Intraocular Lenses in Switzerland: Choosing the Right Implant

An intraocular lens is a small optical implant placed inside the eye to replace or complement the crystalline lens. It is one of the most commonly implanted medical devices in the world: every cataract operation ends with the placement of an implant. But intraocular lenses are also used to correct high myopia, hyperopia, astigmatism and presbyopia in patients whose lens is still clear. Monofocal, multifocal, extended depth of focus, toric, phakic implants placed in front of the lens: the choice is wide, and it determines the quality of vision for decades. This page explains how these implants work, who they are for, how to choose them, how the assessment, procedure and recovery work, what the risks are, what Swiss insurance covers and where to consult in the 26 cantons.

There are two main families of intraocular lenses. Implants placed after the lens has been removed, during cataract surgery or clear lens exchange, permanently replace the eye's natural lens. Phakic implants, placed without removing the lens, correct high refractive errors in younger patients when laser is not suitable. The procedure takes fifteen to thirty minutes per eye, under anaesthetic drops, as day surgery. Basic insurance covers cataract surgery with a standard implant; so-called premium implants and refractive surgery are at the patient's expense. Budget guidelines in percentages on our page on intraocular lens prices in Switzerland.

An intraocular lens, or intraocular implant, is a tiny lens with an optic about six millimetres in diameter, extended by flexible haptics or a plate that hold it in place in the eye. It is made of a transparent, biocompatible material, usually a soft acrylic that folds to pass through an incision of two to three millimetres, then unfolds inside the eye.

Its power, expressed in dioptres, is calculated for each eye so that the image forms exactly on the retina. Once in place, it cannot be felt, requires no maintenance and is designed to last a lifetime. Unlike a contact lens, it is not removed every evening and does not touch the surface of the eye.

To understand the role of an implant, you need to know the eye's two natural lenses. The cornea, a transparent dome at the front of the eye, provides about two thirds of the optical power. The crystalline lens, behind the iris, provides the remaining third and above all the focusing: thanks to a muscle that changes its curvature, it allows the eye to switch from distance to near vision. This is accommodation.

When the total power of the eye does not match its length, the image forms in front of the retina — myopia — or behind it — hyperopia. When the cornea is more curved along one axis than the other, the image is distorted: this is astigmatism. An intraocular implant can correct these three errors while replacing a clouded lens.

Your glasses prescription contains most of the information the surgeon starts from. Knowing how to read it helps you follow the discussion about choosing the implant.

The prescription is not enough to calculate an implant: biometry provides the length of the eye and the shape of the cornea. But an old prescription shows how your eyesight has changed, which is useful for knowing whether myopia is stable before a phakic implant, or whether recent myopia indicates an early cataract.

The lens ages in two stages. From your forties, it hardens and loses its flexibility: accommodation decreases, and reading close up becomes difficult. This is presbyopia, which affects everyone. Later, generally after sixty, the lens gradually clouds: vision becomes blurred, colours dull, glare troublesome. This is cataract.

These two phenomena explain the two main moments when implants are discussed. Cataract requires the lens to be removed and replaced; the implant is then used to correct myopia, hyperopia or astigmatism, and possibly presbyopia. Between forty-five and sixty, some people choose to replace a still-clear lens to be free of glasses: this is clear lens exchange, a refractive procedure. Our page on cataract surgery in Switzerland covers the disease itself in detail.

Cataract is not reserved for older people. It can appear earlier in people with diabetes, after long-term corticosteroid treatment, after an eye injury, in highly short-sighted people or with an eye disease such as uveitis. It sometimes shows as rapidly increasing myopia, blurred vision in one eye or marked glare.

In young adults, the choice of implant is particularly important, as the patient will live with it for a very long time. The operated eye loses its accommodation, while the other eye may still retain it; this imbalance is discussed, and an extended depth-of-focus implant or a suitable strategy may be proposed. Cataract surgery remains covered by basic insurance when it is medically indicated.

A violent blow to the eye, from a squash ball, a bottle cork, a branch or a punch, can cause a cataract, sometimes years later, as well as fragility of the lens supports. The operation is then more delicate and may require capsule support devices or an implant fixed differently.

The best prevention remains wearing protective glasses in high-risk sports — squash, badminton, ice hockey, floorball, paintball — and for gardening and DIY. After an implant has been fitted, this precaution remains valid.

After cataract surgery, many patients describe rediscovering the world. The clouded, yellowed lens acted like a brown filter that dulled colours and scattered light. Once replaced by a clear implant, whites look whiter, blues more intense and contrast sharper. Some even feel that their home needs repainting.

Sensitivity to light is often greater in the first few weeks, as the eye receives more light than before. Sunglasses outdoors and indirect lighting at home make this period more comfortable. Night glare caused by the cataract, which hindered driving, usually disappears with a monofocal implant. When only one eye has been operated on, the difference in tint between the two eyes can be surprising; it fades after the operation on the second.

The idea arose from an observation during the Second World War. The British ophthalmologist Harold Ridley noticed that fragments of Perspex lodged in the eyes of injured pilots were remarkably well tolerated. He concluded that this material could be used to make an artificial lens, and implanted the first intraocular lens in 1949, after cataract surgery.

The early days were difficult, with heavy implants and frequent complications. The following decades brought soft foldable implants, small incisions, ultrasound phacoemulsification, then toric and multifocal implants. Phakic implants, placed without removing the lens, developed from the 1990s. Today, cataract surgery with an implant is one of the most common and safest procedures in medicine, and Switzerland performs tens of thousands every year.

The word pseudophakic means that the eye no longer has its natural lens but an implant that takes its place. The word phakic means that the eye has kept its natural lens. This distinction shapes everything else: indications, ages, risks and coverage are not the same.

The monofocal implant

It offers clear vision at a single distance, chosen in advance, usually distance vision. Glasses are still needed for reading. It is the reference implant, the one that offers the best quality of vision and the fewest light effects. It is also the one covered by basic insurance for cataract surgery.

The enhanced monofocal

Some monofocal implants have slightly modified optics that extend intermediate vision a little, useful for a dashboard or a screen, without markedly increasing halos.

The extended depth-of-focus implant

Also called EDOF, it stretches the range of sharp vision from distance to intermediate, at computer distance. Near vision often needs to be supplemented with light glasses. Light effects are moderate.

The multifocal or trifocal implant

It divides light between several focal points to provide distance, intermediate and near vision. It allows many patients to do without glasses day to day. In return, it can cause halos around lights at night and a slight loss of contrast, to which the brain adapts within a few months in most patients.

The toric implant

It corrects corneal astigmatism. It exists in monofocal, extended depth-of-focus or multifocal versions. It must be oriented along a precise axis during the procedure.

The light-adjustable implant

Its power can be modified after the procedure by sessions of exposure to ultraviolet light, until the desired correction is obtained. It requires wearing protective glasses during the adjustment period and remains uncommon.

The ideal implant would reproduce the lens of a young adult: it would change power to switch from distance to near, without halos or loss of contrast. So-called accommodating implants have been designed to move slightly in the eye under the action of the focusing muscle. In practice, their range remains small and variable from one patient to another, and they have not replaced multifocal or extended depth-of-focus implants.

Research continues, with fluid-filled implants, optics that change shape or implants whose power can be modified after the procedure. Some could arrive in the coming years. It is not advisable, however, to delay necessary cataract surgery while waiting for future technology: the implant fitted today can, if needed, be supplemented later with an additional implant.

No implant is better in absolute terms. The right choice depends on how you use your eyes, your tolerance of light effects, the condition of your eyes and how independent of glasses you want to be. A frequent night driver does not have the same priorities as a keen reader or someone who works at a screen all day.

Vision is often summed up as acuity, measured by reading smaller and smaller letters on a chart. But quality of vision also depends on contrast sensitivity, which allows you to distinguish a grey pavement on a grey road or a face in dim light, and on night vision, which is sensitive to halos and glare.

A patient can read every letter on the chart and complain of less comfortable vision in the evening. Conversely, another may have slightly lower acuity and very pleasant vision day to day. Discussing these dimensions with the surgeon helps you choose the implant according to what matters most to you.

Monovision involves setting one eye, generally the dominant one, for distance vision, and the other for intermediate or near vision, with monofocal implants. The brain naturally uses the eye best suited to each distance. This strategy avoids the light effects of multifocal implants, but slightly reduces depth perception and the sharpness of each eye taken alone.

It particularly suits people who have already tried it with contact lenses and adapted well. A contact lens simulation before the procedure is often offered. A milder version, mini-monovision, with a smaller difference between the two eyes, gives good intermediate vision with few drawbacks.

Before choosing monovision with implants, you are often offered a trial with contact lenses for a few days: one lens corrects one eye for distance, the other for reading or screen distance. This simple test shows whether your brain adapts well to this difference between the eyes. Some people get used to it within a few hours; others feel unbalanced or have difficulty driving.

Use the trial to go about your usual activities: driving by day, reading, screen work, cooking, sport. If the trial is conclusive, monovision is a reliable option without the halos of multifocals. If it is not, mini-monovision with a smaller difference, or another type of implant, can be discussed.

Most modern implants are made of hydrophobic acrylic, a flexible, stable and well-tolerated material associated with a low rate of posterior capsule opacification. Hydrophilic acrylics and silicone are also used. Some implants have a filter that reduces blue light; their benefit in protecting the retina is still debated. Aspheric implants correct part of the cornea's optical aberrations and improve contrast, particularly in low light.

The design of the optic's edges, square and sharp on most current implants, slows the migration of the cells that cause posterior capsule opacification. The shape of the haptics determines the implant's stability in the capsular bag, an important point for toric implants, which must stay on the right axis.

Before the procedure, the surgeon asks at what distance you want to see without glasses. This choice is as important as the choice of implant. Aiming for emmetropia — clear distance vision without correction — is the most common choice. Some long-standing short-sighted people prefer to keep slight myopia that allows them to read without glasses, as they always have. Others choose monovision.

• What do you do most often: driving, reading, screen work, DIY, gardening?
• Do you mind wearing glasses for certain activities?
• Do you often drive at night?
• Have you already worn contact lenses in monovision?
• Are you bothered by reflections and halos?

Your answers guide the target and the type of implant. The two eyes are generally planned together, even if they are operated on a few days or weeks apart.

Astigmatism is a difference in curvature of the cornea between two axes, like a spoon rather than a marble. It distorts images at all distances. Slight astigmatism is very common and causes little trouble; above a certain value, it markedly degrades uncorrected vision.

A toric implant must stay on its axis: a rotation of a few degrees reduces its effectiveness. Current implants are very stable, but if rotation occurs in the first few days, prompt repositioning is possible. Multifocals tolerate residual astigmatism poorly, hence the importance of correcting it carefully when choosing this type of implant.

Very long eyes, those of highly short-sighted people, pose particular challenges: a thinner, more fragile retina, an increased risk of detachment, a sometimes looser capsule. The surgeon carefully examines the periphery of the retina, sometimes treats fragile areas by laser before the procedure, and stresses the warning signs. Phakic implants allow younger people to have their myopia corrected without touching the lens.

Very short eyes, those of highly long-sighted people, have a narrow anterior chamber that can carry a risk of angle-closure glaucoma. In these patients, lens exchange sometimes has a double benefit: correcting vision and widening the space in the eye, which reduces this risk. Implant calculation is more delicate, and specific formulas are used.

Phakic implants are placed without removing the lens. They work like a contact lens placed inside the eye, permanently but reversibly. They are mainly for young people, whose lens is still flexible and provides accommodation, and whose myopia, hyperopia or astigmatism are too high, or whose cornea is too thin, for laser surgery.

The posterior chamber implant

The most widely used is a soft implant made of collagen copolymer, slipped behind the iris, just in front of the lens, without touching it. Recent versions have a small central opening that lets the aqueous humour circulate, which usually avoids having to make a small hole in the iris beforehand. It is invisible from the outside.

The iris-clipped implant

Less often used today, it is fixed in front of the iris by two small clips. It suits certain anatomies and can sometimes be seen close up under certain lighting.

Toric versions

Both types of implant exist in toric versions to correct associated astigmatism.

These guidelines vary between manufacturers and surgeons. The pre-operative assessment measures each parameter precisely, and the implant is often manufactured or selected to measure for your eye, which requires a few weeks.

To correct myopia, laser remains the first option for most patients. A phakic implant becomes worthwhile in several situations: high myopia beyond what laser can safely correct, a cornea that is too thin or irregular, significant dry eye that laser could worsen, or a wish for a reversible solution.

The choice is made after a complete assessment. Our page on LASIK in Switzerland presents the laser techniques.

Clear lens exchange, sometimes called refractive lens surgery, involves removing a still-transparent lens and replacing it with an implant, as in cataract surgery, but before the cataract appears. The aim is to correct both the refractive error and presbyopia, by choosing a multifocal or extended depth-of-focus implant or monovision.

This procedure is mainly for people over about fifty, presbyopic, often long-sighted, in whom laser gives less lasting results and who will develop a cataract in any case. It avoids a second procedure later. In highly short-sighted people, lens exchange increases the risk of retinal detachment, and the decision is made with caution, after a careful examination of the retina.

A phakic implant remains in an eye that keeps its natural lens, its corneal cells and its fluid dynamics. Regular follow-up, at least once a year, is therefore advised for as long as the implant remains in place. It includes measuring vision and eye pressure, examining the position of the implant relative to the natural lens and, often, counting corneal cells.

With age, the natural lens thickens and may move closer to the implant. When a cataract appears, generally at a similar age to the general population, the phakic implant is removed during cataract surgery and a conventional implant is fitted. The correction of the myopia is then built into the calculation of the new implant. This scenario is planned from the outset and does not call into question the value of the phakic implant during the years it was worn.

An intraocular lens can be proposed at any adult age, for different indications. The ideal candidate has eyes that are healthy apart from the error to be corrected, realistic expectations and a good understanding of the trade-offs of each implant. The condition of the eye surface, cornea, macula and optic nerve determines the choice: a multifocal implant is not advised with macular disease, advanced glaucoma or severe untreated dry eye.

For a cataract, there is no universal threshold. Surgery is performed when loss of vision interferes with daily activities — reading, driving, recognising faces, work, leisure — or when glare becomes troublesome. Waiting too long brings no benefit: a very advanced cataract makes the procedure more delicate and needlessly deprives you of good vision, with an increased risk of falling in older people.

For refractive surgery, there is no urgency: the decision can mature while you have an assessment, compare options and put the budget together. In young short-sighted people, you must wait until the myopia is stable. In presbyopic people, lens exchange is often discussed when glasses become a real constraint or an early cataract appears.

For drivers, a loss of vision that no longer meets the legal visual requirements is a clear reason to operate. Your ophthalmologist will tell you whether your vision remains sufficient to drive while waiting for the operation.

Cataracts are now operated on in patients aged ninety and over. The procedure, short and under anaesthetic drops, is generally well tolerated. It can greatly improve independence: reading, watching television, recognising faces, moving around without falling. Better vision reduces the risk of falling, one of the main causes of loss of independence in older people.

In these patients, simplicity is key: a monofocal implant, a target for distance or slight myopia according to habits, suitable arrangements for the drops, often with the help of a relative or a home care service. Difficulty lying still, dementia or tremors are discussed with the team, which can adapt the anaesthesia.

Glaucoma

Cataract surgery can even lower eye pressure slightly in some patients. The choice of implant takes the glaucoma into account: multifocals are generally avoided in advanced forms, as they reduce contrast and complicate interpretation of the visual field. In some cases, glaucoma surgery can be combined.

Macular degeneration

The macula, the centre of the retina, provides fine vision. When it is affected, a monofocal implant is preferred. Cataract surgery can improve vision if the cloudy lens contributed to the problem, but it does not slow the disease, whose treatment continues.

Diabetic retinopathy

It must be stabilised before the procedure, often by laser or injections. The risk of macular oedema after the operation is higher, hence prolonged anti-inflammatory drops and close follow-up.

History of uveitis

Eye inflammation must have been calm for several months before the procedure. The choice of implant material and intensified anti-inflammatory treatment reduce the risk of recurrence.

Dry eye is very common, especially after fifty, in contact lens wearers and in people who work at screens. It has two consequences for an implant. Before the procedure, it makes corneal measurements unstable, which can skew the calculation. After the procedure, it is often temporarily worsened by the incisions and drops, and it blurs vision, especially with a multifocal implant.

That is why the assessment often includes an examination of the eye surface, and prior treatment with artificial tears, eyelid care or other treatments may be proposed a few weeks before the measurements. After the procedure, preservative-free artificial tears make recovery more comfortable. Vision that fluctuates during the day and improves when you blink is very often linked to dryness, not to the implant.

Pierre, 72, cataract

Retired, a keen reader, rarely drives at night. He chooses monofocal implants set for distance and keeps reading glasses, a solution fully covered by basic insurance, apart from the deductible.

Anne, 66, cataract and astigmatism

Her astigmatism would leave her vision blurred even with a standard implant. She opts for toric monofocal implants and no longer wears glasses for driving.

Marc, 58, long-sighted and presbyopic

He has worn glasses for everything for ten years. After an assessment with no contraindication, he chooses clear lens exchange with trifocal implants and accepts a period of adaptation to halos.

Julie, 31, high myopia

Her cornea is too thin for laser. She receives posterior chamber phakic implants, fitted a week apart, and keeps her accommodation.

Hans, 63, coach driver

He drives a lot at night. The surgeon advises against trifocals and proposes enhanced monofocal implants, with light glasses for reading.

Claire, 54, previously had laser surgery

Short-sighted and treated by laser twenty years ago, she develops an early cataract. Thanks to her old measurements, the implant calculation is reliable; she chooses mini-monovision.

"The implant has to be changed every ten years"

False. An implant is designed to last a lifetime and does not wear out.

"The cataract can come back"

False. The removed lens does not grow back. What is called a secondary cataract is clouding of the capsule, treated in a few minutes by laser.

"With a multifocal, you never wear glasses again"

Not always. Many patients do without day to day, but some keep glasses for prolonged reading in low light or for night driving.

"Phakic implants are reserved for extreme cases"

False. They are proposed whenever laser is less suitable, which also concerns moderate myopia with a thin or dry cornea.

"You have to wait until the cataract is ripe"

False. Surgery is performed when the visual difficulty justifies it, without waiting for complete clouding, which also makes the procedure simpler.

"The operation is painful"

False. Under anaesthetic drops, most patients feel only slight pressure.

An implant does not give you the eye of a twenty-year-old. It replaces an optical function, not the quality of the retina or optic nerve. If macular disease, glaucoma or old amblyopia already limit vision, the implant cannot exceed these limits. With a multifocal implant, the vision obtained is very functional at all distances, but it involves trade-offs, particularly at night.

It is useful to set concrete goals rather than an ideal: reading a menu without glasses, driving by day without correction, working comfortably at a screen. These goals help the surgeon choose the implant and help you judge the result.

• It does not treat a disease of the retina or optic nerve.
• It does not eliminate dry eye.
• It does not prevent capsule opacification, which is treated by laser.
• It does not correct a squint.
• It does not guarantee perfect vision at all distances, day and night.
• It does not restore the accommodation of a young eye.

Professional drivers

Bus, taxi and lorry drivers, train drivers: night vision quality and the absence of halos come first. Monofocals or extended depth-of-focus implants are often preferred to trifocals. The visual requirements specific to these professions must be checked with the ophthalmologist and, where appropriate, the occupational physician.

Visual professions

Graphic designers, photographers, retouchers and architects need high contrast and precise intermediate vision. A monofocal or an extended depth-of-focus implant in mini-monovision is often appreciated.

Precision trades

Watchmakers, jewellers, dentists and surgeons work very close up, often with magnifying loupes. Perfectly stable near vision is essential; some choose a monofocal set for their working distance.

Screen-based jobs

Office workers, IT specialists and accountants spend the day at a screen. Intermediate vision is the priority, which points towards implants that improve it.

Musicians

Reading a score on a music stand happens at an intermediate distance, often under stage lighting. These particular conditions deserve to be described to the surgeon.

Leisure activities matter as much as work when choosing an implant. A golfer wants to follow the ball in the distance and read the scorecard; a hiker needs good contrast vision on the trail and comfortable map reading; someone who sews or embroiders works very close up. Amateur astronomers and night drivers are more sensitive to halos. Skiers and mountaineers, exposed to intense light, appreciate an implant with good contrast and well-fitted glacier glasses.

Listing your favourite activities and the distance at which they take place is one of the most useful exercises before the consultation. The surgeon can then explain, activity by activity, what each implant will offer you and where glasses will still be useful.

Choosing the implant before the examination

Arriving at the consultation with a specific implant in mind, seen in an advertisement, can lead to a contraindication being overlooked.

Underestimating night driving

The halos of a trifocal are more troublesome for those who drive a lot at night.

Forgetting dryness

A dry eye surface degrades vision with any implant, and even more so with a multifocal.

Neglecting intermediate vision

Screens take up a large part of the day; a monofocal set for distance often means wearing office glasses.

Aiming for perfection

An implant does not guarantee perfect vision at all distances, day and night.

1. Describe your needs

List your activities, the distances that matter to you and your attitude towards glasses.

2. Have a complete assessment

The measurements determine which implants are possible for your eyes.

3. Understand the trade-offs

Quality of vision, independence from glasses, light effects, cost: no implant maximises everything.

4. Choose the target

Distance, monovision, slight myopia: the target matters as much as the implant.

5. Get organised

Dates for both eyes, drops, someone to accompany you, time off work, check-ups.

• Do glasses really bother me, or only for certain activities?
• Am I prepared to accept halos at night so as to stop wearing reading glasses?
• Do I have eye diseases that limit the benefit of a premium implant?
• What budget am I prepared to spend on the non-reimbursed part?
• Am I prepared to wait a few months for adaptation?

The result of an implant depends largely on the quality of the measurements. The assessment often takes one to two hours and includes several painless tests. If you wear contact lenses, you must remove them several days beforehand, or even two to three weeks for rigid lenses, as they temporarily distort the cornea.

Calculating the implant power relies on sophisticated mathematical formulas that incorporate the measurements of your eye. Recent formulas achieve great precision, but a small residual error remains possible, particularly in very short or very long eyes or eyes that have had laser surgery. If you have had refractive surgery, bring your old measurements if possible: they help a great deal.

Choosing the right implant power amounts to predicting where the implant will sit in the eye after healing, and how light will focus there. The first formulas, which were simple, used only the length of the eye and the curvature of the cornea. Modern formulas incorporate more measurements, such as anterior chamber depth, lens thickness or corneal diameter, and sometimes draw on large databases of results.

In the vast majority of cases, the result is within half a dioptre of the target, an error that goes unnoticed or is easily corrected. Patients with atypical eyes should nevertheless know that a supplementary correction is slightly more likely.

Your lifestyle

The surgeon asks about your activities, your screen use, night driving, your leisure activities and your attitude towards glasses.

Your medical history

General diseases, diabetes, treatments, previous eye surgery, dryness, allergies.

Examination and assessment

Slit-lamp examination, then additional tests, sometimes at a separate visit.

The proposal

Type of implant, target vision, order of and interval between the two eyes, expected results and limitations.

The quote

For a cataract with a standard implant, insurance covers most of the cost; for a premium implant or refractive surgery, you are given a detailed quote.

Reflection

Take the time to compare the options. A decision about a multifocal or phakic implant is not made in a hurry.

• Your latest glasses prescription and, if possible, an older one.
• Reports of any eye surgery, particularly refractive laser.
• The results of your last eye examination, if you have them.
• The list of your treatments and general conditions.
• A few lines about your visual activities and what you want regarding glasses.

This information allows an informed first opinion. The final choice of implant will always require a complete assessment at a consultation.

• Which implant do you recommend for me, and why not another?
• What target vision do you propose for each eye?
• Do my eyes have a particular feature that limits the choice: dryness, macula, glaucoma, previous laser?
• What precision can I expect from the implant calculation?
• What happens if the refractive result is not as planned?
• How many multifocal or phakic implants do you fit each year?
• What interval between the two eyes?
• What part of the quote is reimbursed, and what part remains at my expense?

A good surgeon presents the trade-offs of each implant without systematically steering you towards the most expensive, and tells you clearly if a premium implant does not seem suitable for your eyes.

A second opinion is particularly useful if you are offered a multifocal implant while you drive a lot at night, clear lens exchange while you are highly short-sighted, or if you are hesitating between a phakic implant and laser. The assessment measurements can often be passed on to the second ophthalmologist, which avoids repeating everything. Two concurring opinions are reassuring; two different opinions deserve to be compared, asking each surgeon to explain their reasoning.

Before the procedure, you sign a document specifying the chosen implant, the target vision, the alternatives, the risks and the limitations. For a premium or phakic implant, it mentions in particular the light effects, the possibility of a supplementary correction and the financial share at your expense. Read it carefully at home, check that the implant and target match what was discussed for each eye, and ask your questions before signing.

Intraocular lenses are fitted by ophthalmologists holding a specialist title in ophthalmology, and more precisely by those who perform anterior segment surgery. Cataract surgery is performed in cantonal and university hospitals, private eye clinics and outpatient centres. Phakic and premium implants are mainly offered in centres specialising in refractive surgery.

Check the practitioner's title in the federal MedReg register. For a multifocal or phakic implant, ask how many of these the surgeon fits each year, which implants they use and why, and how they handle any dissatisfaction.

The ophthalmologist is not alone in your care pathway. The optician adapts your glasses after the procedure, and is often the first to notice a loss of vision linked to an early cataract, when no lens corrects it any longer. In many practices, the orthoptist carries out some of the assessment tests, such as biometry and topography, and sometimes measurements of binocular vision and the dominant eye.

After the procedure, if a small correction is still useful, the optician advises you on the type of lenses suited to your implant. If you have chosen monovision, they can also offer supplementary glasses for night driving or the cinema.

Implant surgery is performed in hospitals, eye clinics and outpatient centres. Check that the facility has a cantonal licence, an operating theatre dedicated to ophthalmology, recent measuring equipment for biometry and topography, and clear arrangements for emergencies outside opening hours. For premium implants, the availability of several models allows the surgeon to genuinely choose the best-suited implant, rather than one from a single range.

Contact lenses

Remove them several days before the assessment, often a week for soft lenses and two to three weeks for rigid lenses, as instructed by your ophthalmologist.

Dry eye

If you have dry eyes, treatment with artificial tears or eyelid care before the measurements improves their precision.

Medicines

Mention all your treatments. Some prostate medicines change how the iris behaves during the procedure; the surgeon must know. Anticoagulants are often continued for this type of surgery, by medical decision.

On the day

Come without make-up or cream around the eyes, with someone to accompany you and your sunglasses.

At home

Have your drops ready, a bottle of artificial tears and arrangements so that you do not need to drive for a few days.

• Complete assessment done, implant chosen and ordered.
• Quote signed, your share known, insurance confirmation if necessary.
• Prescription for drops collected from the pharmacy.
• Contact lenses removed for the prescribed period.
• Someone to accompany you home, no driving.
• Sunglasses, protective shield if provided in advance.
• Care team's number saved.

A few preparations make the first few days easier. Clear objects from walkways, as vision is blurred on the evening of the procedure and depth perception may be altered between the two eyes. Prepare a clean, well-lit place for using the drops, with a mirror and a timetable. Plan simple meals, a protective shield and clean tissues. If you have a pet, keep it from sleeping near your face for the first few days.

For older people who live alone, a night light in the corridor and bathroom limits the risk of falling on the first night, when one eye is still blurred and the other is waiting its turn. A phone with important numbers saved in large print, placed by the bed, completes these simple precautions.

The operation can be performed in any season. In summer, intense light and swimming require more precautions in the first few weeks; in winter, snow and cold wind in the mountains call for protective glasses. For refractive surgery, choose a period when you can take a few days off for each eye and avoid swimming pools and contact sports for two to four weeks. For a cataract, there is no point waiting for a particular season when vision becomes troublesome.

Finally, think about your commitments: an exam, a family event or a busy period at work just after the procedure add needless pressure. A few quiet days around each eye make recovery much calmer and more pleasant.

Fitting an implant is almost always done under topical anaesthesia, with drops, sometimes supplemented by an injection of anaesthetic inside the eye, and often by light intravenous sedation that relaxes without putting you to sleep. You are awake, you see a bright light and blurred shapes, but you feel no pain. Anaesthesia by injection around the eye or, more rarely, general anaesthesia are reserved for particular situations, such as a person unable to stay still.

You arrive one to two hours before the procedure. Drops are applied to dilate the pupil, then anaesthetic drops. You lie down, with your face covered by a sterile drape that leaves only the operated eye exposed. During the procedure, you see an intense light and coloured movements; you are asked to look at the light. It takes fifteen to thirty minutes. After a short period of monitoring, you go home accompanied, with a shield over the eye. That evening, vision is often blurred; it generally clears from the next day.

The idea of an eye operation while awake worries many patients. This apprehension is normal. A few points are reassuring: the eye is anaesthetised by drops and you feel no pain; you do not see the instruments clearly, only a light; the speculum prevents blinking, so you do not have to worry about it; and the procedure is short.

If your anxiety is strong, mention it before the procedure. Light intravenous sedation relaxes you without putting you to sleep. The team talks to you during the procedure and warns you of each step. Many patients say afterwards that the wait was harder than the operation itself, and the second eye is generally experienced much more calmly.

Preparation

The pupil is dilated with drops, the skin around the eye and the eye surface are disinfected, then a sterile drape and a small speculum that keeps the eyelids open are put in place.

The incisions

The surgeon makes two or three micro-incisions at the edge of the cornea, of two to three millimetres. In some clinics, a femtosecond laser makes these incisions and the opening in the capsule.

Removing the lens

For a pseudophakic implant, the surgeon opens the lens envelope, breaks the lens up with ultrasound and aspirates it, leaving the capsule in place.

Placing the implant

The folded implant is injected through the incision and unfolds in the capsule. A toric implant is rotated to the planned axis. For a phakic implant, the implant is slipped behind the iris, in front of the natural lens, which is kept.

End of the procedure

The incisions usually close without stitches. An antibiotic is placed in the eye, then a protective shield is applied. The whole process takes fifteen to thirty minutes per eye.

The femtosecond laser can perform several steps of the operation: the corneal incisions, the circular opening of the capsule and fragmentation of the lens, as well as small incisions to correct slight astigmatism. It offers great regularity, particularly for opening the capsule, which interests some surgeons for centring premium implants.

Large comparative studies have not, however, shown a clear improvement in final vision or a reduction in complications compared with the manual technique performed by an experienced surgeon. The laser slightly lengthens the time spent in theatre and is generally charged as a supplement. It can be a plus in certain situations, but it is not essential for an excellent result. Ask your surgeon what they expect from it in your case.

The two eyes are generally operated on separately, a few days or a few weeks apart. This interval allows the result of the first eye to be checked, the calculation for the second to be adjusted if needed, and the very low risk of an infection affecting both eyes to be limited. Some centres operate on both eyes on the same day, with strict precautions, for selected patients; this practice remains less common.

Between the two procedures, the difference in correction between the eyes can be uncomfortable, especially in highly short-sighted or long-sighted people. A contact lens on the non-operated eye, or temporary glasses, help you through this period. A short interval is often preferred for this reason.

Fitting a phakic implant resembles cataract surgery, with a few differences. The pupil is dilated for a posterior chamber implant, or on the contrary constricted for an iris-clipped implant. The natural lens is not touched: the implant is injected through a small incision and slipped into place, without fragmentation or aspiration. The procedure often takes about fifteen minutes.

A few hours later, eye pressure is checked before you leave, as an early pressure spike is one of the specific risks of these implants. Vision is often spectacular from the next day for very short-sighted patients, who discover clear vision without correction on waking. The two eyes are generally operated on a few days apart.

For a cataract, the most affected eye, the one whose vision is most impaired, is generally operated on first. For refractive surgery or multifocal implants, some surgeons start with the non-dominant eye, so that the patient can become familiar with the result before the eye that guides their vision is operated on. The result of the first eye also helps refine the calculation for the second. This decision is made with the surgeon, who can test your dominant eye at the consultation.

Just as you are right- or left-handed, you have a dominant eye, the one the brain favours for aiming or looking into the distance. It can be identified with a simple test: looking at a distant object through a hole formed by your hands, then closing each eye in turn, the eye that keeps the object in the hole is the dominant eye. This matters in several decisions: in monovision, the dominant eye is generally set for distance; for different implants in each eye, it often receives the one that favours distance vision.

The balance between the two eyes is as important as the quality of each. Too great a difference in correction between the eyes can impair depth perception and cause fatigue. This is another reason to plan both eyes together from the outset, and not to leave a long interval between the two procedures when the initial prescription was high. Your surgeon or the orthoptist will test your dominant eye at the assessment.

In people with a long-standing squint or an eye that has been weaker since childhood, binocular balance deserves particular attention: suddenly changing the correction of one eye can sometimes trigger double vision. The orthoptic assessment allows this risk to be anticipated and the strategy adapted.

The drops, antibiotics and anti-inflammatories, must be used according to a precise schedule for several weeks. It is essential not to rub the eye, to avoid swimming pool water and dust in the first few weeks, and to wear the shield at night for a few days. Most patients resume their usual activities within a few days.

The check-up the next day is a key moment. The ophthalmologist measures the vision of the operated eye, often already good, and the pressure inside the eye, which can rise temporarily after the procedure. They examine the cornea, sometimes slightly swollen in the first few days, which explains still-hazy vision, and check for excessive inflammation or signs of infection.

They also check the position of the implant: well centred and, for a toric implant, on the right axis. For a phakic implant, they assess the space between the implant and the natural lens, called the vault, which must be sufficient without being excessive. Finally, they go over the instructions for the drops and precautions again and set the next appointment. This is the right time to ask all your questions about what you are experiencing.

Day 0

Right eye operated on at nine o'clock, home at eleven with a shield. Blurred, dazzled vision, slight gritty sensation.

Day 1

Check-up in the morning: vision has improved markedly, colours look very vivid. Drops started four times a day.

Day 4

Reading the newspaper with off-the-shelf reading glasses. A walk with sunglasses.

Day 8

Left eye operated on. In between, the difference in vision was a little disconcerting.

Week 3

Back to daytime driving with the ophthalmologist's approval. No more need for distance glasses.

Month 2

End of the drops, prescription for final reading glasses.

Month 18

Slight drop in vision in the right eye: posterior capsule opacification treated by laser in five minutes.

Day 0

Implant fitted in the left eye in twenty minutes. Home with a shield, vision blurred but already different.

Day 1

Check-up: eye pressure is normal, the implant well positioned. She reads the letters on the chart without glasses for the first time since childhood.

Day 3

Back to working from home. Slight halos around lamps in the evening.

Day 7

Implant fitted in the right eye. Both eyes are now balanced.

Week 3

Back to jogging. She puts her thick glasses away in a drawer.

Month 6

Complete check-up, normal corneal cell count. Annual follow-up scheduled.

With a multifocal or extended depth-of-focus implant, the eye receives several images at the same time, and the brain learns to select the most useful one. This adaptation, called neuroadaptation, takes a few weeks to a few months. At first, near vision may seem less comfortable than expected, and rings of light appear around headlights and street lamps.

In the vast majority of patients, these phenomena fade markedly over time, and many end up no longer noticing them. Sufficient lighting improves near reading. A small minority remain bothered; dry eye, residual astigmatism or capsule opacification may be the cause and can be treated. Exceptionally, the implant can be exchanged for a monofocal, ideally in the first few months.

Patients with trifocal implants often describe a new freedom: reading the time, a message or a label without looking for their glasses, switching from screen to document without changing correction. Most forget about their glasses within a few weeks. A few habits make life easier: good lighting for small print, a suitable reading distance, slightly further away than with reading glasses, and clean windscreens to limit light scatter at night.

Halos around headlights and street lamps are noticed by most patients at first, then ignored by the brain. Some notice slightly less sharp vision in dim light; an extra lamp is generally enough. Those still bothered beyond six months should mention it: solutions exist, from correcting dryness to capsule laser.

Drops

Follow the schedule scrupulously. Wash your hands beforehand, gently pull down the lower eyelid and apply the drop without touching the eye with the bottle.

Washing

Showering is possible from the next day, avoiding soapy water running into the eye. Wash your hair with your head tilted back for the first few days.

Make-up

Avoid eye make-up for one to two weeks, then use new products to limit the risk of infection.

Reading and screens

Allowed as soon as you feel like it; they do not tire the implant. Any fatigue comes rather from dryness.

Gardening and DIY

Wait one to two weeks for dusty activities, and wear protective glasses.

Sunlight

In the first few days, light seems brighter and colours more intense, especially after a cataract. Wear sunglasses outdoors.

The clear shield given after the procedure protects the eye at night, when you might rub it without realising. It is fixed with tape on the forehead and cheek, without pressing on the eye. Wear it every night for the indicated period, often a week, as well as during naps. Wash it with soap and water every day. Sleeping on your back or on the side of the non-operated eye for the first few nights completes this protection.

If you usually wear glasses to read in bed, put them on before removing the shield and keep them within reach. Also avoid feather pillows that release dust, and pets in the bed, during this first week. On waking, do not rub a sticky eye: gently clean the eyelids with a damp sterile compress, from the inner corner outwards, then apply the first drop of the day.

Good lighting improves near vision with all implants, and even more so with a multifocal, whose near vision is better in sufficient light. A reading lamp directed at the page, neutral rather than very warm light and no reflections on the screen make a real difference. Conversely, after a cataract, the eye perceives more light: very bright or bare light sources can dazzle. Lampshades, indirect lighting and dimmers help find the right balance.

On the day of the procedure, someone close to you must take you home. In the first few days, they can help you with the drops, especially if you find them difficult to use yourself, and with getting to check-ups, as you will not be able to drive. They also need to know the warning signs: increasing pain, reduced vision, flashes or a curtain. For an older person living alone, arranging help for a few days, or visits from a home care service for the drops, is often useful.

A computer screen is generally fifty to seventy centimetres away, an intermediate distance. A monofocal implant set for distance often gives slightly blurred vision at this distance, which means wearing office glasses. Extended depth-of-focus implants and trifocals offer better intermediate vision. A smartphone, held closer, falls rather under near vision.

If you work at a screen all day, say so from the first consultation. The surgeon can also set one eye slightly closer in mini-monovision. After the procedure, dry eye, common in front of a screen, may be more troublesome in the first few weeks; remember artificial tears and regular breaks.

A smartphone is generally read at thirty-five or forty centimetres, a near distance. With a monofocal implant set for distance, reading glasses are needed to read a message, which is often felt to be the most frequent daily constraint. Trifocals solve this problem for most patients; extended depth-of-focus implants partly do so, especially by increasing the font size. Enlarging the text and increasing screen brightness helps whatever the implant.

Driving is often one of the first freedoms regained after cataract surgery, when vision had become insufficient. You must not drive on the day of the procedure, nor until your vision is stable and the doctor has authorised you to drive again. The legal visual requirements for driving apply as before; your ophthalmologist will tell you whether you meet them, with or without glasses.

With a multifocal implant, night driving may be impaired in the first few months by halos around headlights. Most patients get used to them, but professional drivers or those who drive a lot at night often favour a monofocal or extended depth-of-focus implant. Keep windscreens and glasses clean, as dirt increases light scatter.

Swiss roads impose particular visual conditions. The many tunnels force the eye to switch suddenly from full light to dim light, and back again. Snow intensely reflects sunlight. Fog over the Plateau in autumn and winter reduces contrast. These are exactly the situations in which a cataract is most troublesome, and in which the differences between implants are felt.

After cataract surgery, most drivers notice a clear improvement when leaving tunnels and in fog, thanks to restored transparency. With a multifocal implant, slightly reduced contrast may be noticeable in fog, and halos from tunnel lighting in the first few months. Polarised sunglasses are invaluable on snow; take them off when entering tunnels. Tell the surgeon if you often drive on mountain roads or drive a lot in winter.

After a phakic implant, the instructions are similar. Sports with a risk of a direct blow to the eye always justify protective glasses, implant or not.

In Switzerland, many patients spend time in the mountains, where ultraviolet radiation is more intense and snow strongly reflects light. Modern implants filter ultraviolet light, but the surface of the eye, the eyelids and the surrounding skin remain exposed. In the first few weeks after the procedure, the eye is particularly sensitive to light.

Wear good-quality sunglasses with full ultraviolet protection and, at high altitude or on snow, wraparound glacier glasses. Cold, dry wind on the summits also worsens dry eye; artificial tears in your pocket are useful when hiking and skiing.

For office work, a return is often possible two to three days after the procedure, sometimes the next day. Jobs exposed to dust, chemicals, water or intense physical exertion require one to two weeks. Jobs requiring perfect vision, such as professional driving or certain precision work, wait for the ophthalmologist's authorisation and sometimes for vision to stabilise after the second eye has been operated on.

After an operation with a monofocal implant, vision is often stable within two to four weeks; this is the time to prescribe final glasses if needed. With a multifocal, adaptation continues for several months. The drops are reduced gradually according to the schedule given. A check-up at one month, then at three or six months, is usual. After that, regular eye follow-up remains advisable, as for anyone your age.

Even with an implant, glasses may still be useful. With a monofocal set for distance, reading glasses are often enough; varifocal lenses also cover intermediate vision. With a multifocal, light glasses can improve prolonged reading in low light or correct a small residual error. After monovision, glasses that balance the two eyes are sometimes useful for night driving.

Wait until vision has stabilised, generally four to six weeks after the second eye has been operated on, before having final glasses made. In the meantime, off-the-shelf reading glasses can help. Sunglasses, on the other hand, are useful from the first day.

An intraocular implant requires no maintenance, but the eye that holds it continues to age. Regular eye check-ups remain useful to screen for glaucoma, macular degeneration or diabetic retinopathy, and to treat posterior capsule opacification in good time. The frequency depends on your age and history, often every one to two years.

Keep the implant card given after the procedure, which shows the model and power of each implant. It will be invaluable if another ophthalmologist needs to treat you, if you ever need other eye surgery or if safety information about an implant model is published.

To judge the result of an implant, start from the goals set before the procedure: reading without glasses, driving by day without correction, working at a screen. A few months after the operation, note in which situations you still wear glasses and in which you are bothered. This concrete review, discussed with the surgeon, is more reliable than an overall impression. It also helps identify what can still be improved, such as dryness to be treated or a small correction for a specific activity.

• Does my vision match what was expected at this stage?
• Is the refractive result close to the target?
• How much longer must I use the drops?
• When can I resume driving, sport and make-up?
• Are the halos I see normal, and will they decrease?
• Should I have glasses made, and when?

Intraocular lens surgery is among the safest in medicine, but no procedure inside the eye is risk-free. Serious complications are rare; knowing about them allows you to react in time.

Posterior capsule opacification

Months or years after an operation with an implant, the capsule surrounding the implant may become cloudy, causing a gradual loss of vision. It is not a recurrence of the cataract. A laser treatment, called YAG capsulotomy, opens the capsule in a few minutes, painlessly, in the consulting room. Vision becomes clear again within a day or two.

Residual refractive error

Slight residual myopia, hyperopia or astigmatism may persist. They are corrected with light glasses, supplementary laser or, more rarely, by adding or exchanging an implant.

Light effects

Halos, glare, arc-shaped reflections at the side of the visual field. They are more common with multifocals and generally diminish over time.

Inflammation and macular oedema

Inflammation of the eye, or even swelling of the central retina, can occur in the weeks after the procedure. Treatment with drops prevents and treats it. People with diabetes are more at risk.

Raised eye pressure

Temporary after the procedure or more lasting, particularly with a poorly sized phakic implant. It is monitored at the check-ups.

Implant displacement

An implant can decentre or, for a toric, rotate off its axis. Repositioning is possible.

Retinal detachment

Rare, but more common in highly short-sighted people. Flashes, a shower of floaters or a curtain in the visual field require urgent consultation.

Infection

Endophthalmitis, infection inside the eye, is very rare thanks to the antibiotic placed at the end of the procedure, but serious. It shows as increasing pain, redness and loss of vision in the following days.

Increasing pain, significant redness, a sudden drop in vision, flashes or a curtain require a consultation the same day. Outside opening hours, contact the nearest eye emergency department.

Implant exchange is rare. It is discussed in the event of persistent intolerance of a multifocal's light effects, a significant power error that cannot be corrected otherwise, significant decentration or, exceptionally, clouding of the implant material. Before considering it, the surgeon looks for and treats simpler causes: dryness, posterior capsule opacification, residual astigmatism.

Exchange is easier in the first few months, before the capsule adheres strongly to the implant. Later, it remains possible but requires more precautions. If you are dissatisfied, talk to your surgeon early rather than waiting several years.

When an eye that already has an implant has a residual refractive error, or when a patient wants to add a presbyopia correction years after a cataract, a second, very thin implant can be placed in front of the first, in the space behind the iris. These add-on implants exist in monofocal, toric and multifocal versions.

They avoid removing an implant already fused in the capsule, which is more delicate. They also allow a multifocal correction to be tried reversibly, as the add-on implant can be removed. Their indications remain limited and are discussed with a surgeon experienced in refractive surgery.

• Choosing a multifocal implant solely on the promise of no longer wearing glasses, without discussing night driving.
• Having the assessment while still wearing contact lenses.
• Forgetting to mention previous laser surgery.
• Rubbing the operated eye or stopping the drops too early.
• Judging a multifocal in the first few weeks.
• Neglecting dry eye before and after the procedure.
• Ignoring flashes or a curtain after the procedure.

In Switzerland, cataract surgery is covered by compulsory health insurance when medically indicated, with a standard implant, under the usual deductible (franchise) and co-payment (quote-part) rules. When the patient chooses a more expensive implant — multifocal, extended depth of focus or sometimes toric — the price difference and additional tests are generally at their expense.

Billing practices vary between facilities. Ask for a written quote that separates the reimbursed part and the part at your expense, and check with your insurer. Supplementary insurance sometimes covers part of the supplement or the choice of facility; read your policy terms.

For covered cataract surgery, the steps are generally simple: the ophthalmologist sets the indication and the facility bills the insurer directly, according to your insurer's system. You then receive the bill for your share, deductible and co-payment. If you choose a premium implant, the facility gives you a written agreement specifying the supplement at your expense.

For treatment at a facility in another canton, or in the private ward, check your supplementary insurance cover. For non-reimbursed refractive surgery, payment is generally requested before or on the day of the procedure. Keep all the invoices: depending on your situation, some medical costs can be taken into account in your tax return; ask your canton's tax administration.

Cataract surgery is available in almost every canton, often close to home. Phakic and premium implants are more concentrated in cities with refractive surgery centres.

Geneva

University hospital and many eye clinics; full range of premium and phakic implants. Reference for prices of the private part.

Vaud

Lausanne has a renowned university eye hospital and private centres; Morges, Nyon, Vevey and Yverdon also offer cataract surgery.

Neuchâtel and Jura

Cataract surgery locally in Neuchâtel, La Chaux-de-Fonds and Delémont; phakic implants are found rather in Lausanne, Bern or Basel.

Fribourg

Bilingual provision in Fribourg for cataract and some premium implants.

Valais

Sion and several regional hospitals perform cataract surgery; for phakic implants, many patients go to Lausanne or Bern.

Bern and Solothurn

Bern has a university clinic and refractive centres; Biel/Bienne, Thun, Solothurn and Olten cover cataract surgery regionally.

Basel

University clinic and private centres, with a full premium offering.

Zurich, Aargau, Schaffhausen

The widest provision in German-speaking Switzerland, with many refractive centres in Zurich and Winterthur; Aarau and Baden also offer premium implants.

Central Switzerland

Lucerne and Zug concentrate the premium offering; neighbouring cantons perform cataract surgery locally or in Lucerne.

Eastern Switzerland

St. Gallen offers a full range; Thurgau, Appenzell and Glarus look to it or to Zurich.

Graubünden

Chur performs cataract surgery and fits premium implants; remote valleys organise their check-ups accordingly.

Ticino

Lugano, Bellinzona and Locarno have experienced surgeons; consultations in Italian.

For cataract, proximity is generally the best option, as provision exists in almost every canton. For a phakic or premium implant fitted by a highly specialised surgeon, some patients travel an hour or two by train. The arrangements remain simple: a check-up the next day, ideally staying the night nearby or returning accompanied, a check-up at one week, then more widely spaced check-ups that can sometimes be carried out by your usual ophthalmologist. Plan both eyes a few days apart to combine journeys.

Explanations about choosing an implant are technical; understanding them fully is essential to make an informed choice. In French-speaking Switzerland, all consultations take place in French. In the major German-speaking cities, many ophthalmologists see patients in French or English; check when booking. In Ticino, consultations are held in Italian. Biel/Bienne and Fribourg offer bilingual consultations.

For an intraocular lens, proximity is a real advantage: a check-up takes place the day after the procedure, then several more in the following weeks, and the two eyes are often operated on a few days apart. For 45 cities, this table shows where surgery usually takes place, whether premium and phakic implants are available locally, and the price difference observed compared with Geneva on the non-reimbursed part.

For cataract surgery with a standard implant, covered by basic insurance, the tariff varies little between cantons and the price difference is not a criterion. It becomes relevant for premium implant supplements and for refractive surgery, entirely at the patient's expense.

For the non-reimbursed part, we express prices as relative indices, which are more meaningful than amounts that vary between centres and change over time.

Details by city and how to read a quote appear on our page on intraocular lens prices in Switzerland.

Guidelines by city appear on our page on intraocular lens prices in Switzerland.

For refractive surgery or a custom-made implant, a deposit is often requested when the implant is ordered, expressed as a percentage of the quote. Ask about the conditions for postponement and cancellation, particularly if the custom-made implant has already been manufactured. Postponement for medical reasons, such as conjunctivitis or an infection, should be possible without penalty. Ask for these conditions in writing.

Refractive surgery is the subject of much advertising: headline prices, promises of never wearing glasses again, implants presented as revolutionary. A few reflexes help you keep a critical mind. Check what the displayed price includes: assessment, implant, follow-up, any corrections. Be wary of absolute promises: no implant offers perfect vision at all distances without trade-offs. And make sure the proposal is based on a complete assessment of your eyes, not just on your age and glasses prescription.

Patient testimonials are useful for getting an idea of the experience, but they have their limits. A patient who is happy with their trifocal says nothing about your eyes or your needs, and a negative testimonial may concern an old implant or a particular situation. Reviews of a centre mainly tell you about the welcome and organisation. For medical quality, the best indicators remain the surgeon's experience, the quality of the assessment and the clarity of the explanations received at the consultation.

If a testimonial strikes you, note it down and ask your surgeon: they can tell you whether the situation described could concern you, and how it would be handled at their centre.

Often added are the basic insurance deductible and co-payment for a cataract, drops, artificial tears, any reading or office glasses, travel for check-ups and, for a monofocal implant, suitable glasses after stabilisation. In the long term, an implant that frees you from glasses can also reduce the budget spent on frames and contact lenses.

Pseudophakic: An eye whose lens has been replaced by an implant.

Phakic: An eye that has kept its natural lens.

Biometry: Measurement of the eye's dimensions to calculate the implant.

Dioptre: The unit of power of a lens.

Toric: An implant that corrects astigmatism.

EDOF: Extended depth-of-focus implant.

YAG capsulotomy: The laser that treats posterior capsule opacification.

Phacoemulsification: Fragmentation of the lens by ultrasound.

Emmetropia: Absence of refractive error; clear distance vision without correction.

Neuroadaptation: The brain's adaptation to a multifocal implant.

• Implants replace or complement the natural lens to correct vision.
• A monofocal offers the best quality of vision at one distance; a multifocal offers more independence, with trade-offs at night.
• Phakic implants correct high myopia when laser is not suitable.
• The precision of the assessment determines the result.
• Cataract surgery with a standard implant is covered by basic insurance.
• Posterior capsule opacification is treated in a few minutes by laser.
• Flashes or a curtain after the procedure require urgent consultation.

Medespoir Suisse helps you understand the options, prepare your questions and find ophthalmologists who regularly fit the implants you are interested in, in your region and your language. We also help you read quotes and distinguish what is reimbursed from what remains at your expense.

Intraocular lenses have transformed eye surgery: they restore sight to people with cataract and free young or presbyopic patients from glasses. Choosing an implant is an important decision, which depends as much on your eyes as on your lifestyle. A precise assessment, a frank discussion of the trade-offs and an experienced surgeon are the keys to a result that will suit you for decades. For the budget, see our page on intraocular lens prices in Switzerland.

Budget

Price differences between cities and cantons, the quote breakdown and ways to save are detailed on our page Intraocular lenses: prices in Switzerland.

Related procedures

• Cataract surgery in Switzerland
• LASIK in Switzerland

Our guides

• Eye surgery guide for Switzerland
• Cosmetic surgery in Switzerland

Answers to the most frequent questions about intraocular lenses in Switzerland.

Understanding intraocular lenses

What is an intraocular lens? It is a small optical implant, about six millimetres in diameter, placed inside the eye to replace or complement the crystalline lens. Its power is calculated for each eye so that the image forms sharply on the retina. It is designed to stay in place for life, without maintenance.

How is it different from a contact lens? A contact lens sits on the surface of the eye and is removed daily or regularly. An intraocular lens is placed inside the eye during surgery; it cannot be felt, requires no maintenance and cannot be lost or become infected like a contact lens.

When is an intraocular lens fitted? Mainly during cataract surgery, to replace the clouded lens. It is also used to correct high myopia or hyperopia with a phakic implant, and to correct presbyopia and refractive errors by clear lens exchange, in patients who want to be free of glasses.

What is a phakic implant? It is an implant placed without removing the natural lens, in front of it. It corrects myopia, hyperopia or astigmatism, often too high for laser. The natural lens continues to focus, which suits young patients. The implant can be removed if necessary.

What is a pseudophakic implant? It is the implant placed after the lens has been removed, during cataract surgery or clear lens exchange. It permanently replaces the eye's natural lens and sits in the lens envelope, called the capsular bag.

Is the implant visible? No. It lies behind the cornea and, usually, behind the iris. No one can see it with the naked eye. Some iris-clipped implants can be glimpsed very close up under particular lighting, which remains exceptional.

Can the implant move or fall out? It is held by its haptics or plate and becomes stable within a few weeks as the capsule heals. Slight decentration or rotation is possible, especially in the first few days, and can be corrected. Late dislocation is rare and mainly concerns eyes with fragile supports.

How long does an implant last? A lifetime. The materials used are stable and do not wear out. There is no need to change it. An exchange is only considered in the event of a particular problem, such as intolerance of a multifocal's light effects or a significant power error.

Can you feel the implant in the eye? No. The inside of the eye has no sensitivity to contact with the implant. A gritty feeling in the first few days comes from the small incisions and dryness of the surface, not from the implant itself.

Are implants MRI-compatible? Yes, intraocular implants are compatible with MRI and security scanners, as they contain no metal. Simply mention your eye surgery if asked about your medical history.

Choosing your implant

What is the difference between monofocal and multifocal? A monofocal gives clear vision at a single distance, generally distance vision, and glasses are still needed for reading. A multifocal divides light between several distances to provide distance, intermediate and near vision, at the cost of night halos and a slight loss of contrast, especially in the first few months.

What is a trifocal implant? It is a multifocal implant offering three main focal points: distance, intermediate for the computer, and near for reading. It allows many patients to do without glasses day to day. It requires an adaptation period and is less suitable for frequent night drivers.

What is an EDOF implant? It is an extended depth-of-focus implant. It stretches the range of sharp vision from distance to intermediate, at the distance of a screen. Near vision often requires light glasses. Light effects are less than with a trifocal.

What is a toric implant? It is an implant that corrects corneal astigmatism. It has markings that allow the surgeon to orient it along a precise axis. Without it, significant astigmatism would leave vision blurred even after the operation, requiring glasses.

Which implant should I choose if I often drive at night? A monofocal implant, possibly enhanced, or an extended depth-of-focus implant, which cause fewer halos than trifocals. Professional drivers and people very sensitive to glare generally favour these options, even if it means wearing glasses for reading.

Which implant should I choose if I read a lot? A trifocal offers good near vision without glasses. A monofocal set for distance with reading glasses gives the best reading quality, particularly in low light. Monovision is another option. The choice depends on how much you want to do without glasses.

What is monovision? It is setting one eye for distance and the other for intermediate or near vision, with monofocal implants. The brain uses the eye suited to each distance. It avoids halos but slightly reduces depth perception. A prior contact lens trial is often offered.

Can a short-sighted person keep their near vision? Yes. Many short-sighted people like reading without glasses. The surgeon can aim for slight myopia, which preserves near reading without correction, at the cost of glasses for distance. This is a common and very comfortable choice for those who have always been used to it.

Are premium implants worth the price? They bring real benefit to those who want to reduce their dependence on glasses and whose eyes are suitable. For others, a standard monofocal offers excellent vision and glasses are no burden. The right implant is the one that meets your needs, not the most expensive one.

What is a light-adjustable implant? It is an implant whose power can be modified after the procedure by exposure to ultraviolet light in the consulting room. It allows the result to be fine-tuned according to how you see. It requires wearing protective glasses during the adjustment period and remains uncommon.

Does the implant filter blue light? Some implants have a yellow filter that reduces part of the blue light, like the aged natural lens. Its benefit in protecting the retina has not been proven with certainty. It is generally not a decisive selection criterion.

Can a different implant be chosen for each eye? Yes, this is sometimes a strategy, for example an extended depth-of-focus implant in one eye and a trifocal in the other, or monovision. The surgeon plans both eyes together to obtain the best balance.

Phakic implants and refractive surgery

When is a phakic implant preferable to laser? With high myopia or hyperopia, a cornea that is too thin or irregular, significant dry eye, or when you want a reversible solution. For moderate corrections with a normal cornea, laser often remains the first option.

Up to what age can a phakic implant be fitted? Generally up to about forty-five. Beyond that, presbyopia sets in and a cataract looms; lens exchange often becomes a better option, as it also corrects presbyopia and avoids a second procedure later.

Does a phakic implant correct presbyopia? No. It corrects myopia, hyperopia or astigmatism, but not presbyopia. The natural lens that is kept will continue to age; at around forty-five or fifty, reading glasses will become necessary, as for any non-presbyopic person.

Is a hole needed in the iris before a phakic implant? With recent posterior chamber implants that have a central opening, it is generally no longer necessary. For other models, a small laser opening in the iris may be made before the procedure to ensure circulation of fluid in the eye.

Can a phakic implant cause a cataract? The risk exists, particularly if the implant is too close to the natural lens. Current implants and precise sizing have greatly reduced this risk. If a cataract develops, the phakic implant is removed during cataract surgery and replaced with a conventional implant.

What is clear lens exchange? It is the replacement of a still-clear lens with an implant, to correct vision and presbyopia. It is mainly for people over fifty, often long-sighted. It avoids future cataract surgery. It is refractive surgery, at the patient's expense.

Is lens exchange risky in highly short-sighted people? It increases the risk of retinal detachment, which is already higher in highly short-sighted people. The decision is made after a careful examination of the retina, and the patient must know the warning signs. In young short-sighted people, a phakic implant is often preferred.

Can laser be performed after an implant? Yes. If a small residual error persists after an implant, a supplementary corneal laser can refine it, a few months after the procedure, once vision is stable. This is a common strategy to achieve maximum precision.

Can a phakic implant be removed? Yes. This is one of its advantages. It can be removed or exchanged if the prescription changes, in the event of a complication or at the time of cataract surgery. Removal is a short procedure, similar to insertion.

Assessment and procedure

How long does the assessment take? One to two hours in general, sometimes over two visits. It includes refraction, optical biometry, corneal topography, macular examination, often a corneal cell count and a dilated fundus examination. After dilation, you will not be able to drive for a few hours.

Should I stop wearing contact lenses before the assessment? Yes. Contact lenses temporarily distort the cornea and skew the measurements. You are generally asked to remove them a week beforehand for soft lenses and two to three weeks for rigid lenses. Your ophthalmologist will tell you the exact interval.

How is the implant power calculated? From the length of the eye, the curvature of the cornea, the depth of the anterior chamber and other parameters, entered into calculation formulas. Modern formulas are very precise, but a small error remains possible, particularly in very short or very long eyes or eyes that have already had laser surgery.

I have had laser surgery: is that a problem? It is not a contraindication, but calculating the implant is more difficult as the cornea has been changed. Bring your old measurements and reports if you have them. Multifocal implants are sometimes less suitable after certain lasers; the surgeon will advise you.

Is the procedure painful? No. It is performed under anaesthetic drops, often supplemented by light sedation. Most patients feel only pressure and see a bright light. In the following days, a gritty feeling is common but rarely painful.

How long does the procedure take? Fifteen to thirty minutes per eye. With preparation and monitoring, allow two to three hours on site. You go home the same day, accompanied.

Are both eyes operated on the same day? Usually not: the two eyes are operated on a few days or weeks apart, which allows the result of the first eye to be checked. Some centres operate on both eyes on the same day for selected patients, with strict precautions.

What do you see during the procedure? An intense light, moving shapes and colours. You are asked to look at the light. You do not see the instruments clearly. Many patients find the experience much less daunting than they had imagined.

What is femtosecond laser-assisted surgery? It is the use of a laser to perform certain steps: incisions, opening the capsule, fragmenting the lens. It brings great precision, but studies have not shown clear superiority in visual outcome compared with the manual technique. It is often charged as a supplement.

Do I need to fast? For anaesthetic drops alone, a light meal is often allowed. If sedation is planned, a few hours' fasting is generally required. Follow the facility's instructions.

Can I have surgery if I take anticoagulants? Yes, usually without stopping them, as small-incision surgery bleeds very little. The decision lies with the surgeon and the prescribing doctor. Always mention your treatments.

Do some medicines cause problems? Medicines used for certain prostate problems can make the iris floppy during the procedure. The surgeon must know so as to adapt the technique. Mention them even if you stopped them long ago.

Recovery and daily life

When will I see clearly after the procedure? Often from the next day, sometimes after a few days if the eye is slightly inflamed. With a monofocal implant, vision stabilises within two to four weeks. With a multifocal, adaptation continues for several months.

How long do I need to use drops? Usually three to six weeks, tapering gradually. They are antibiotics and anti-inflammatories, sometimes combined in the same bottle. Follow the schedule and do not stop them yourself.

Do I need to wear an eye shield? Yes, generally at night for a few days to a week, to avoid rubbing the eye in your sleep. During the day, sunglasses or your usual glasses protect the eye from dust and wind.

When can I drive again? When vision is sufficient and the ophthalmologist allows it, often a few days after the procedure. Do not drive on the same day. Between the two eyes, the difference in vision can make driving uncomfortable; be careful.

Can I read and use a screen after the procedure? Yes, as soon as you feel like it. Reading and screens do not tire the implant. Dry eye may, however, make screens uncomfortable; artificial tears and breaks help.

When can I wear make-up? Avoid eye make-up for one to two weeks, then use new products, particularly mascara and eye pencil, to limit the risk of infection. Make-up on the rest of the face is possible earlier.

When can I swim? Avoid swimming pools, hot baths and swimming in lakes or the sea for two to four weeks, because of the risk of infection. After that, swimming goggles are advised for the first few months.

Can I take the train or travel? Travel within Switzerland is possible from the first few days, taking your drops with you. Plan your trips so as not to miss the check-ups, particularly the one the next day and the one in the first week.

Can contact lenses be worn after an implant? It is rarely necessary, but possible if a small correction is useful, once the eye has healed. Between the operations on the first and second eyes, a contact lens on the non-operated eye can help balance vision.

Will I still need glasses? It depends on the implant and the chosen target. With a monofocal set for distance, reading glasses are needed. With a trifocal, many patients do without. A small residual correction may justify light glasses for certain activities.

Do colours change after the procedure? Often, yes, especially after a cataract: the yellowed lens filtered out blues, and colours look brighter and cooler after the operation. The brain gets used to it quickly. Painters and photographers are often struck by this change.

When can I resume sport? Walking from the next day, cycling and jogging after about a week, swimming after two to four weeks, ball sports with protective glasses after two to four weeks. Ask the ophthalmologist's advice for combat sports or diving.

Practical questions

What documents should I bring to the consultation? Your latest glasses or contact lens prescription, your old glasses, reports of previous eye surgery, particularly refractive laser, the list of your medicines and your insurance card. Also note your questions and your main visual activities.

Can I come to the assessment alone? It is possible, but not advisable if pupil dilation is planned: vision remains blurred and dazzled for a few hours, and you will not be able to drive. Come accompanied or by public transport.

How long is the wait before the procedure? For a cataract, a few weeks to a few months depending on the centre. For a phakic or custom-made implant, allow for manufacturing time, often several weeks. For a premium implant, the implant sometimes has to be specially ordered.

Is time off work needed? Often a few days for office work, one to two weeks for physical work or a dusty environment. Your ophthalmologist will give you a certificate suited to your job.

Can I sleep on my side? Avoid sleeping on the side of the operated eye for the first few days, and wear the shield at night. After that, you can return to your usual position.

Can I bend down and lift things? Everyday movements are allowed. Violent exertion, lifting very heavy loads and prolonged head-down positions should be avoided in the first few days, according to the surgeon's instructions.

Can I drink alcohol after the procedure? In moderation, it does not interfere with the eye's healing. Avoid it on the day itself if you have had sedation, and take care not to rub your eyes or fall.

Can I stay at altitude? After a conventional implant, altitude poses no particular problem. Stays in the mountains are possible from the first few days with sunglasses. If gas has been injected into the eye for another operation, specific restrictions apply; this is not the case for an implant alone.

What if I forget a drop? Use it as soon as you realise, then return to the normal schedule. Do not use two at once. If you often forget, use reminders on your phone or a chart.

Should I wait between two different drops? Yes, about five minutes, so that the first drop is not washed out by the second. Close the eye gently for a minute after each drop.

Can follow-up take place near home? Often, yes, for later check-ups, with your usual ophthalmologist, in agreement with the surgeon. The check-ups the next day and in the first week are generally carried out at the centre that performed the operation.

Side effects and risks

What is posterior capsule opacification ("secondary cataract")? It is clouding of the capsule surrounding the implant, months or years after the procedure. It causes a gradual loss of vision. It is treated in the consulting room, in a few minutes and painlessly, with a YAG laser. It is not a recurrence of the cataract.

Is YAG laser treatment risky? It is a very safe procedure. After the laser, floaters may appear for a few days, and eye pressure is checked. The risk of retinal detachment is very low but slightly increased in highly short-sighted people. It is covered by basic insurance.

Do halos disappear? With a multifocal, halos around lights at night diminish markedly within a few months in most patients, as the brain adapts. They do not always disappear completely. If they remain very troublesome, treatable causes such as dryness or posterior capsule opacification are looked for.

What is dysphotopsia? It is the perception of unwanted light phenomena: reflections, arcs of light or a crescent-shaped shadow at the side of the visual field. It is common in the first few weeks and usually disappears spontaneously. Rarely, it persists and may require an additional procedure.

Can the result be imprecise? A small residual refractive error is possible, despite precise measurements. It is corrected with light glasses, supplementary laser or, more rarely, an additional implant or an exchange. Ask about the conditions for these corrections before the procedure.

What is the risk of infection? Infection inside the eye is very rare thanks to disinfection and the antibiotic placed at the end of the procedure, but it is serious. Increasing pain, significant redness and loss of vision in the following days require immediate medical attention.

Which signs require urgent consultation? Increasing pain, significant redness, a sudden drop in vision, flashes of light, a shower of floaters or a curtain in the visual field. In these cases, contact the team or an eye emergency department the same day.

Can the implant cause glaucoma? A rise in eye pressure can occur after the procedure, generally temporary. With a poorly sized phakic implant, it may be more lasting. Check-ups measure the pressure. Patients who already have glaucoma receive suitable follow-up.

Are the corneal cells at risk? Any intraocular surgery causes a small loss of cells from the inner surface of the cornea, without consequences in most patients. With some phakic implants, the loss may continue, hence regular cell counts during follow-up.

Can the implant be changed if I am not satisfied? Yes, it is possible, ideally in the first few months before the capsule becomes too adherent. An exchange is more delicate than a first implantation. It is reserved for significant dissatisfaction, after treatable causes have been ruled out.

Price and insurance

Is cataract surgery reimbursed? Yes, when medically indicated, by compulsory health insurance, with a standard implant, under the usual deductible (franchise) and co-payment (quote-part) rules. Supplements for premium implants and certain tests remain at your expense.

Are multifocal implants reimbursed? The cataract procedure is covered, but the extra cost of the multifocal implant and associated tests is generally at the patient's expense. Ask for a quote that clearly separates the two parts.

Is the toric implant reimbursed? With a cataract, the procedure is covered; the supplement for the toric implant is often at the patient's expense, depending on the facility and the situation. Find out before the procedure and ask for a written answer.

Are phakic implants reimbursed? As a rule, no: they fall under refractive surgery, at the patient's expense. Exceptions can be discussed for certain particular medical situations, on prior request to the insurer.

How much does a phakic implant cost? In relative indices, on a base of 100 for clear lens exchange with a monofocal implant, a posterior chamber phakic implant is around 120 to 160 per eye, and a toric version around 135 to 175. Differences between cities appear on our price page.

How much does clear lens exchange cost? With a monofocal implant, it serves as the reference in our comparisons, at an index of 100 per eye. With a trifocal implant, allow about 130 to 170. It is refractive surgery, entirely at the patient's expense.

Is the femtosecond laser charged as an extra? Often, yes, as an option. It is not essential for a good result. Ask whether it is included in the quote and what benefit the surgeon expects from it in your case.

Is Geneva the most expensive city? Geneva serves as the point of comparison and is among the cities with the highest fees for the private part, along with Zurich. Elsewhere, the differences are often 5 to 20%. For covered cataract surgery, the differences are small.

Does supplementary insurance contribute? Some policies cover part of the supplements for premium implants, free choice of facility or refractive surgery. Conditions vary greatly; check your policy and ask for written confirmation before the procedure.

Particular situations

Can a multifocal implant be fitted with glaucoma? It is often not advised if the glaucoma is advanced, as it reduces contrast and can interfere with visual field monitoring. With early, well-controlled glaucoma, an extended depth-of-focus implant can sometimes be discussed. The decision is made with the specialist managing your glaucoma.

And with macular degeneration? A monofocal implant is preferred, as multifocals reduce contrast, which is already reduced by the disease. Cataract surgery can improve vision if the cataract contributes, but it does not treat the macula.

Can people with diabetes receive an implant? Yes. Diabetes must be well controlled and the retina examined and, if necessary, treated before the procedure, as the risk of macular oedema is higher. Close follow-up is put in place after the operation.

Can an implant be fitted after retinal detachment? Yes, but the assessment is more complex, particularly implant calculation if the eye has been operated on. The choice is made with the ophthalmologist managing your retina.

Can a child receive an implant? In some congenital or traumatic cataracts, implants are fitted in children, in specialist paediatric centres. Refractive implants, however, are not fitted in children or adolescents.

Can an implant be fitted after a corneal transplant? It is possible, with a more delicate calculation and a suitable choice of implant, often monofocal. The health of the transplanted cornea's cells is carefully assessed.

And with dry eye? Dryness must be treated before the measurements, as it skews them. After the procedure, it may worsen temporarily. Severe dryness makes multifocal implants less suitable, as it degrades image quality.

Can I have surgery with amblyopia? Yes, but the amblyopic eye will not exceed its previous maximum vision. The choice of target and implant takes the dominant eye into account. Multifocals are generally avoided in an amblyopic eye.

Where to have surgery in Switzerland

Who fits intraocular lenses in Switzerland? Ophthalmologists holding a specialist title who perform anterior segment surgery. Phakic and premium implants are mainly offered in refractive surgery centres. Check the title in the federal MedReg register.

Where can I have cataract surgery near home? Cataract surgery is available in almost every canton, in hospitals, eye clinics and outpatient centres. Proximity makes the check-ups the next day and in the first week easier, as well as the operation on the second eye.

Where can phakic implants be found in Switzerland? Mainly in refractive surgery centres in the major cities: Geneva, Lausanne, Bern, Basel, Zurich, Lucerne, St. Gallen, Lugano and a few others. Allow for the manufacturing time of a custom-made implant.

Can I consult in French in German-speaking Switzerland? Often, yes, in the major cities. Check when booking. When choosing an implant, it is important to understand the explanations fully; do not hesitate to ask for a consultation in French.

How do I choose between two centres? Compare the surgeon's experience with the planned implant, the quality of the assessment, the clarity of the explanations about trade-offs, how follow-up is organised, the conditions in the event of a residual error and the transparency of the quote. A second opinion is a normal step.

How many check-ups should I plan for? Generally the next day, at one week, at one month and at three or six months, for each eye. As the two eyes are often operated on a few days apart, several check-ups can be combined.

Can Medespoir guide me? Yes. Send us your latest glasses prescription, any eye reports and a few words about your visual needs. An ophthalmologist will give you a first opinion and we will direct you to suitable centres, in your region and your language. Free and without obligation.

Send us your latest glasses prescription, any eye reports and a few words about your visual needs. An ophthalmologist will give you a first opinion and an estimate. Free and without obligation.