Glasses and cataract surgery ...

what are your main options?

David Kinshuck

 both eyes +1.0d or -1.0d

 both eyes +5.00 or more
 both eyes -3.0d

 both eyes -8.0d or more

 monovision

General rules

 As a rule both eyes have to balance, that is your prescription should not differ more than
3 dioptres between both eyes.
 The surgeon will often aim for 0d (or -1.0d if you already have a 'minus' prescription).
 The measurements of your eye are never completely accurate, so if the surgeon aims for
0d he may get -1.0d - +1d, and a few patients will have an even greater variation.
 There is always some astigmatism after surgery....getting to an accurate 0d is nearly
impossible.
 The surgeon will try to keep your prescription similar between both eyes, and try and
achieve 0.0d, so you will not need distance glasses.
 Reading glasses need an extra +2.5 or so to your distance prescription. So even if you
have no distance glasses, you will still need reading glasses
 this is just an explanation, and will not be accurate for all patients

Here are some common examples of options

Case1
If your prescription is about +1.0d or
-1.0d. in both eyes

 Before surgery you did not wear glasses for distance vision but needed reading glasses.
 The surgeon will try to keep your prescription similar, that is to try and achieve 0.0d, so
you will not need distance glasses.
 You will of course need reading glasses, which will be an extra +2.5 or so to your
distance prescription.
 These glasses may be reading glasses only, varifocals, or bifocals. (Which of these you
will be given depends on what you want/what your optometrist advises.)

Case 2..If both eyes are +5.00 or more

Here there is a dilemma. If the eye being operated on achieves 0.00 (that is perfect
distance vision without glasses), and the other eye is still +5.00, both eyes may not
'balance'.

So the options include,

1. Operating on the first eye and achieve 0.00; then operating on the second eye as well (a
different day), so both eyes achieve 0.00. This is the usual option.
2. trying to balance both eyes, so the surgeon may try to achieve +3.0d in the operated
eye...both eyes should still balance. You will still need glasses, but they will not be as
thick. (And you will not need a second operation to balance the two eyes.)
3. A much less common option now... operating on the first eye and achieve 0.00; then
using a contact lens in the other eye to balance both eyes.

Case 3..If both eyes are -3.0d

Here there is another dilemma. If the eye being operated on achieves 0.00 (that is
perfect distance vision without glasses) you will need reading glasses in that eye.

So the options include,

1. trying to achieve -3.0d after the operation so there is no change...you will need distance
glasses, but see well for reading without glasses. Often varifocals are best. (And you will
not need a second operation to balance the two eyes.)
2. trying to achieve 0d after the operation; but then you may not balance (and may need
the other eye operating on) and you may need reading glasses
3. Operating on both eyes and try and achieve 0d in both eyes, so you will not need
distance glasses. You will of course need reading glasses, which will be an extra +2.5 or
so to your distance prescription, so you may need a separate pair of reading glasses or
varifocals.
4. Operating on one eye and try and achieve 0d. To balance the other eye, the other eye
may be prescribed a contact lens. Then you would not need distance glasses.
5. You would of course need reading glasses, which will be an extra +2.5 or so to your
distance prescription, so you may need a separate pair of reading glasses or varifocals.

Case 4..If both eyes are -8.0d or more

 Here there are several options

1. trying to balance both eyes, so the surgeon may try to achieve -5.0d in the operated
eye...both eyes should still balance. You will still need glasses, but they will not be as
thick. (And you will probably not need a second operation to balance the two eyes.)
2. trying to achieve -3.0d after the operation; both eyes may not balance though, and you
may need the second eye operating on to balance. But if you are -3.0d you will not need
reading glasses for that particular eye, although you will need distance glasses.
3. Trying to achieve 0d after the operation; both eyes will not balance though, and you will
usually need the other eye operating on. You will need reading glasses, but you will not
usually need distance glasses.
4. (In fact if detailed sight is needed as for driving, you may need distance glasses, but the
lenses should be thin.)

Monovision
This term describes the use of one eye for distance and one for reading. This is not very
popular, but works for some people described in more detail

 for best results the prescription will be less than 1.5d difference between the 2 eyes
 one eye for reading, one eye (the dominant eye) for distance
 try and determine the dominant eye and here. If there are bilateral cataracts, operating
on this eye will be appreciated the most.
 for prolonged reading glasses may still be necessary (to obtain binocular vision)
 personally I would not offer this option unless the patient is already using monovision
before surgery

Cases..others
Naturally there will be many patients who do not 'fit' the cases above, but this outline
helps you consider the options.
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Heart of England Trust

page edited Sept 2017
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