Cataract surgery & premium IOLs
Lens selection, astigmatism and range of vision, by Gurpal Virdi, MD · San Francisco Bay Area, California
Medically reviewed by Gurpal Virdi, MD, refractive and cataract surgeon and ICL-sizing researcher · Last reviewed: 25 August 2026
A cataract is the gradual clouding of the eye's natural lens. Surgery removes it and implants an intraocular lens in its place, and it is one of the most commonly performed and most successful operations in medicine. Because the implanted lens is permanent, choosing it well is the part worth spending time on.
I'm a refractive and cataract surgeon trained in premium IOL selection, astigmatism management with toric lenses, and presbyopia-correcting implants. I also built and maintain IOL Reference, an intraocular lens database used by cataract surgeons worldwide, which grew directly out of how hard it is to compare lens platforms objectively.
How is an intraocular lens chosen?
Lens selection starts with measurement, not preference. Biometry establishes the eye's axial length and corneal power; topography characterises astigmatism and corneal regularity; the ocular surface is optimised first, because dry eye distorts every one of those measurements. Retinal health, pupil size, prior refractive surgery and how you actually use your vision then narrow the options. A patient who reads all day and one who drives at night are not well served by the same lens.
What is a premium or presbyopia-correcting IOL?
A standard monofocal IOL gives excellent optical quality at a single distance, usually distance vision, with reading glasses for near. Presbyopia-correcting lenses, including extended depth of focus (EDOF) and multifocal designs, extend the range of functional vision so glasses are needed less often. The trade is real: added range generally costs some contrast sensitivity and can introduce halo or glare at night. The lenses are excellent in well-selected eyes and disappointing in poorly selected ones, which is why candidacy matters more than marketing.
What is a toric IOL, and do I need one?
A toric IOL corrects corneal astigmatism at the time of surgery. Uncorrected astigmatism blurs vision at every distance, so leaving a meaningful amount untreated undercuts even the most advanced lens. Toric lenses must be aligned to a specific axis, so measurement accuracy and intraoperative alignment both matter to the final result.
What is a Light Adjustable Lens?
The Light Adjustable Lens (LAL) is unusual in that its power can be changed after it is implanted. Once the eye has healed, ultraviolet light treatments fine-tune the lens, and the result is then locked in. For eyes where prediction is harder, including those with prior LASIK, PRK or RK, being able to adjust after the fact rather than predict perfectly beforehand is a genuine advantage.
Is laser cataract surgery better than manual?
Femtosecond laser-assisted cataract surgery automates several steps that a surgeon otherwise performs by hand. It is a real technology with real uses, but the large comparative studies have not shown a decisive visual advantage over skilled manual surgery in routine cases. Lens selection and measurement accuracy influence your result considerably more than which platform opened the eye.
Cataract surgery in the San Francisco Bay Area
I completed ophthalmology residency at the University of Missouri, where I served as chief resident, and refractive surgery fellowship training at Parkhurst NuVision in San Antonio. I offer premium cataract surgery alongside EVO ICL, LASIK, PRK, SMILE and refractive lens exchange.
If you are researching cataract surgery in the Bay Area now, the questions worth asking any surgeon are the same ones I would ask: how do you measure the eye, how do you handle astigmatism, and how do you decide which lens goes in? For the ICL side of refractive surgery, see EVO ICL.
Does Medicare pay 100% for cataract surgery?
Not quite, and the distinction is the single most misunderstood thing about paying for cataract surgery.
What Medicare covers. Cataract surgery is medically necessary once the cataract affects your vision enough to meet the threshold, and Part B covers the surgeon's fee, the facility fee, and a standard monofocal intraocular lens. It also covers one pair of glasses or contact lenses after surgery, which is unusual, since Medicare does not otherwise cover eyewear.
What you still pay. The Part B deductible and then a 20% coinsurance on the Medicare-approved amount, unless you have supplemental coverage that picks it up. Medicare Advantage plans vary and have their own networks and cost-sharing.
What is not covered at all. Upgrades beyond the standard monofocal lens: toric lenses for astigmatism, extended depth of focus and multifocal lenses, and the Light Adjustable Lens. These are billed to you directly, as is femtosecond laser assistance when it is used for a refractive rather than a medical purpose. Practices should give you this figure in writing before surgery.
So the honest summary is that Medicare covers the operation and a basic lens. It does not cover the decisions that make it a refractive procedure. If you want a broader range of vision without glasses, that portion is out of pocket, and it is worth knowing that before you are asked to choose a lens on a consent form.
Common questions
Will I still need glasses after cataract surgery? With a monofocal lens, usually for reading. With presbyopia-correcting lenses, often much less, though independence from glasses is a goal rather than a guarantee.
Can cataracts come back? Not the cataract itself. The thin membrane holding the lens can cloud over months to years afterwards, which is treated with a brief in-office YAG laser procedure.
Can I have cataract surgery after LASIK? Yes, though prior corneal laser surgery makes lens power calculation harder. Specialised formulas and adjustable lens technology both help.
Is cataract surgery painful? It is performed with topical anaesthetic and light sedation, and most patients describe pressure and light rather than pain.
How do I compare specific lens models? IOL Reference is the database I built for exactly that purpose.
Educational information, not medical advice. Discuss your specific eyes with a qualified ophthalmologist.