As patients reach middle age, the lens in the eye becomes firmer and less able to focus for near tasks such as reading. This phenomenon, known as presbyopia, is corrected with reading glasses or bifocals. During cataract surgery, a standard intraocular lens (IOL) that has a single focal point is implanted. Most patients opt to have their vision set for distance and rely on glasses for near vision. Some patients, especially those who have been nearsighted their whole lives, choose to retain good near vision without glasses and use glasses for distance activity. There are three options available for near vision correction following cataract surgery.
1. Reading glasses. If you choose to see at distance with your new lens implants, then you will need reading glasses or bifocals following surgery.
2. Monovision. Some patients have had monovision correction with contact lenses or laser vision correction, where one eye is corrected for distance and the other for near. If you have tried this in the past and have tolerated it well, then this arrangement can be kept following cataract surgery.
3. Presbyopia-correcting intraocular lenses. There are two technologies that offer correction for near vision, the multifocal lenses such as ReSTOR, and the accommodating lenses such as Crystalens. It is important to realize that there is no guarantee that patients who receive any of these lenses will be “glasses-free.” In the FDA studies of these lenses, 80% of patients never wore glasses, while 3% always wore glasses. These premium lifestyle lenses are not covered by insurance. Financing is available for your convenience. Those patients who still need glasses for their tasks despite these premium lenses may choose to have laser refractive surgery (e.g. LASIK) to further improve their vision. Your cataract surgeon will refer you to an affiliated refractive surgeon. There will be an additional cost for any laser refractive surgery following cataract surgery.
a. Multifocal lenses. ReSTOR is best for patients who want good up-close vision for reading and hobbies such as sewing and knitting. These lenses can occasionally cause glare and halos during night driving. Patients usually adapt to this after 3 months, but there is a small number of patients that may still be bothered by halos.
b. Crystalens also offers good vision for distance and intermediate, but there may be some need for reading glasses for prolonged reading periods.