Cataract Surgery: how to choose the right intraocular lens
07.09.2026
“The cataract needs to be operated on: let’s talk about which lens to implant.” For many patients, this sentence raises an unexpected question. You arrive at the clinic assuming the operation is the same for everyone, only to discover that the choice of intraocular lens — the small artificial lens that will replace your clouded natural one — will shape the way you see for years to come. Monofocal, toric, multifocal: what do these names mean and, above all, how do you arrive at the right choice? This guide brings some order to the subject, with one important premise: a lens is not picked from a catalogue, but chosen together with your specialist, based on careful examinations and on your individual needs.
What the intraocular lens does (and why the choice matters)
Cataract surgery removes the clouded crystalline lens and replaces it with a clear intraocular lens (IOL), designed to remain in the eye permanently. The lens, however, does more than restore transparency: it also determines the distances at which the eye will focus. This makes the operation an opportunity to correct pre-existing refractive errors such as myopia, hyperopia and astigmatism. The power and type of lens are calculated individually for each eye: it is one of the most important decisions of the whole journey.
Did you know?
In the first half of the 18th century came a decisive insight: cataract was not a membrane in front of the lens, as had been thought, but the crystalline lens itself turned opaque. And the first planned cataract extraction documented at the time was performed by Jacques Daviel in Cologne on 18 September 1750.
Sources: Grzybowski A et al., Acta Ophthalmologica 2022; Leffler CT et al., Clinical Ophthalmology 2025
The main families of intraocular lenses
Monofocal lenses
They focus at a single distance, usually far vision. They are the well-established standard: they provide sharp, high-quality vision, but reading glasses are normally still needed for near tasks. They are often the recommended choice when other eye conditions are present.
Toric lenses
They are designed to correct corneal astigmatism, which a standard spherical lens cannot compensate for. They come in both monofocal and multifocal versions: when astigmatism is significant, a toric lens reduces its impact on vision without having to correct it entirely with glasses.
Multifocal and EDOF lenses: the so-called premium lenses
Premium lenses — multifocal, trifocal and extended depth-of-focus (EDOF) designs — distribute light across several focal points, with the aim of reducing dependence on glasses at multiple distances: far, intermediate (the computer screen) and near. These are mature technologies, but they are not suitable for every eye: they require careful patient selection and an honest conversation about expectations, because in certain situations — night driving, for instance — they can cause halos or glare, generally well tolerated and tending to lessen as the eye and brain adapt. How to measure objectively how well a lens of this kind lets you see at every distance is the subject of a multicentre study born at Palazzo Manzoni and published in the American Journal of Ophthalmology.
How the right lens is chosen
The choice arises from the meeting point between clinical data and lifestyle. On the clinical side, the eye examination is completed with dedicated tests: biometry to calculate the lens power, corneal topography to measure astigmatism, OCT scanning to assess the macula and optic nerve, along with an evaluation of the ocular surface and of any dry eye. Conditions such as macular disease or advanced glaucoma may point towards a monofocal lens, which in those cases offers more reliable visual quality. On the personal side, habits matter: how much you read, how many hours you spend at a screen, whether you often drive at night, and how much depending on glasses weighs on you. There is no single best lens: there is the lens best suited to that eye and that life.
What to expect after surgery
Visual recovery after cataract surgery is usually quick, but full stabilisation takes a few weeks. With multifocal lenses, neuroadaptation also comes into play: the brain gradually learns to use the different focal points, and vision tends to improve over the first months. It is worth knowing that no lens can guarantee complete independence from glasses in every situation: a light pair of glasses for specific tasks may still be useful even with premium lenses. Post-operative check-ups are there precisely to follow this process and answer the questions that arise in daily life.
Did you know?
Adaptation to multifocal lenses can be seen in the brain. At the University of Coimbra, 30 patients were studied with functional MRI: 3 weeks after surgery, areas involved in attention and learning were activated, while at 6 months brain activity returned to a “non-effort” pattern, with no change in the eye’s optical measurements.
Source: Rosa AM et al., Journal of Cataract & Refractive Surgery 2017
Choosing your lens in Brescia
At the Palazzo Manzoni Surgical Institute, at Via dei Mille 14 in the centre of Brescia, the entire cataract pathway takes place under one roof: the comprehensive eye examination with dedicated diagnostics (biometry, topography, OCT), the discussion about the choice of lens — monofocal, toric or premium — and the operation itself in the Institute’s own operating theatres, with post-operative check-ups carried out by the same specialist. This makes it possible to build the decision calmly, on measured data and direct dialogue.
Frequently asked questions about intraocular lenses
With a premium lens, will I be able to give up glasses entirely?
Multifocal and EDOF lenses aim to significantly reduce dependence on glasses, and many patients manage most activities without them. No lens, however, can guarantee this in every situation: for particular tasks, such as prolonged reading of very small print, glasses may still be useful.
Does the intraocular lens last a lifetime?
Yes: the lens does not wear out and does not normally need to be replaced. In the months or years after surgery, the capsule that supports it may occasionally become cloudy (so-called secondary cataract): this is treated with a quick, painless outpatient laser procedure.
Who decides which lens to implant?
It is a shared decision: based on the test results, the specialist presents the options genuinely suitable for that eye, explains the advantages and limitations of each, and weighs them against the patient’s needs and expectations. Not every lens is suitable for every eye.
How do I book a cataract assessment in Brescia?
You can call 030 294 2437 or book online through the Palazzo Manzoni website. The visit includes the examinations needed to assess the cataract and, where surgery is indicated, to begin planning the choice of intraocular lens.
At the Ophthalmology department of the Palazzo Manzoni Surgical Institute in Brescia, cataract surgery and lens selection follow a dedicated pathway, from diagnostics to the operating theatre: you can learn more on the pages devoted to cataract surgery and premium lenses, and book a visit by calling 030 294 2437.
