they can read well on a sight chart.

In my lens-exchange practice, I am regularly referred patients that are unhappy with the quality of vision following multifocal intraocular lens implants and I see how significant that dissatisfaction can be. These unhappy patients can leave a lasting impression on eye doctors who look after them. They are a selected group, however, and their experience does not establish the dissatisfaction rate among all multifocal IOLs recipients.

Many contemporary EDOF lenses are well tolerated. Some, particularly non-diffractive designs, can offer a lower burden of troublesome haloes and glare than diffractive multifocal or trifocal IOLs. This is one reason they attract eye doctors who want a broader range of vision but are cautious about night-time visual effects.

4:49How the Vivity lens works

Watch on YouTube →

EDOF is a category, not one optical design. Some use diffraction; others use non-diffractive methods to shape or broaden the focus. The likelihood of haloes, glare and reduced contrast varies with the design and the individual eye. Enhanced monofocal lenses are another category with some improvement in intermediate vision, and should not automatically be relabelled EDOF.

A randomised registration study of one non-diffractive EDOF design found better intermediate and near vision than its monofocal control, with similar reported visual disturbances. That result is specific to the studied lens and selected eyes; it does not establish that every EDOF lens has identical contrast or night vision to every monofocal.

As more surgeons implant EDOF lenses, they gain experience with their benefits and compromises. Optometrists also become more familiar with them as they see more patients living with these implants. Seeing satisfied patients can build confidence and a favourable view of a particular design, just as seeing difficult cases can create reservations. I think this growing familiarity helps explain the interest I am seeing among eye doctors.

EDOF IOLs still involve compromises. Some patients remain unhappy with their visual quality or need more glasses than they expected. Combining an EDOF lens with mini-monovision can improve nearer vision, but fine print may still require glasses. Suitability depends on the eye examination, the exact lens and the intended focus of each eye.

What are the optical limits?

Only a finite amount of light enters the eye. A conventional monofocal lens concentrates its useful focus mainly at one distance. A multifocal lens distributes light between different focal distances; while one image is in focus, other light contributes out-of-focus information. This helps explain why greater range can come with reduced image contrast and haloes.

It would be too simple to say that every lens offering a wider range works by splitting light, or that all such lenses lose the same amount of contrast. Non-diffractive EDOF lenses broaden or shape the focus, and performance depends on the design, pupil, lighting and the rest of the eye.

No current implant recreates all the flexibility of a healthy young natural lens. Technology can improve the balance, but promises of perfect vision at every distance, in every lighting condition and without glasses should be treated cautiously. I would not claim that future designs can never improve on today’s options.

+

Ageing can also reduce contrast sensitivity through changes elsewhere in the visual system. That is one reason I consider visual quality alongside the number of tasks someone can perform without glasses.

Can difficult cases influence eye doctors’ preferences?

Optometrists and ophthalmologists see the everyday successes of cataract surgery, but they also see people whose visual quality falls short of their expectations. A minority with persistent problems may return repeatedly and understandably describe those problems in detail.

Those experiences can leave a stronger impression than an uncomplicated result. This is a plausible influence on personal preferences, not proof that eye doctors are biased or that multifocal lenses are generally unsuccessful. Experience can work in the other direction too: both the US and Iberoamerican surveys found greater willingness to select presbyopia-correcting lenses among surgeons familiar with implanting them.

My own lens-exchange work brings me into contact with a selected group of dissatisfied patients. It gives me useful insight into the problems, but cannot tell us how often they occur among everyone receiving a particular lens.

What happens if someone is unhappy with a multifocal lens?

I specialise in intraocular lens exchange for people who are unhappy with their implants, including multifocal lenses. First, we need to identify the cause. Dry eye, a residual glasses prescription, clouding of the capsule behind the lens, lens position and retinal disease can all affect the result. Changing the implant is not always the answer.

For carefully selected patients, exchanging a multifocal lens for a monofocal can improve unwanted visual effects. However, this is complex surgery rather than a simple reversal. Risks include damage to the capsule or its supporting fibres, inflammation, macular swelling, infection and retinal complications. Previous YAG laser capsulotomy can make an exchange more difficult, so its timing deserves particular care when exchange is being considered.

Exchange can improve visual quality while increasing dependence on glasses. Published series also show that improved symptoms do not guarantee overall satisfaction, particularly when near vision is lost. I discuss both sides of that trade-off before proceeding.

The patients who undergo exchange are those troubled enough to seek another operation and willing to accept its risks. Others may remain dissatisfied but prefer glasses, other treatment or observation. Exchange numbers alone therefore do not measure all dissatisfaction, and I cannot put a reliable percentage on the unoperated group.

6:28Lens exchange after YAG capsulotomy

Watch on YouTube →

What about eye health five or ten years later?

A lens choice is intended to serve someone for many years. The implant does not prevent later macular degeneration, an epiretinal membrane, glaucoma or other changes in the eye. These can reduce vision or contrast with any implant.

My concern is that someone who already accepts an optical compromise to gain a wider range of focus may have less tolerance for another source of reduced visual quality. This is a consideration in counselling, rather than proof that every later retinal condition will cause more loss with a multifocal than with a monofocal. A review of multifocal lenses and retinal disease found the evidence too limited to justify a blanket prohibition.

Someone initially comfortable without glasses may need them five or ten years later because their prescription, eye health or visual tasks have changed. That is a possibility, not a fixed expiry date or an established frequency. Small long-term studies have also reported continued satisfaction with multifocal lenses at ten years.

New blur should be assessed rather than attributed automatically to the implant. Glasses can correct a refractive error, but they do not restore vision lost from retinal or optic nerve disease.

What did I choose for my mother, and what would I choose for myself?

For my mother, I advised EDOF lenses and she has been very happy with them. That personal choice illustrates why I do not apply a blanket rule that everyone should have a particular type of lens. A relative’s choice still does not establish what would suit another person’s eyes.

For my own eyes, I am currently uncertain. As of October 2026, I would most likely consider monofocal lenses with mini-monovision, or EDOF lenses with mini-monovision. Fortunately I do not have cataracts and so do not need to make that decision yet.

This is a provisional preference, not a recommendation for every patient. My examination findings, tolerance of an imbalance between the eyes, daily visual demands and the available technology would all matter. My answer may change as lens designs and evidence develop.

How can patients and optometrists use this information?

The useful question is why an eye doctor prefers a particular balance of benefits and compromises, rather than simply copying their implant. Before cataract surgery, discuss the exact lens model, the intended focus of each eye and the tasks for which glasses are still likely.

Patients should explain how much they drive at night, read, use screens or work with fine detail, and whether sharpness, depth perception or fewer glasses matters most. Optometrists can add valuable information about past prescriptions, monovision tolerance, ocular surface health and retinal findings.

Ask what happens if the visual quality is disappointing, what can be treated without another operation and what exchange would involve. The guide to lens implants available in Australia and PureSee and Vivity comparison explain the options in more detail.

What another eye doctor chooses can inform the conversation. Your own eyes and priorities should determine the decision.