Patients Have Many Lens Choices After Cataract Surgery

Cataract surgery is both simple and complex. It’s simple because it’s a well-tested procedure, the most commonly performed surgery in the United States. 3.7 million people each year get the lenses they were born with replaced by artificial implants. Yet it’s also complex, because patients have several lens choices after cataract surgery offering different perspectives.

Lens choices after cataract surgery

Why Do We Need Cataract Surgery?

Cataract surgery is a unique opportunity to improve your vision. The surgery doesn’t only remove the clouded lens in your eye, known as a cataract. It also lets the surgeon change the overall refractive state, the way light bends when it passes through your lens.

Astigmatism (imperfect curvature of the lens or cornea), myopia (near-sightedness), and hyperopia (far-sightedness) are the most common refractive errors among adults. Patients compensate for them with eyeglasses or contact lenses, especially for clearer distance vision.

By the time a visually significant cataract has developed, nearly all patients also have some form of presbyopia, the inability to adjust focus. That’s most commonly experienced as a loss of near vision and/or the requirement for reading glasses or bifocal spectacles.

Cataract surgery removes the natural lens and replaces it with a plastic lens implant known as an intraocular lens (IOL). The eye’s refractive state can be modified by adjusting the power of the IOL. Advanced technologies such as toric lenses, extended depth of focus (EDOF) lenses, and multifocal (MF) lenses offer additional solutions to correct astigmatism and presbyopia.

Most patients can take advantage of any of these options. However, patients with certain ocular problems may not be good candidates for specialty lenses or IOL strategies. These issues include dry eye, corneal scarring and retinal issues. And patients in very poor health generally may not be able to undergo cataract surgery.

Choosing the Right Lens for You

You and your surgeon will discuss your lens choices after cataract surgery along with refractive targets during surgical planning. For the first time in your life, you’ll be able to decide how you want to see the world. Be sure of your choice, though: IOL replacement surgery (aka IOL exchange) has additional risks and limitations and remains a last resort, used only in rare circumstances.

Many patients elect to set their best uncorrected vision for distance, a condition known as emmetropia. For some patients, this matches what they're accustomed to and is an easy decision. For others, such as those who are myopic prior to cataract surgery, picking an emmetropic target opens up a new world of vision. They can now see an alarm clock across the room, watch TV or drive, all without glasses. However, they’ll often require nonprescription reading glasses to see things up close.

Some myopic patients value the ability to see up close without glasses and pick a different goal for their surgery. In that case, glasses will be required to see clearly in the distance. For a patient who loves to read in bed or work closely with handheld devices, this goal may be appealing. Both of these kinds of IOLs are known as monofocal lenses.

Less Common Lens Choices After Cataract Surgery

A surgeon operating on a patient with a significant amount of astigmatism may suggest a toric lens to further improve the clarity of uncorrected vision. A toric IOL has markers indicating the correcting axis of the lens and must be precisely positioned, so this axis aligns with the steepest part of the cornea. (Astigmatism can also be corrected after surgery with glasses.)

EDOF or MF implants can provide clear distance AND near vision through the same implant, giving a patient complete independence from glasses and operating in a similar fashion to bifocals. Contact lens wearers who use monovision contacts – adjusting one eye for distance and the other for reading – can have this configuration built into their eyes during cataract surgery. Please note: Toric and multifocal lenses aren’t covered by most insurance. Monofocal lenses (either distance or near vision) most often are covered in the cost of surgery.

To schedule a cataract consultation at Horizon Eye Care, call 704-365-0555 Monday-Thursday, 8 a.m. to 5 p.m., or Friday, 8 a.m. to 3 p.m. The optical department closes on Fridays at 2:30 p.m.