All The Options For Fine Tuning Vision After Cataract Surgery
Not everyone will have perfect 20/20 vision after cataract surgery.
Some people will be left with some remaining prescription after cataract surgery. As much as we all want it to be, cataract surgery isn't 100% accurate
Now, it's relatively easy to correct this remaining prescription with a pair of glasses. That is the route that most people go after cataract surgery to fine tune and sharpen up their vision more.
But this route isn't great if you had cataract surgery done to get OUT of glasses. Slapping on a pair of glasses to get the sharpest vision isn't the most palatable option.
Fortunately, there are ways to surgically fine tune vision after cataract surgery. The most common by far is a laser eye surgery procedure such as lasik or PRK. However, other options include rotating or changing the lens inside the eye. And there are even special lenses designed to be fine tuned after surgery!
So let's look at each method and when it becomes the best way to fine tune your vision after cataract surgery.
Note: this article is about the ways to correct residual prescription after cataract surgery. Check out Adjusting And Training Eyes After Cataract Surgery to find out how to fine tune vision even when the prescription is on target.
Laser Eye Surgery
A lasik or PRK enhancement is the most common surgical way to correct any prescription remaining after cataract surgery. And for good reason - it works really well!
Using a laser, the curvature of the cornea (the front clear part of the eye) is able to be sculpted to change how the eye focuses light, correcting prescription.
Lasik creates a flap within the cornea prior to the treatment to allow for a quick recovery time of about a day. PRK treats the surface of the eye directly and has a longer recovery time of about a week as the surface heals back over.
Before a lasik treatment is performed, typically the surgeon will want a certain amount of time, such as three months, following the cataract operation for the eye to stabilize. And because lasik works on the cornea, it doesn't interfere with the new artificial lens placed during cataract surgery in any way.
The biggest disadvantage with laser eye surgery is cost. If you had cataract surgery with a surgeon who also does laser eye surgery, then you are probably in luck. Your own surgeon can do lasik for you and it may even be covered under the cost of your upgraded cataract procedure.
But if your cataract surgeon doesn't do lasik, then it may be harder to get any sort of laser enhancement. You may be forced to pay out of pocket (which can cost roughly around $2,500 per eye).
Other than the cost of laser eye surgery, the second biggest disadvantage is dry eye. In the short term after lasik or PRK, you will have an increased amount of dry eye and will be on frequent artificial tears to treat. If you have significant dry eye beforehand, your surgeon may postpone the procedure until the dry eye can be treated and brought under control. (but which is a good idea anyway since dry eye can affect the prescription of the eye and cause fluctuation of vision).
Who is it best for?
Well, laser eye surgery is good for almost anyone - especially if it is already covered under your initial cataract procedure. However, it won't be great for those individuals who have uncontrollable dry eye or abnormal or irregular corneas.
Also check out What To Know About A Lasik Touch Up After Cataract Surgery
Ok, this one only applies to a small percentage of individuals. And you’ll know if this you even before the cataract is removed and replaced with an artificial lens.
Most artificial lenses have a single prescription. And this prescription can't change. After the lens settles down within the eye, the correction is what it is.
But there is a special lens that can be fine tuned AFTER cataract surgery. This is called the light-adjustable lens.
This lens is placed during cataract surgery like any other usual lens. But the different thing about this lens is that it will change shape in response to UV light. Roughly 2-3 weeks after cataract surgery, the surgeon will apply UV light in just the right way to change the shape of the lens to correct any residual prescription error.
It allows for zero prescription and about as perfect of vision as possible.
Trouble with UV light is that it is everywhere. Outdoors especially, but also indoors as well. To prevent the lens from responding to ambient UV light, one must wear special UV blocking glasses both outdoors and indoors until all the lens treatments are completed.
This lens also may not just require a single treatment. It can take up to 3-5 treatments to fully optimize this lens. This means more visits with your eye doctor until the lens is perfect.
Overall, it takes some commitment to get the best possible vision with this lens.
Who is it best for?
Of course, fine tuning vision with the light adjustable lens is only really an option for those that got the light adjustable lens in the first place. But it is the main feature of this lens.
The light adjustable lens is great for those who may experience less accuracy with cataract surgery. This includes those who have had prior corneal procedures such as Lasik or RK. It can also be great for those who want to correct vision with monovison to get the focus exactly where it needs to be.
Rotation Of Artificial Lens
Sometimes you may have extra astigmatism after cataract surgery all you may need is for the lens to be rotated within the eye.
Correcting astigmatism isn't too complex. Unlike simple nearsightedness or farsightedness which just require “power” to correct, astigmatism requires “power” in a certain “direction”.
During cataract surgery special lenses, called toric lenses, can be used to correct astigmatism. These lens have astigmatism correcting power and also an indicator to rotate the lens and line it up with the direction of the astigmatism.
Toric cataract lens, notice the dots which indicate the direction of the astigmatism correction on the lens; image © 2018 Jung, N.Y., Lim, D.H., Hwang, S.S. et al., used under CC BY 4.0 / modified from original
And this works well!
But one issue that can occur early after cataract surgery is that these lenses can rotate out of position. As these lenses rotate out of position, they correct less and less astigmatism - leaving you with residual astigmatism.
So the fix? Rotate these lenses back into the correct position. This avoids the need for any laser eye surgery and can allow for a quicker fine tuning of vision.
Other than having to go through another procedure, there isn't much - as long as the procedure is done soon after the initial cataract surgery. If rotating the toric lens can fix the residual astigmatism, than it can be a good way to fine tune the vision.
A month or later after cataract surgery and this procedure becomes a little more challenging. The bag or capsule that holds the new artificial lens starts to “shrink-wrap” over the new lens making it more difficult to free up the lens for rotation.
Who is it best for?
Of course, you must have had a toric lens placed during cataract surgery.
If the surgeon suspects the toric lens rotated shortly after surgery, your eyes will be dilated so that the surgeon can measure the position of the lens. This information is frequently fed into an online calculator to determine if rotating the lens can fix that astigmatism.
However, if there is extra nearsightedness or farsightedness, simply rotating the lens may not be enough to correct the vision and laser eye surgery may be considered instead.
Replacement Of Artificial Lens
Sometimes cataract surgery can really miss the mark completely and leave a significant amount of prescription remaining.
In these cases, the artificial lens can be removed and replaced with another one with a different power.
Similar to rotating the artificial lens, this requires another procedure. And similar to rotating the artificial lens, it's best done early on.
Similar to when rotating the artificial lens, the lens must be freed up from the capsule before it can be removed. This can become more challenging over time as that capsule seals up that new lens.
Who is it best for?
Because exchanging an artificial lens can be a complex procedure, it is generally reserved as the last option. Many surgeons still prefer to do a laser eye surgery enhancement. But if lasik or PRK isn't an option, and the prescription is way off, replacing the lens becomes to go-to method to fine tune the vision. It can also be done if one can't tolerate their multifocal artificial lens.
Similar to rotating the lens, all the data about the eye and prescription is plugged into online calculators to determine which power of lens will properly correct the vision.
Even if the vision you have after cataract surgery isn't quite perfect, in most cases it can be fine tuned to eliminate any residual prescription. This is most commonly achieved through a laser eye surgery procedure such as lasik or PRK. But others methods exist (with even lenses designed for this purpose) to get things just right.
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