Q: I need to schedule cataract surgery pretty soon, as my driving is getting more difficult after dark. I hear that I will need to choose what kind of “implant” lens I will want. I have no idea how to choose!
A: This is without a doubt the most common question we hear as we plan cataract surgery for our patients. So, number one…..talk with your regular eye doctor, usually your Optometrist or Optometric Physician, as we specialize in vision correction. We are the most qualified professionals to guide decisions on vision matters.
There are three options for the “intraocular lens” or implant that is placed inside your eye after your natural cloudy lens is removed. And you are right, you will be asked to choose this critical aspect before your procedure. So let’s do a little homework:
- Distance only implants: This lens ( like a small rigid contact lens ) will replace your natural distance vision. Based on the measurements your eye surgeon takes, this lens is chosen in the prescription ( just like your glasses prescription ) to give your perfect distance vision. But it will not. The predicted lens should give you very good vision, certainly much better than your cloudy cataract vision, but rarely is it truly perfect. Many people as so happy with this improved eyesight that they tell their friends and family that they see “perfectly”. They usually do not really see 20/20, but they do see very well! Virtually all post cataract patients still have a mild vision prescription, and actually see better for distance with a little help from new glasses. And besides…..you will need prescription lenses for near vision, so almost always we prescribe progressive lenses to give you that really sharp vision for driving, along with your new close up prescription for reading.
- Monovision: This is a “system”, not a lens type, where we choose a distance vision implant for one eye and a near/reading implant for the other eye. Monovision works pretty well, but does not provide binocular vision….meaning your depth perception may be off. And while the near vision lens can be good for close reading ( generally about 15” away ) it is not ideal for computer screens ( generally 25” away ). My advice is if you are already one of those people who have been successfully using monovision with contact lenses before cataract surgery, then choose monovision for your implants too.
- Multifocal implants: This lens is designed in a bullseye or concentric ring pattern with both distance and near vision all built in. This sounds like the best of both worlds….and it can be. But our experience has found that while many patients do enjoy having near vision without readers, they often have less than ideal distance vision. This can be a major frustration for those folks, and is not easily corrected. You will also incur more out of pocket costs for this option. Yes, you could have another eye surgery to replace that multifocal implant, but this is far more difficult and risky than your first “regular” cataract procedure. Improving that distance vision for driving with new glasses or contact lenses is very difficult, in my experience.
I will add that many people having cataracts removed will receive unsolicited “advice” from friends and family. As with most medical advice from non-medical professionals, please take such advice with a grain of salt. Each person’s vision is different, and our vision needs are different. You and your regular eye doctor are best suited to discuss and decide your best post surgical vision correction, so when you return to them in a week or so after your procedure, your new vision correction can be prescribed for you.