IOL design differences

We have many different IOL designs available for use in cataract surgery and even within the most popular category (single-piece, hydrophobic acrylic, aspheric monofocal IOLs) there are multiple choices. These IOLs often are more similar than different, but there are crucial differences that you must know to select the best IOL for each specific patient. There is no perfect IOL and don’t believe the sales agents who tell you that their lens is the best across the board. You must judge for yourself.

In this photo, where the two images have been placed at the same magnification, the overall optic diameter for both is 6 mm but the IOL on the left appears to have a null-zone in the periphery with a focusing optic of about 5 mm. Why? The answer to this, and much more, is revealed in the video below.

click to learn about IOL differences and why you should have access to all of them:


  1. Many of your videos speak to operating on the steep axis to decrease post op astigmatism. There has been considerable material written recently by the likes of Warren Hill and Doug Koch suggesting that the effect of a well constructed 2.4 mm wound is 0.10 diopters with a resulting recommendation that strategic placement of the primary incision is negligible. I am wondering if you have seen reproducible results or if it requires a 2.7 mm keratome

    1. In the videos where I mention placing the incision on the steep axis, a 2.75 or 2.8mm wide keratome is being used. And often this is paired with an opposite LRI (or full thickness phaco incision for further flattening effect). While many factors influence the surgically induced astigmatism, the effect from the 2.8mm incision is definite and measurable.

  2. Any comments or experience with the B&L enVista single piece acrylic IOL? Do you use it for patients that may benefit from an aberration neutral IOL?

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