Cataract Surgery, Lens Implants, Reading Glasses, Monovision, and LASIK

Patients undergoing cataract surgery now have the option of implants which correct the need for reading glasses to various degrees — all involving some degree of tradeoff. LASIK can also be used to create monovision after cataract surgery if necessary.

A patient from Santa Maria today asked my how cataract surgery would affect her reading vision.

Patients undergoing cataract surgery have their natural lens removed and a plastic “implant” put in its place inside the eye. The strength of the implant can be adjusted to correct your prescription without using LASIK or PRK. For this reason, if you have visually significant cataracts (rather than very early and very mild cataracts), then it makes more sense to have lens replacement surgery than to have laser vision correction on the cornea.

When the implant is put into the eye, there are two broad categories to choose from: lenses that correct presbyopia (the need for reading glasses) and lenses that do not correct for presbyopia (monofocal lenses). Of the presbyopia correcting lenses (or “premium implants”), there are two sub-types: accomodating intraocular lenses and multifocal intraocular lenses. Examples of accomodating implants include the Crystalens and examples of multi-focal implants include the ReStor and the Technis Multifocal IOL.

There are tradeoffs in chosing any of these lenses. Monofocal non-accomodating implants offer the best possible distance vision, but they require reading glasses for seeing up close. Accomodating lenses often help for mid-range vision, but do not provide thrilling close vision. Multifocal lenses can give outstanding near vision, but often involve some sacrifice in visual quality at distance, particularly under dim light conditions.

After cataract surgery, many patients who selected monofocal implants (rather than presbyopia correcting implants) feel frustrated with their inability to see up close without reading glasses. One solution for these patients has been to perform LASIK or PRK on the non-dominant eye to help it read better up close by creating a degree of monovision. Monovision refers to having one eye for close and one eye for distance. Monovision, however, also involves a bit of a trade-off in which some distance vision and quality is sacrificed to gain better close visual performance. In the end, there still is no way to give lens replacement surgery patients after cataract surgery the quality of near, mid, and far vision that a healthy 25 year old with perfect eyesight enjoys. The good news, though, is that there are many options, some of which involve additional laser vision correction on the cornea such as LASIK afater cataract surgery, for patients who develop cataracts.

In my next blog, I’ll discuss an interesting new corneal laser technique which is neither LASIK nor PRK which may be of help to patients who have already had cataract surgery but still need reading glasses. This laser procedure, which is not yet approved by the FDA, is called “Supracor.”

Cataract Surgery, Lens Implants, Reading Glasses, Monovision, and LASIK

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