Cataract Surgery - How Do I Choose The Best Focus For My Eyes?

Cataract surgery is one of the most common surgeries performed in the United States. Nearly everyone develops a cataract if they live long enough. A cataract is a natural clouding of the lens in the eye. Cataract surgery removes that cloudy lens and replaces it with a clear artificial lens (an implant lens). Because the implant lens can be chosen to focus at different distances, you can choose how you would like your eyes to focus after surgery.

Start by thinking about how you spend your day. Consider your work, hobbies, driving, reading and other activities of daily living.

Distance vision covers everything beyond arm’s length — driving, watching television, walking through the house and recognizing faces across the room. In my experience, most people would like to see clearly at a distance without glasses.

Intermediate vision is roughly at arm’s length. The importance of intermediate vision has increased with the use of cellphones and computers, but it is also the distance we use when doing household chores like cooking, cleaning, folding laundry and personal hygiene.

Near vision is anything closer than arm’s length. This is important for reading fine print and medication labels, and for detailed crafts like needlepoint and other fine handwork.

The main options

Both eyes set for distance. When both eyes are optimized for distance, intermediate and near vision will be blurry, but over-the-counter reading glasses solve that inexpensively. Some patients prefer prescription progressive lenses that allow them to see clearly at all distances but require adjusting head position to get the glasses adjusted properly for the applicable distance.

Both eyes set for closer vision. This is an option for people who spend most of their time reading or working up close and who don’t mind glasses for driving and distance vision.

Monovision. One eye is set for distance and the other for intermediate or near. Some people can adapt to this option and can see well at distance and near without much need for glasses. Other people find it difficult to get used to and feel off-balance. With monovision, depth perception is slightly reduced as well. If you have worn monovision contact lenses successfully in the past, that is a good indication that you might do well with monovision after cataract surgery.

Multifocal implant lenses. These are designed to provide distance, intermediate, and near vision from a single implant. Many patients are delighted and rarely reach for glasses. But there are tradeoffs: image quality is not quite as crisp as a single-focus lens, halos or glare around headlights at night are common, and some patients still need glasses for small print.

The light adjustable lens. This newer option takes a different approach. The lens is made of a special material that can be adjusted with ultraviolet light treatments in the office a few weeks after surgery. You get to test drive your vision and adjust it — improving distance, adding some near, or trying monovision — before the result is permanently locked in. It’s a particularly good choice for people who have had prior LASIK surgery, where hitting the focusing target on the first try is harder to predict. The tradeoffs are that these implant lenses require several extra office visits for the light treatments, you must wear special ultraviolet-protective glasses until the lens is locked in, and it typically carries an additional out-of-pocket cost.

A few honest realities

No lens perfectly reproduces the lens of a young person with good vision. Every option involves a tradeoff. Your other eye conditions such as dry eye, macular degeneration and prior surgery also affect which choices are best, and your surgeon will take these into consideration.

The bottom line

There is no single best lens or focusing setup after surgery. The choice depends on your priorities, eye history, and your desire to be free from glasses for certain activities. Have a conversation with your eye doctor to determine what is right for you.

Dr. Allan Rutzen can be reached at Rutzen Eye Specialists & Laser Center, located at 489 Ritchie Highway, Suite 200, in Severna Park. Learn more about cataract surgery at www.rutzeneye.com or by calling 410-975-0090.