While most people come away from cataract surgery feeling satisfied, a friend was recently disappointed by his results. He thought that after surgery—voila!—he would have perfect vision both up close and far away, with no need for glasses or contacts. In reality, that kind of result isn’t common with cataract surgery. In my friend’s case, the procedure greatly improved his ability to see where his golf ball landed, but he found that doing a crossword puzzle still required reading glasses.

So what happened? Perhaps my friend’s doctor hadn’t explained how cataract surgery really works—and hadn’t told him that certain compromises must often be made in terms of near and far vision. Either that, or my friend hadn’t listened carefully to the doctor. It would have been much better if he could have decided himself what sort of vision he wanted after the surgery—but now, of course, it’s too late for that!

THE TRUTH ABOUT CATARACT SURGERY

Unlike LASIK surgery, where you can try on a pair of contacts or glasses to simulate what your “new” vision will look like, it is impossible to do this with cataract surgery—so it’s important to have an in-depth conversation with your doctor about how you really use your eyes in daily life before you have the surgery. To find out more about what exactly a patient needs to know, I called ophthalmologist Brett Levinson, MD, who practices in Baltimore. His office performs 900 cataract surgeries per year, and the staff is trained to help patients understand their options.

No one has to get cataract surgery, noted Dr. Levinson, but it can greatly improve some patients’ quality of life. Sixty percent of people above the age of 60 have at least one cataract—a hazing of the natural lens in the eye. If the resulting blurred or decreased near and far vision (which some people say is like peering through a dirty windshield) or glare (for example, being blinded by oncoming headlights at night) become sufficiently disturbing, an eye surgeon can remove your cloudy lens and replace it with an artificial, corrective one. In most cases, this is a fairly simple outpatient procedure that takes less than 30 minutes per eye and doesn’t require general anesthesia. And the lenses tend to last a lifetime. But here’s the trickier part: There are three sorts of artificial lenses—and which you choose determines the kind of vision you will have after surgery. It doesn’t matter how good your near or far vision is before surgery, because your eye lens is being replaced, so you have a choice to make about which kind of vision you’d prefer. The good news is that your “new” vision will last forever, because unlike a natural lens, an artificial lens isn’t vulnerable to age-related vision changes.

WHICH LENS TO CHOOSE?

If you want cataract surgery, make sure that your doctor offers these three lenses, said Dr. Levinson. Then discuss the pros and cons of each…

  • Monofocal lens. This is the most basic and most commonly used lens because it is covered by medical insurance. It is a single-focus lens, meaning that it allows your eye to focus sharply either near or far—your choice. So with this sort of lens, you can opt to improve distance vision only, which means that you will probably still need glasses for up-close vision… or, if having sharp up-close vision without glasses is more important to you, you can have your eyes focused for near vision, but you’ll probably still need glasses for distance. A third option: You could put a near-focused artificial lens in one eye and a distance-focused artificial lens in the other—then your brain can blend the two together to improve both your up-close and distance vision (but the experience can be annoying for some). This is called monovision, but perfect 20/20 vision can’t usually be achieved. Also, monofocal lenses do not correct astigmatism. So if you have a moderate or severe amount of astigmatism (usually due to an irregularly shaped cornea) before cataract surgery and choose a monofocal lens, you may still need to wear glasses after surgery—two pairs, one for distance and one for reading.
  • Toric lens. This lens is similar to the monofocal lens—the only difference is that it corrects astigmatism for one type of vision (distance or up-close). You’ll still need glasses—but only one pair, for the other type of vision that is not corrected. This type of lens carries an additional out-of-pocket cost—typically about $750 to $1,500 per lens.
  • Multifocal lens. This is the most advanced type of lens—the design is only about 10 years old—and not all doctors offer it. So if it interests you, be sure to ask about it. This lens corrects both up-close and distance vision (but does not correct astigmatism). Multifocal lenses work by splitting light entering the eye into a near and distance focus. The brain then learns to interpret these images, creating the ability to see well at a distance and close. The big advantage: Most people with the multifocal lens will not need glasses for most situations. But your eye has to be completely healthy for you to be a candidate—for instance, if you have macular degeneration, the lens won’t work properly. And the surgery to implant a multifocal lens demands high precision—there is little room for error, or else your vision could end up blurry or with glare or halos—so make sure you are choosing an experienced eye surgeon who is board-certified. Also, ask how many surgeries he has performed and if you can speak to past patients. Insurance plans don’t cover these expensive lenses, which run about $2,500 per eye. If your vision does end up blurry and it bothers you, you can have laser vision-correcting surgery or wear glasses or contacts.

Bottom line: Cataract surgery can leave you very happy with your vision… but for the best chance of that, you’ve got to really talk thoroughly to your doctor about the options that are open to you and the compromises that they involve. This is one place where you do not want to be surprised!