Accommodating Intraocular Lenses (IOL)

An accommodating intraocular lens (IOL) is an artificial lens implant that moves or changes shape in your eye, enabling dynamic focusing at various distances. 

It mimics the seamless adjustments (accommodations) that the natural lens makes in the eye as the focus shifts from distance to near and vice versa.

What Are Accommodating IOLs Used For?

Accommodating IOLs are an optional component of cataract surgery. Cataracts affect the natural eye lens, causing vision loss through cloudiness.

If you have cataracts, your eye surgeon (ophthalmologist) can remove the affected lens surgically. The doctor may replace the lens with an accommodating IOL to restore your vision.

People with the following refractive errors may also benefit from accommodating IOL implantation:

• Presbyopia (age-related decline in near-vision acuity)
• Farsightedness
• Nearsightedness
• Poor medium-range vision

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How Are Accommodating IOLs Different?

“Accommodation” is the primary attribute of accommodative IOLs. It gives the lenses greater visual range compared to other types of IOL.

They’re different from regular IOLs in several ways, such as:

• The lenses can change shape or move inside the eye.
• The natural eye manipulates these IOLs.
• An accommodating IOL has a single focusing distance that can change dynamically from distance to near vision focus.
• A multifocal IOL provides multiple focusing distances at any given time.
• A traditional monofocal lens has only one focusing distance that cannot change dynamically.

What Is Accommodation?

In terms of eye correction, an accommodation is when your eye manipulates the shape of the lens to change focusing distances (focal length). By accommodating, your eye can adjust focus seamlessly from distance vision to near vision and vice versa.

How Does It Work?

An accommodative IOL provides dynamic refractive power. It works with your natural eye and automatically adjusts its focusing power depending on the object distance.

How Does It Work with the Structure of Your Eye?

Your accommodating IOL assumes its default position or shape to allow clear distance vision. When you look at a closer object, the ciliary muscles contract and move or change the shape of the IOL.

The IOL assumes an appropriate position, or a more convex curve, with a shorter focal length. This accommodation brings the nearby object into sharper focus.

In this way, your accommodative IOL implant lets you see nearby objects clearly without compromising your distance vision.

Types of Accommodating IOLs

Various accommodating IOL designs achieve dynamic vision differently. Common types include:

• Single-optic accommodating IOLs
• Dual-optic accommodating IOLs
• Deformable surface accommodating IOLs  

Single-Optic Accommodating IOLs

Typical IOLs have two basic components — optics and haptics. An optic is the actual lens that provides focusing power. Haptics hold the optic in place and interact directly with the contracting or relaxing ciliary muscles in the eye.

A single-optic accommodating IOL has only one optic. The lens moves to provide near vision when eye muscles contract.

Dual-Optic Accommodating IOLs

A dual-optic accommodating IOL has two optics. One optic provides a fixed focusing distance, while the other changes dynamically.

When eye muscles contract, one of the optics moves forward, shifting the focus to nearby objects.

Deformable Surface Accommodating IOLs  

Deformable accommodating IOLs are shape-changing lens implants. They assume a convex shape when the ciliary muscles contract, providing sharper near vision.  

Who Is a Candidate to Receive Accommodating IOLs?

You must be an eligible candidate for cataract surgery to receive accommodating IOLs, but there are other factors that qualify people who can get them.

Consider getting an accommodating IOL implant if:

• You require a higher vision range without spectacles
• You have not had too many vision correction surgeries on the eye with cloudy vision
• You do not have eye diseases like glaucoma (optic nerve damage)
• Your eyes’ ciliary muscles are in good shape

The lenses can impact your vision in different ways. Before surgery, discuss possible outcomes and any unique vision needs with your eye surgeon.

Advantages of IOLs

Accommodating IOLs offer the following vision benefits:

• Most people achieve sharp distance vision and better near vision with these IOLs.
• Reduced dependency on glasses when performing near-vision activities like reading.
• You gain a lower risk of side-effects, such as halos and glare.

Risk and Potential Complications

While accommodating IOLs can adjust appropriately to your vision requirements, they can pose several risks. These include:

• Vision range can decline with time
• You may need reading glasses even with accommodating IOLs
• Scar tissue may form in the eye after surgery, causing blurry vision
• You may need laser surgery to remove the scar tissue

Costs

Without insurance, laser cataract surgery with non-standard IOLs might cost between $4,000 and $6,000 per eye.

Is Accommodating IOL Procedures Covered by Insurance?

Medicare can cover laser-assisted cataract surgery and implantation of standard monofocal IOLs. If you have an accommodative IOL inserted in your eye, you’ll pay for any extra cost out-of-pocket.

Accommodating IOLs and multifocal IOLs are premium lenses that Medicare and most private carriers consider medically unnecessary. The average cost of these specialized lenses is roughly $3,000, although prices vary widely.  

FAQs

How do accommodating lenses work?

Accommodating IOLs move or change shape inside your eye to provide good distance vision and clearer near vision. They can reduce your dependency on reading glasses.

How much do IOLs cost?

The price of intraocular lenses varies by type. Premium lenses, such as accommodating IOLs and multifocal IOLs, may cost about $3,000 each.

The cost of IOLs plus laser-assisted cataract surgery lies between $4,000 and $6,000.

References

1. Clinical Application of Accommodating Intraocular Lens. (June 2018). International Journal of Ophthalmology.

2. IOL Implants: Lens Replacement After Cataracts. (April 2021). American Academy of Ophthalmology.

3. Four Steps to Make Premium IOLs Worth the Cost. (March 2020). Review of Optometry.

4. Artificial Accommodating Intraocular Lens Powered by an Ion Polymer-Metal Composite Actuator. (June 2021). Plos One.

5. Cataract Surgery: Risks, Recovery, Costs. (September 2021). American Academy of Ophthalmology.

6. How Much Does Cataract Surgery Cost?. (April 2021). VeryWell Health.

7. Laser-Assisted Cataract Surgery and CMS Rulings 05-01 and 1536-R. (August 2020). U.S. Department of Health & Human Services.