Can my astigmatism be corrected with cataract surgery?

Yes!  There are two options for fixing astigmatism.

[1] A special implant (toric) - corrected concurrently with cataract surgery.  70% of people could benefit and see better post surgery with an implant that fixes corneal astigmatism.

[2] LASIK post cataract removal - corrected once stable after cataract surgery (~3-6months)

Not all surgeons off this correction.  Talk to your Optometrist prior to surgeon referral.

Ultrasound vs. laser … Is cataract surgery not always done with laser?

There is a common misconception that all cataract surgery is done with laser.  Perhaps because the procedure is so quick and efficient or that there is so much advertising for LASIK refractive surgery… but patients often confuse the two surgeries and how the procedure is done.

The two main clarifications that I make with patients are:

1] Cataract Surgery is not LASIK.   LASIK is a laser-based procedure to reshape the cornea (the outer surface) of the eye.  Cataract surgery removes the cloudy lens from inside the eye and replaces it with an implant.   In some circumstances these two procedures can be combined (not concurrently) but they are different procedures requiring different technologies and surgeon skill sets.

2] Cataract removal surgery typically uses ultrasound energy (not laser) to break up the natural lens to remove it.  However, laser energy can also be used for this purpose.  This is an increasingly popular option … but it is not widely done in this region - Ontario. 

What are the pre-surgery eye measurements required for implants?

There are several eye measurements that a surgeon will take into consideration for your surgery.

1] The refraction (your glasses prescription)
2] The curve of the cornea
3] Measurements of the length of the eye (ultrasound)

These are all used to determine the best implant.   In this region, some of these measures are come with extra charges.  I always recommended these measurements be taken (even if a charge) because it does improve the accuracy of the final post-surgery glasses prescription (or lack thereof!).

I have heard of doing one eye for distance and one eye for near?

Monovision is a method to fit contact lenses or determine the power of implants which intentionally creates clarity in the distance in one eye and clarity up close with the other eye.   It works well with early focusing difficulties but tends to fail as one requires increasingly different close/far powers with age.  Because implants do not have any dynamic focusing ability, the near/far powers are quite different.

In my experience this arrangement is not suitable for implants UNLESS the patient currently, successfully wears monovision-fit contact lenses.

It would be possible to trial contact lenses prior to surgery to simulate monovision but sometimes the cataract cloudiness is so significant that a proper trial is a challenge.

Why can I not wear my old glasses after cataract surgery?

The new implant’s focus power is different that your old natural lens’ power.   Your glasses need to change to match the new focus power.

Often your lenses in your glasses can be swapped out. 

Sometime immediately after surgery (too soon for an Rx)... it is better to pop out one spectacle lens and wear the glasses mono!

“Before my cataract surgery, I used to be able to read without glasses?!”

If you are someone who can/could read without glasses before cataract surgery.  Your vision will be flipped up-side-down.  Instead of having good uncorrected close vision… your distance vision will be good uncorrected after cataract surgery.

This is a common point of anxiety of folks that think something is wrong.

Although this reversal is always well discussed by eye care provider teams, folks are still always shocked how poor that their close vision is after cataract surgery.  This is due both to the power change but also can be due to larger pupils post-surgery which change the optics of your eye.

Can I drive without my glasses?

Often distance vision is improved enough to pass province/state driving requirements.  However, be careful that you actually remove any previous restrictions from your driver’s license!

This can usually be done directly at a drivers’ centre or through your Optometrists office.

“Can’t I just wear cheap dollar-store readers after my cataract surgery?”

Over-the-counter reading glasses will not hurt your eyes.  This is not a health question. 

It is a pet peeve of mine that surgeons will sometimes say… “You will only need drug-store readers after surgery”.   I feel that this is an unfortunate communication for two reasons.

#1 - There is always a better optical correction than drug-store readers!   Whether it be the optics of the lens, a minor astigmatism correction, right/left Rx differences, prism or multifocal functionality of the lens… pre-fab readers are the most unevolved correction available.  There are plenty of superior options.

#2 – When a patient hears that they only need reading glasses… that can get translated to … “I do not need an annual eye exam”.   This is dangerous because glaucoma and macular degeneration and other eye problems are independent of cataract.  They should be checked too!