You have a friend named Rita whom you’ve known since eighth grade. Fast forward a few decades (or six), and now you’re in your 70s. Rita has always had thick eyeglass lenses but then she had cataract surgery. And suddenly her glasses aren’t so thick anymore. In fact, she barely wears her glasses. So, does cataract surgery mean no more glasses? Well, it depends.
What are Intraocular Lenses?
You might be surprised to learn that whether or not you’ll still need glasses after cataract surgery depends largely on a tiny, artificial lens.
When you have cataract surgery, your eye’s natural lens—called the crystalline lens—is removed because it has become cloudy (this cloudiness is what we call a cataract). Unfortunately, the cloudy part can’t just be removed like a skin spot; the entire lens has to go.
But since your natural lens plays a crucial role in focusing light and helping you see clearly, it must be replaced. That’s where an intraocular lens (IOL) comes in. This is a small, clear, artificial lens made of plastic that is inserted into your eye during cataract surgery.
Your surgeon places the IOL into the same location where your natural lens used to sit—inside a small membrane called the capsular bag. Even better, the IOL is custom-calculated to match your specific vision needs.
In most cases, the IOL is designed to correct your distance vision, meaning that many people who once needed glasses or contacts for seeing far away (whether they were nearsighted or farsighted) no longer need them after surgery.
But It Still Depends…
When you have your initial consultation with your cataract surgeon, discussing your IOL will lead to a significant decision. This is because you have a choice. As mentioned above, most people will choose to have clear vision for far distance – but this often means they still need glasses for the computer and reading. Alternatively, some people who do a lot of reading may choose to have their IOL calculated to provide clear vision up close and they will put on glasses for far distance vision instead. Or, if you want to get creative, some people opt to have one IOL that gives them long distance vision in one eye and an IOL that gives them near vision in the other eye. This is an arrangement called monovision, and it might sound strange but many people get along with it quite well.
Many surgeons will also offer more advanced options such as multifocal or extended depth of focus intraocular lenses. These have been cleverly engineered to provide a range of clear distances within the single IOL, so that you can see clearly to watch TV without glasses and to read a text on your phone. This really minimizes dependence on glasses after cataract surgery.
But still, it depends.
Despite the advances in technology, people who have paid the premium for multifocal IOLs may still find they’d like their vision to be a little clearer for certain activities. Unlike your natural focusing system during your younger days, which would focus either on distant objects or near objects or anything in between, a multifocal IOL means your brain is looking through a focus for both distance and near at the same time. Over time, your brain does adapt to this new experience of vision, but don’t expect it to be as sharp for either distance or near compared to when you were 20 years old.
Because of the optics of a multifocal IOL, you may find your contrast sensitivity a little compromised. This means that the edges of objects may seem soft or fluffy when you view them, or it might be harder to make out the outline of a rock on the footpath at sunset. Tiny print is still, well, tiny.
So even though a multifocal IOL may have almost gotten rid of the need for you to wear glasses after cataract surgery, it’s still only almost. You may still prefer to wear a pair of distance glasses for driving at night or a pair of reading glasses to figure out the allergens on a box of cookies.
If you’re approaching the time for cataract surgery, you’re also approaching the time when you need to decide what sort of IOL you’d like. How do you choose? A good starting point would be to schedule a consult with your cataract surgeon who should be able to discuss IOL options and cataract surgery risks.