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 Will I Need Glasses After Cataract Surgery?

Come learn how you can eliminate glasses with cataract surgery!

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Imagine being able to see clearly after cataract surgery without the need of putting on glasses in the morning. Imagine not having to worry about reaching for your glasses for reading or driving. Now, imagine these thoughts becoming a reality through the assistance of advanced cataract procedures performed by Dr.’s Lipstock and Stevens at Lipstock Cataract Center.

Dr.’s Lipstock and Stevens perform a variety of cataract surgery procedures to help cataract surgery patients solve the vision problems of nearsightedness, farsightedness, astigmatism, and presbyopia (the need for reading glasses).

NEARSIGHTED: When an eye is nearsighted, the cornea and lens are too strong for the length of the eye, so light comes to a focus before it hits the retina. Because of this, images are blurred.

FARSIGHTED: In farsighted eyes, the cornea and lens are not strong enough for the length of the eye, so light comes to a focus behind the retina, so images are blurred.

ASTIGMATISM: When an eye is astigmatic, the cornea is oval instead of spherical creating two focal points and thus blurred vision.

PRESBYOPIA: Presbyopia is the inability to see near objects such as print in books, phones or computers. Presbyopia comes on in one`s 40`s and gradually worsens over the years. Presbyopia also occurs in all people after cataract surgery regardless of their age.

Dr.’s Lipstock and Stevens’ procedures can help reduce or eliminate eyeglasses after cataract surgery.

 

Types of Cataract Surgery to Correct Astigmatism

 

1. LIMBAL RELAXING INCISIONS (LRIS) FOR ASTIGMATISM

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 the laser vision correction techniques known as LASIK or PRK or as accurate as the Light Adjustable Lens, but they are less expensive and performed by the surgeon at the same time as cataract surgery.

The costs of LRI’s are not covered by any insurance and will be billed separately to those patients that choose to have them.  After cataract surgery, if even clearer vision without glasses is desired, Laser Vision Correction may then be performed.

 

2. TORIC IOL FOR ASTIGMATISM

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This is a special astigmatism correcting intraocular lens implant. Although careful measurements are made prior to surgery and more precise placement of the lens is required than with a standard IOL, the cataract surgery itself is very similar to standard cataract surgery. The results of Toric IOL’s are more accurate than LRI’s, but not as accurate as astigmatism corrected by LASIK or PRK or the Light Adjustable Lens. Toric IOL’s cost is not covered by medical insurance and will be billed separately. After surgery, if even clearer vision without glasses is desired, LASIK surgery may then be performed.

 

3. LASIK or PRK

These are laser vision-correcting procedures that are typically performed on patients who do not have cataracts. They can also be performed after cataract surgery to eliminate residual refractive errors (nearsightedness, farsightedness and astigmatism). They reshape the corneal window of the eye, reducing all refractive errors.

 

4. Light Adjustable Lens (LAL)

This is the IOL our doctors most highly recommend. It is an amazing new technology invented by a Nobel Prize winning American engineer. The LAL eye surgery provides the clearest vision of all without eyeglasses.

In the FDA approval study (the LAL is fully FDA approved), those who received the LAL were twice as likely to achieve 20/20 vision than those who received a standard IOL.  Furthermore, the LAL is the only IOL that is adjustable after cataract surgery.  If at 3 weeks after surgery vision without eyeglasses is blurry due to a residual refractive error such as nearsightedness, farsightedness, or astigmatism the patient is seated at a light delivery device (LDD). The doctor then shines the preprogrammed ultraviolet light onto the eye painlessly for 90 seconds. This alters the shape of the LAL and the refractive error is either eliminated entirely or greatly reduced. No LRI’s or Toric IOL’s are needed to correct astigmatism because the light treatment will accomplish that.

   

BLENDED VISION for Cataract Patients:

THE WAY TO ACHIEVE INDEPENDENCE FROM READING EYEGLASSES

The first goal of cataract surgery is to enable one to see clearly with eyeglasses. The second goal is to minimize or eliminate one’s need for eyeglasses.

 

What is Presbyopia?

Presbyopia is the decrease of the focusing muscle in the eye’s ability to change the shape of our lens to help us focus on near objects. This ability gradually decreases after age 40.  Even if you do not have nearsightedness, farsightedness or astigmatism, near vision becomes increasingly blurry after age 40.  Reading glasses or bifocals are needed to see up close if you have become presbyopic.

Blended Vision

During standard cataract, the natural lens is replaced with a plastic intraocular lens (IOL). The standard “Monofocal” IOL used renders one presbyopic. If the IOL power is chosen for clear distance vision without eyeglasses, one will need reading glasses for near vision.

One approach to address presbyopia after cataract surgery is to set the dominant eye for distance vision and the non-dominant eye for near vision without eyeglasses. This is called BLENDED VISION. The idea is that with both eyes open one will not be aware of the difference between the two eyes and both distant and near objects will appear clear without eyeglasses.  As long as one does not target the near eye to be able to see very small print even in dim light then the brain is able to blend the two images together quite well for the vast majority of people. Near and far images appear clear and the need for reading glasses is greatly reduced.  This works very well, and it avoids the hazy vision and severe halos that can sometimes exist with multifocal and extended depth of focus IOL’s such as Panoptics and Symphony.  Some patients with blended vision may notice halos at night while driving, but simple night driving glasses eliminates those halos.

Benefits of Blended Vision

What are the benefits of blended vision?

  • Solves the problems of cataracts and presbyopia (over-the-counter reading glasses may be necessary for very fine print or reading in very dim light)
  • Cost is approximately 1/5th the cost of premium Multifocal or Extended Depth of Focus IOL’s
  • Excellent vision outcomes

In a trial of Blended Vision performed by Dr. Lipstock and presented as a formal paper at the 2011 American Society of Cataract and Refractive Surgery annual international meeting, over 99% of patients reported they were happy with the results.

 

Light Adjustable Lens (LAL) for Presbyopia

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The LAL is the most precise IOL available and, as discussed above, it is the only IOL that is adjustable after cataract surgery. It therefore enables the only truly customizable result. This comes into play when not only considering blended vision for cataract surgery but also how much blended vision. One could ask the doctor to program the Light Delivery Device for blended vision. If after a few days the patient wants more near vision or better distance vision the patient is simply seated at the LDD again and the treatment is repeated. These adjustments can be repeated up to three times thereby enabling a truly customized result for your unique lifestyle requirements.

 

Multifocal IOLs for Presbyopia

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The latest version of this type of IOL is called Panoptics. It enables each eye to see without glasses both at distance (driving), intermediate (computer) and near (books and medicine bottles).  For those who want the most independence from glasses this IOL would be an excellent choice.

However, most patients will experience halos around lights or difficulty driving at night and for some patients (approximately 5%) these halos are severe. Also occasionally some patients experience a hazy type of vision with this type of IOL. Most patients adapt over time to these symptoms and enjoy their life without much need if any for glasses. 

However, some do not adapt and in some cases the IOL may need to be surgically exchanged for a different type. These IOL’s are also very sensitive to residual refractive errors, so an increased number of patients require LASIK or PRK after cataract surgery to fine tune the results and enable visual clarity.

 

Extended Depth of Focus IOL’s for Presbyopia

This type of IOL, called Symphony, enables each eye to see without glasses at both distance and intermediate but not at near for small print. For small print a low power drugstore reading glasses are usually required. 

Symphony gives a somewhat better quality of vision than Panoptics, but with this lens about 5% of patients can also experience severe halos and starbursts around lights. In general, the near vision ability with Symphony is not as good as many patients obtain with blended vision.

To learn more about correcting nearsightedness, farsightedness, astigmatism, and presbyopia during cataract surgery, schedule a cataract exam with Dr. Lipstock today!