Posted by: Hubert H. Pham in Eye Health & Vision Care
When people come in to talk about cataract surgery, the question I hear all the time is:
“So… which lens should I pick?”
I wish it were a simple answer. I really do. But lenses aren’t like picking a shoe size. What works beautifully for one person might be completely wrong for someone else, even if their numbers look similar on paper.
So instead of starting with the lens, I start with you—how you use your eyes, what bothers you, what you want to be able to do without thinking about glasses, and honestly, what your tolerance is for little visual quirks. Everyone has a different line.
Your Vision Goals Matter More Than the Lens Names
A few examples I hear every week:
“I’m on the computer all day. I don’t care about tiny print.”
“I drive a lot at night, so glare will drive me crazy.”
“I’m done chasing reading glasses around the house.”
“I had LASIK back in the 90s, so please help me make sense of this.”
Your eye anatomy adds another layer—dryness, astigmatism, previous surgery, and sometimes just how your eye heals in general. All of that plays into the choice.
It’s never one-size-fits-all. If it were, you’d already know the answer before stepping into the exam room.
Light Adjustable Lens (LAL)
If there’s a lens that gets closest to “designing” your vision, it’s this one.
We place the lens during surgery, and then afterward we adjust it with light treatments. It feels a bit surreal the first time patients go through it—“Wait, we can change this now?”
It’s incredibly helpful for people who’ve had LASIK or who really want to fine-tune their vision instead of hoping the numbers land perfectly on day one.
Multifocal & Trifocal Lenses (like the new Panoptix Pro or Envy)
These lenses are for people who want more freedom from glasses. Distance, intermediate, near—all built in.
Some patients absolutely love them. They can read a menu, check their phone, see the dashboard, and not think twice.
But here’s the honest part:
Some patients notice halo or glare around lights, especially early on. A lot of folks adapt, a few don’t. I always make sure people know this upfront, because nothing is worse than being surprised after surgery.
Extended Vision Lenses (like Vivity)
This is a good middle-ground option.
Most people get very solid distance and computer vision. Near vision is “pretty good” for many day-to-day tasks—larger print, phone screens—but tiny print in dim lighting still usually needs help.
The nice thing is that glare and halo tend to be less noticeable with this design.
Accommodative Lenses
These lenses move slightly inside the eye to help with focusing.
When they work well, people get crisp distance vision and useful intermediate vision (computer distance, price tags, cooking). Tiny print still usually needs readers.
Results are more variable in this category, so I look closely at your measurements before recommending it. Most surgeons don’t use these lenses very often at this time.
Toric Lenses for Astigmatism
If you have moderate or significant astigmatism, a toric lens can make a big difference.
Without correcting the astigmatism, even the “best” lens won’t perform like it should.
Most patients with toric lenses end up with sharper distance vision and a lot fewer glasses.
Monovision
If you’ve worn monovision contacts and actually liked them, we can recreate that with surgery.
If you’ve never worn monovision contacts, I always simulate it first. Some brains love it. Some absolutely do not. A really good way to do this is actually to opt for the Light Adjustable Lens (mentioned above), which can be reversed if you don’t love it.
How We Make the Decision Together
During your consultation, I show you your imaging, we talk about what your eyes are capable of, and we weigh the pros and cons in a very practical way.
Sometimes I’ll ask something like: “If we can get you sharper distance vision and cut down your dependence on glasses, does that feel like the right direction?”
And you’ll tell me what matters most to you. That conversation usually gets us to the answer.
Premium lenses aren’t about being “fancy.” They genuinely make everyday life easier for a lot of people—better clarity, fewer glasses, less frustration.
If You’re Thinking About Cataract Surgery
If your vision is getting hazy or you’re starting to plan ahead, I’m happy to sit down with you, look at your measurements, and help you figure out which lens actually fits your life—not someone else’s.
Call us or schedule a visit when you’re ready.
By Dr. Hubert H. Pham, MD MS Board Certified Ophthalmologist
Eye Specialists & Surgeons of Northern Virginia