The primary goal of refractive lensectomy or cataract surgery is to reduce your dependence on glasses and contacts by removing the eye’s natural lens and replacing it with a clear lens (the intraocular lens [IOL] or “implant”). Because of recent advances in IOL technology as well as technology used to measure the eye and plan surgery, we can often make our patients less dependent on glasses. Some patients are able to eliminate glasses entirely, although it is impossible to guarantee with any of these technologies that you will be able to function without glasses for all tasks.

After you have had surgery and your vision is fully corrected for distance, you will no longer be able to focus on near objects. By removing the natural lens inside your eye and replacing it with an artificial lens, you will lose the ability to adjust focus on objects at different distances. There are three ways to deal with this problem:

1. Aim for Distance Vision in Each Eye Using a Monofocal Lens

The simplest approach is to correct each eye for distance with your artificial lens and to use reading glasses for your near vision. This is the option that most of our cataract surgery patients choose. It uses the tried and true technology of monofocal (single-focus) IOLs that has been developed with great success for over 50 years. Using the sophisticated technology along with third generation formulas to calculate lens powers, well over 90% of our patients with otherwise healthy eyes will achieve vision that is 20/40 or better — good enough to pass a drivers’ license test without glasses in any state in the country.

Patients with monofocal lenses and good distance vision generally require reading glasses or bifocals to see up close. Reading glasses have the virtue of being inexpensive (generally around $10) and readily available without a prescription. Wearing reading glasses of some kind is very common after cataract surgery.


2. Aim For Monovision With Monofocal Lenses

Monovision is a common technique to reduce your dependence on glasses or contacts. One eye is corrected for distance with the correct artificial lens power, and the other eye is corrected for near by using a lens that is slightly too strong. Therefore, one eye sees better distance and the other eye sees better near. Together they see well at all distances, though most people still need some help for some visual tasks such as reading for long periods of time or for night driving.

The disadvantage or monovision is that both eyes no longer work together for distance or near vision. Some patients, realizing the advantage or increased freedom from glasses and contacts, tolerate this disparity extremely well. Other patients are unable to tolerate the imbalance between the two eyes. It is important that a patient go through a trial with monovision contact lenses before having monovision permanently implanted in the eye.


3. Aim For Both Near and Distance Vision in Each Eye With Multifocal or Accommodative Lenses

Multifocal or accommodative lenses offer the best potential for reducing your dependence on glasses or contacts after surgery. These lenses work by providing simultaneous near and distance vision in each eye, thus allowing both eyes to work together for both distance and near. There are three enhanced IOLs, and each of these designs has relative strengths and weaknesses as follows:

	ReZoom	ReSTOR	crystalens
Distance	Excellent	Good	Excellent
Intermediate	Very Good	Fair	Very Good
Near	Good	Excellent	Good
Total Add Power	+ 2.60 D	+ 3.20 D	+ 1.25 D