The Need for Eyeglasses After Cataract Surgery 

Eyeglasses are required for correcting blurred vision due to “refractive errors” of the eye.  Refractive errors are conditions in which light does not come to a sharp focus on the retina.  Refractive errors have traditionally been corrected with eyeglasses, contact lenses, and refractive surgery such as LASIK.  Refractive errors consist of nearsightedness, farsightedness astigmatism and presbyopia.

• Nearsightedness: Distant images are blurry.
• Farsightedness: Near images are blurry as well as distant images.
• Astigmatism: This often occurs along with nearsightedness and farsightedness.  It is due to the oval shape of the cornea or lens.  It causes both distant and near objects to be blurry.
• Presbyopia: The focusing muscle in the eye changes the shape of our lens to help us focus on near objects.  This ability gradually decreases after age 40.

Traditional intraocular lens implants placed in the eye at the time of cataract surgery do not correct astigmatism.  Furthermore their shape cannot be altered by the focusing muscle, so one is rendered presbyopic.  Very careful measurements are made prior to surgery to minimize any nearsightedness or farsightedness, although some amounts of these refractive errors may still remain after surgery.  Because of these reasons many patients require eyeglasses for both distant and near objects after cataract surgery.  Sometimes one eye is set for distance and the other for near so as to get around the problem of presbyopia.  This is referred to as “Blended Vision.”  The vast majority of people do very well with this, although a small few have difficulty adjusting. 

Refractive Surgery to Reduce or Eliminate Eyeglasses After Cataract Surgery  

Cataract surgery is usually covered by your insurance, whereas refractive surgery is not.

Limbal Relaxing Incisions (LRI`s): This is for the treatment of astigmatism.  It does not correct nearsightedness or farsightedness.  One or two tiny relaxing incisions are made at the edge of the cornea at the time of cataract surgery.  These help round out the cornea and decrease the amount of astigmatism.  No extra recuperative time is involved.  LRI's are not as accurate as Laser Vision Correction techniques, but they are less expensive and easily performed by the surgeon at the time of cataract surgery.  The costs of LRI`s are not covered by any insurance and will be billed separately to those patients who choose to have them.  After surgery, if even clearer vision without eyeglasses is desired, Laser Vision Correction can then be performed.

Toric IOL: This is a special type of implant that corrects astigmatism. Although careful measurements are made prior to surgery, the cataract surgery itself is very similar to standard cataract surgery.  As with LRI's the results are less accurate than Laser Vision Correction, and the extra expense not covered by medical insurance is less than Laser Vision Correction and more than for LRI's.

LASIK and PRK: These are Laser Vision Correcting procedures.  They reshape the corneal window of the eye  reducing all refractive errors (nearsightedness, farsightedness and astigmatism).  Both LASIK and PRK are very accurate for getting the eyes to see clearly without eyeglasses at a specific distance.  LASIK and PRK are performed at our Westerre Commons office. The same laser is used for both procedures.  Anesthetic eye drops are first instilled in the eye. With LASIK a thin corneal flap is first made with a laser and then another laser  is used to change the shape of the underlying cornea. With PRK the laser is used on the surface of the cornea without first creating a flap.  For some people one or the other procedure works best; this is determined by Dr. Lipstock at the time of your exam.  LASIK and PRK can be performed a few months after cataract surgery, and they can also be used to fine tune the results of LRI's or Toric IOL's.  

Blended Vision: When having cataract surgery, blended vision (setting the dominant eye for distance and the nondominant eye for near) is usually utilized to get around the problem of presbyopia.  Most people do great with blended vision.  For those who have no significant astigmatism blended vision may be successfully attained with standard cataract surgery without the use of LRI's, Toric IOL's or LASIK or PRK. However if the intended refractive result is not exactly as targeted, it can usually be fine tuned with LASIK or PRK.  For those few who can't adjust to blended vision with its difference between the two eyes LASIK or PRK can be performed to either reduce or eliminate the blended vision. Both eyes are then set more for distance, and reading glasses are used more for near activities. 

For more information about LASIK, PRK,  LRI's, Toric IOL's and blended vision please refer to our other educational materials or speak to a member of our staff.  

Presbyopic IOL's: There are special implants designed to help each eye to see both near and far.  One group of these implants is known as Multifocal IOLs.  The other is Accommodating IOLs.  The cost of cataract surgery is usually covered by medical insurance less co-pays and deductibles (please ask if you do not have insurance coverage or if we do not participate with your provider).  Follow up visits for 90 days are usually included.     

1.)   Multifocal IOLs:  Two such IOLs available in the U.S. are Restore and Rezoom.  These are like bifocal implants.  There are some zones in the implant that are focused for seeing near and some for seeing far.  The problem with the IOLs is that a large number of patients experience annoying glare and halos.  Also some patients experience a general hazy kind of vision.  Because of these side effects, Dr. Lipstock does not recommend Multifocal IOLs.

2.)   Crystalens: Crystalens is an implant that uses a breakthrough technology that enables the same eye to see both far and near without eyeglasses.  This intraocular lens acts similar to the natural lens of a young individual that can move and change its shape to focus on near objects.  It is not quite as effective as a 20 year olds ability to see up close but it is a significant improvement over other intraocular lenses in this regard. In general the Crystalens allows clear vision for distance and an ability to see near objects at an intermediate range such as a computer but perhaps not the small print in a telephone book.  When a Crystalens IOL is used in both eyes and is combined with Blended Vision then most patients can attain the ability to see objects at far, intermediate and near.  With this approach one can obtain maximum freedom from eyeglasses.

LRI's, Toric IOL, LASIK, PRK, Blended Vision, Multifocal IOL's and Crystalens are additional procedures that have individual costs not covered by insurance. Please ask one of our associates for details.  If a significant refractive error remains after either LRI's or Toric IOL, LASIK or PRK can be performed to fine tune the result.