Cataract surgery is among the most commonly performed surgical procedures worldwide and one of the most transformative for patients’ quality of life. When cataract causes the natural lens of the eye to become cloudy, it is replaced with an artificial intraocular lens (IOL). Choosing the right IOL is essential, as it can shape the clarity and quality of your vision for years to come.
Dr Naren Shetty, Director and Head of Cataract & Refractive Surgery at Narayana Nethralaya, has performed over 27,000 cataract and refractive surgeries. He offers the complete range of premium IOLs monofocal, toric, trifocal, and extended depth of focus (EDOF) and recommends the right lens after carefully evaluating your eye anatomy, lifestyle, and visual goals.
Phacoemulsification - Modern Cataract Surgery
Modern cataract surgery uses phacoemulsification - ultrasound energy delivered through a 2- 3mm micro-incision to emulsify and aspirate the cloudy lens. The IOL is then injected through the same incision in a folded state and self-unfolds inside the eye. No stitches, no patch overnight.
Pre-operative biometry
Advanced technologies such as the IOLMaster 700, Argos, and Pentacam were utilized to assess essential biometric parameters, including axial length, keratometry, anterior chamber depth, and anterior segment characteristics, enabling precise IOL power calculation for your eye.
Topical anaesthesia
Anaesthetic drops numb the eye. No injection around the eye, no general anaesthesia. You remain awake and comfortable.
Micro-incision (2- 3mm)
A self-sealing corneal incision is made at the periphery, avoiding any blade contact with the visual axis.
Capsulorrhexis
A precise circular opening is made in the lens capsule to ensure that the lens remains accurately centered and well oriented. This is the most skill-dependent step of the procedure.
Phacoemulsification
Ultrasound energy fragments the cloudy lens nucleus into tiny pieces, which are aspirated through the same probe. The lens capsule (bag) is preserved.
IOL implantation
The premium IOL is injected in a folded state through the micro-incision. It self-unfolds and is centred within the capsular bag.
Post-operative care
Medicated drops for 4- 6 weeks. Vision improves rapidly from Day 1. Full stabilisation in 4- 6 weeks.
Femtosecond Laser-Assisted Cataract Surgery (FLACS)
The most advanced cataract surgery technique uses a femtosecond laser to automate the most critical and difficult steps - resulting in greater precision and potentially better outcomes, especially with premium IOLs where centration and capsulorrhexis accuracy are critical.
Laser Capsulorrhexis
The circular opening in the lens capsule is made with laser precision - perfectly centred and perfectly round. Manual capsulorrhexis is technique-dependent; laser eliminates variability.
Laser Lens Fragmentation
The laser pre-softens and fragments the cataract nucleus before phaco, reducing the ultrasound energy needed and minimising collateral tissue stress.
Laser Corneal Incisions
All incisions including limbal relaxing incisions (for astigmatism) are made with sub-micron laser precision rather than a blade.
Better IOL Centration
Perfectly centred capsulorrhexis ensures premium multifocal and EDOF IOLs are optimally centred on the visual axis - critical for best optical performance.
Premium IOL Types - Which Is Right for You?
The IOL decision is the most important choice in cataract surgery. Here is a comprehensive breakdown of every lens category available at Narayana Nethralaya.
Monofocal IOL
Monofocal IOLs provide excellent clarity at a single focal point - usually distance. They offer the best contrast sensitivity and lowest risk of optical side effects. Reading glasses are usually still required for near tasks such as reading and mobile phone use.
Monofocal Plus / Enhanced Monofocal IOL
A newer category offering slightly extended depth of focus compared to standard monofocals, without the halos and glare risk of diffractive multifocals. A good intermediate option.
EDOF (Extended Depth of Focus) IOL
EDOF IOLs create an elongated focal range rather than discrete focal points. Excellent for distance and intermediate (computer screen) vision with significantly fewer halos than trifocal lenses. Near vision may require reading glasses in low light.
Trifocal IOL
Trifocal IOLs are available in both refractive and diffractive designs, allowing light to be focused simultaneously at three distances — far, intermediate, and near. Most patients achieve a high degree of spectacle independence for distance vision, computer work, and reading. The main trade-off is night-time halos, which are usually mild and tend to improve as the brain adapts over the following weeks.
Toric IOL
Toric IOLs have a cylindrical correction built into the lens optic, correcting corneal astigmatism that would otherwise blur distance vision. Available in monofocal, EDOF, and trifocal platforms. Rotational stability is critical - premium toric IOLs have <3° rotation.
How to Choose the Right IOL
Dr Naren Shetty's IOL selection process is based on four pillars:
Your Lifestyle & Visual Demands
Do you read extensively? Work on a computer all day? Drive at night frequently? A trifocal may suit a reader; an EDOF may suit a night driver.
Your Eye Anatomy
Corneal topography, pupil size, axial length, and angle kappa determine which IOL will perform best. Some patients are poor trifocal candidates due to large angle kappa.
Existing Conditions
Macular degeneration, glaucoma, or prior refractive surgery may limit premium IOL options. A monofocal may be safer in these cases.
Tolerance for Trade-offs
All premium IOLs involve thoughtful trade-offs. Trifocal lenses offer a high degree of spectacle independence, though mild night-time halos may occur. EDOF lenses provide cleaner optics with fewer visual disturbances, but reading glasses may still be needed for near tasks. Dr. Shetty discusses these differences transparently before surgery, helping each patient choose the lens that best aligns with their lifestyle and visual goals.
Frequently Asked Questions - Premium IOL Cataract Surgery
What is the difference between a standard and premium IOL?+
A standard monofocal IOL corrects vision at one distance (usually distance). Premium IOLs - trifocal, EDOF, toric - correct vision at multiple distances and/or correct astigmatism, significantly reducing or eliminating the need for glasses after surgery.
Will I need glasses after premium IOL surgery?+
Most trifocal IOL patients achieve complete spectacle independence. EDOF patients typically need reading glasses for very fine print. Monofocal patients need reading glasses. The result depends on the lens selected, your eye anatomy, and post-operative healing.
Are halos and glare common with trifocal IOLs?+
Mild halos at night are common initially with diffractive trifocal IOLs. Most patients neuroadapt within 4- 12 weeks. Modern trifocal designs (PanOptix, AT LISA tri) have significantly reduced halos compared to older multifocal designs.
Can I have cataract surgery if I've had LASIK before?+
Yes, but IOL power calculation is more complex after LASIK Surgery. Dr. Naren Shetty uses the ASCRS Post-LASIK IOL Calculator, advanced formulas such as Barrett Universal II and AI-based IOL calculations, together with intraoperative aberrometry, to optimize IOL power selection and minimize postoperative refractive error.
How soon can I drive after cataract surgery?+
Most patients can drive within 2- 5 days of surgery once vision stabilises. You should not drive until Dr Shetty has reviewed your vision post-operatively and confirmed it is safe.
Can cataracts come back after surgery?+
The cataract itself cannot return - the natural lens is permanently replaced. However, the lens capsule (bag) can sometimes become cloudy (posterior capsule opacification / PCO). This is treated with a quick, painless YAG laser procedure in clinic.
Is cataract surgery done on both eyes on the same day?+
At Narayana Nethralaya, cataract surgery is typically performed on one eye at a time, with the second eye done 1- 2 weeks later after confirming the first eye has healed well.