Premium vs. Standard Intraocular Lenses: Are Premium IOLs Worth the Investment?
Cataract surgery is more than a procedure to remove a cloudy lens — it’s also an opportunity to choose how you’ll see for the rest of your life. One of the most important choices patients face is whether to go with a standard monofocal intraocular lens (IOL) or invest in a premium option like a multifocal, trifocal, EDOF (extended depth-of-focus) or toric IOL.
This guide breaks down the differences and benefits of each lens type, backed by scientific research, to help you answer the big question: Is A Premium IOL Worth the Investment?
What is a Standard Monofocal IOL?
A monofocal IOL is the default lens used in cataract surgery. It provides clear vision at one set distance — usually for far vision, which means you’ll need glasses for reading or using a computer. These lenses are usually covered by medical aids, making them a practical choice for budget-conscious patients.
Monofocal lenses have excellent optical clarity and are well-suited for patients who don’t mind wearing glasses for near work.
What Are Premium IOLs?
Premium IOLs are designed to expand your range of vision beyond what monofocals can offer — and in many cases, they can reduce or even eliminate your need for glasses.
There are several types of premium lenses:
1. Multifocal/Trifocal IOLs
Multifocal lenses split light into multiple focal points to give you near and distance vision. This helps you to read a book, use a computer and see in the distance without glasses. This splitting of light does cause some problems such as glare and haloes, especially at night time. Multifocal IOLs also perform poorly under low-light conditions such as a dimly lit restaurant.
A recent meta-analysis showed that multifocal IOLS gave better uncorrected near vision, a greater proportion of spectacle independence, but more haloes and glare compared to monofocal IOLs (PMID: 30627791).
2. Extended Depth-of-Focus (EDOF) IOLs
EDOF lenses provide a continuous range of vision from far to intermediate, and even partial near vision, without distinct focal zones. They’re a great option for patients who want reduced spectacle dependence but are sensitive to halos or glare.
A meta-analysis by Liu et al found that EDOF lenses gave better intermediate and near vision compared to monofocal IOLs and better contrast sensitivity compared to trifocal IOLs. however, the incidence of haloes were similar to trifocal IOLs (PMID: 31477053).
3. Toric IOLs
Toric lenses correct astigmatism — a common cause of blurred vision. If you have moderate or high corneal astigmatism, a toric IOL can significantly improve your uncorrected distance vision and reduce the need for glasses (PMID: 26601819).
Toric IOLs are available in both monofocal and premium presbyopia-correcting designs.
Multifocal vs Monofocal IOLs: What Does the Research Show?
Several clinical trials and meta-analyses support the benefits of premium lenses:
Multifocal IOLs outperform monofocals in near and intermediate vision (1–3,10).
Spectacle independence is far more likely with multifocal lenses (5).
Toric IOLs significantly reduce residual astigmatism and improve unaided distance vision (9).
Are Premium IOLs Worth the Cost?
Premium lenses aren’t typically covered by medical aid. The additional cost can range from R7 500 to R20 000 per eye, depending on the lens.
Whether they’re “worth it” depends on:
Your lifestyle – Do you read a lot? Use a computer daily? Drive at night?
Your tolerance for glasses – Hate wearing them? You’ll likely enjoy a premium lens.
Your budget – Can you comfortably afford the out-of-pocket expense?
Your eye health – Premium lenses work best in completely healthy eyes.
At Constantia Eye Clinic, we help patients weigh the cost-benefit balance in a personalized consultation.
Who Should Consider a Premium IOL?
A premium IOL might be right for you if:
You want to minimize or eliminate glasses.
You have an active lifestyle or drive at night.
You have significant astigmatism.
Your eyes are otherwise healthy.
You’re comfortable with the cost and aware of possible visual trade-offs.
You might want to stick with a monofocal if:
You’re on a tighter budget.
You don’t mind wearing glasses for near vision.
You have eye conditions that affect visual quality.
There’s No Perfect Lens: Understanding the Trade-Offs
While premium lenses offer remarkable advances in vision correction, it's important to acknowledge a fundamental truth: there is no perfect solution for presbyopia. Every intraocular lens design involves trade-offs between visual range, contrast, and optical clarity. Knowing this can help patients set realistic expectations and make more informed choices.
Multifocal and trifocal IOLs can significantly reduce your dependence on glasses, but they achieve this by splitting incoming light into multiple focal points. This design, while effective for extending visual range, can reduce contrast sensitivity, especially in low-light environments. By comparison, monofocal lenses offer the highest contrast sensitivity and the clearest image quality under all lighting conditions — making them the most predictable and reliable option for most patients.
Multifocal and EDOF lenses also tend to be more sensitive to underlying or concurrent eye conditions, such as:
Dry eye disease – which can degrade image quality and increase visual disturbances.
Vitreous floaters – which may be more noticeable with multifocal optics.
Macular degeneration or diabetic retinopathy – which can impair central vision and compromise the full benefit of a presbyopia-correcting lens.
For these reasons, multifocal lenses are best suited for patients with healthy eyes, stable tear film, and a strong desire to minimize glasses use, while those with ocular surface issues or retinal conditions may be better served by a monofocal IOL — or a hybrid approach like blended vision.
Ultimately, the best outcomes are achieved when the lens choice is tailored to your individual anatomy, visual priorities and tolerance for optical imperfections. Our team at Constantia Eye Clinic works closely with each patient to ensure these nuances are fully understood before surgery
Conclusion
Premium IOLs can be a life-changing upgrade for patients seeking freedom from glasses. They correct presbyopia, astigmatism, and offer a broader range of vision than standard lenses.
While they do cost more, studies have shown that patient satisfaction and quality of life improve significantly with the right premium IOL.
At Constantia Eye Clinic, we’re committed to helping you choose the lens that matches your lifestyle, eyes and expectations. Whether that’s a cutting-edge multifocal or a tried-and-tested monofocal, our goal is clear: to give you the best possible vision for life.
References
Khandelwal SS, Jun JJ, Ravilla T, et al. Effectiveness of multifocal and monofocal intraocular lenses: A systematic review and meta-analysis. Graefes Arch Clin Exp Ophthalmol. 2019;257(4):621–633.
Cochener B, Boutillier G, Lamard M, et al. Comparison of outcomes with multifocal intraocular lenses: a multicenter clinical study. J Refract Surg. 2011;27(11):753–760.
Zhang Z, Wang Y, Liu X, et al. Comparative efficacy of trifocal versus bifocal intraocular lenses: a systematic review and meta-analysis. Eye (Lond). 2021;35(11):3119–3130.
Zhong Y, Gu X, Chen H, et al. Comparison of trifocal or hybrid multifocal-extended depth optical IOLs: A systematic review and meta-analysis. Sci Rep. 2021;11:8622.
VA Evidence Synthesis Program. Comparative Effectiveness of Multifocal vs Monofocal IOLs. U.S. Department of Veterans Affairs; 2017.
Shen Z, Lin Y, Zhu Y, et al. Intermediate visual acuity is better with trifocal than bifocal intraocular lenses without compromising distance or near visual acuity: A meta-analysis. Sci Rep. 2017;7:45337.
Böhm M. Evaluating the EDOF Effect. EuroTimes. 2024. Available from: https://www.escrs.org/channels/eurotimes-articles/evaluating-the-edof-effect/
Kanclerz P, Grzybowski A. Extended Depth-of-Field Intraocular Lenses: An Update. J Clin Med. 2020;9(9):2847.
Kessel L, Andresen J, Erngaard D, et al. Toric Intraocular Lenses in the Correction of Astigmatism: A Systematic Review and Meta-analysis. Ophthalmology. 2016;123(2):275–286.
Park ESY, Lee H, Kim M, et al. Visual outcomes and spectacle independence after monofocal versus multifocal IOLs. Sci Rep. 2022;12:26315.
Yamauchi T, Takahashi H, Abe T, et al. Comparative visual performance of monofocal and multifocal intraocular lenses. Sci Rep. 2024;14:25451.
