Now that you have a visually significant cataract, that is, a cataract that is interfering with activities that you enjoy doing or those that you must do, the choice is no longer “should you do the surgery,” rather “how should the surgery be done.”  Needless to say, this decision must be made during a consultation with an ophthalmologist with whom you feel  comfortable.  Keep in mind that this is the last and best opportunity to not only remove your cataract but to correct other problems such as nearsightedness, farsightedness presbyopia and astigmatism.

To help with the discussion, the lens options fall into several classes; MONOFOCAL LENSES will deliver good vision at a single point in space, ie, distance or near.  A modern variation on this lens is the ASPHERIC LENS which has a curvature which neutralizes the curvature of the cornea and thus reduces glare and other types of distortion.  A TORIC LENS will correct astigmatism at the same time that it corrects nearsightedness or farsightedness and it has recently been manufactured in an aspheric form.  Then there are the MULTIFOCAL LENSES which are in many instances, aspheric as well.  These lenses correct for distance and near vision.  There is the Restor lens from Alcon Labs, the ReZoom lens and more recently the Tecnis lens from AMO.  In addition, the Crystalens from Bausch and Lomb which is somewhat different from the other lenses but ultimately yields a similar outcome.

The issue is that there are numerous lenses to place in the eye at the time of surgery. The lens must be matched to the patient’s visual needs, not the other way around; one lens does not fit all.  On the one hand, an 80 year old with macular degeneration and cataracts who does not mind wearing reading glasses would fair best with a lens that provides only distance vision and perhaps it should be an ASPHERIC LENS which minimizes glare and maximizes distant vision.  The opposite situation might occur in a 50 year old who needs distance vision, computer vision and reading vision and would be willing to wear reading glasses occassionally.  The latter case would call for a MULTIFOCAL LENS of which there are several. 

It must be said that every style of lens has different advantages and disadvantages and these must be reconciled with the patient; that is my job.  I must find out what you expect and want from the procedure.  What are the tasks that you want to do without glasses and which are you willing to occassionally put the glasses on in order to perform. 

Remember that cataracts come with having birthdays and perhaps this year’s present might be good vision and possibly no glasses to achieve that end.