Cataract surgery that corrects vision-- what if prescription changes?

I’m getting from reading threads on cataract surgery that you have the option to get a corrective lens put in when you have cataract surgery. Every time I’ve had my eyes checked (every 2 years like clockwork) since I first got glasses at age 11, my prescription has changed. So what happens if you get a corrective lens with your cataract surgery and your prescription changes? Clearly, there’s something I’m not understanding about this process.

Good question. I had my surgery 3 years ago with implanted lenses. My vision has not changed a bit since the healing ended. I suspect it won’t either. I await an answer from an opthomologist.

Gary, did your vision change a lot prior to your cataract surgery? Some people’s doesn’t. My good friend kept the same contact lens prescription for over 20 years.

My experience is not typical. Last fall I had cataract surgery with a corrective lens implant. It was intended to give me near-perfect vision in that eye, since there was almost no astigmatism in it. However, after the surgery, more astigmatism developed. I had a corneal reaction called map-dot-fingerprint dystrophy. I had to get a corrective eyeglass lens, and several weeks later had to get a new corrective eyeglass lens. I am not optimistic that this may not happen again. My doctor said that I could get additional surgery (laser correction of the cornea to remove the astigmatism) but I am not confident that this would be a long-term solution given that my cornea reacted badly to the previous surgery. He agreed that this was a reasonable reaction.

I don’t know how old you are, or whether the ever-changing prescription was because of astigmatism or some other condition. My prescription changed a lot until I was in my twenties. Then it didn’t change at all until I was in my forties and presbyopia occurred. Then it was changing every couple of years again. Some of my vision problems were related to the decreasing strength of the focusing muscles. This is supposed to be a non-issue after cataract surgery since the eye muscles are no longer involved.

What kind of implanted lens is appropriate after cataract surgery depends many factors, and should be discussed in detail with the best ophthalmologist you can get. IMHO the surgery should not be done unless the cataract is bad enough that you are experiencing significant reduction in vision. It is generally an extremely safe procedure and complications are extremely rare.

Again, IANAD, YMMV.

This is very helpful info. I’m 65 and I do have astigmatism, but I don’t know why my vision changed a lot oer the years. I don’t mind wearing glasses. Actually I see them as a fashion accessory. I might opt for no correction at all with my cataract surgery.

Since the new lens in your eye is artificial and manmade, it will never change, and you will never need to have a new prescription.

The reason you needed new prescriptions in the past was because your natural lens in your eye was subject to change during your lifetime. The new plastic one is not.

Nevertheless, if you break a lens in your glasses, your optician will refuse to replace it unless you can display a written Rx less than one year old, forcing you go go back to an optometrist and pay him to refract your eyes again. If he gives you a different Rx from that of your broken lens, explain to him that you have had cataract replacement surgery, remind him that your Rx will never change, and ask him to simply prescribe what the old lens was.

I recently went through this ordeal, the lens that came in according to the new Rx was worse than my old glasses, I went back to the optometrist (actually an ophthalmologist), who agreed with me, wrote a new Rx duplicating my old one, and the dispensing optician associated with the Ophthalmologist replaced it at no charge. None of which should have been necessary, but you can’t argue with the flow chart.

Thanks for that, J. Makes sense.

Other than presbyopia and cataracts, vision doesn’t change because the lens changes. It changes because the shape of the eyeball changes.

Back to original question.

A related (sort of) story:

Roughly fifteen to twenty years ago (can’t remember which) I had lasik surgery on my eyes. My vision, which had been 20/200 with astigmatism, suddenly was perfect.

Then maybe three or four years ago I noticed that my vision was no longer what it used to be. My golf ball would disappear about 200 yards out, then about 150 yards out, then even less. While driving, road signs were fuzzy until I got close to them. When bowling, I couldn’t read the automated scoreboard unless I walked up close to it. I was paniced - I just knew my eyes were deteriorating and couldn’t be repaired.

I finally gave up and went to an optometrist, who asked me just why I thought my eyes would quit changing over time just because I had lasik surgery on them once. Then she measured my vision. Turned out I now had 20/30 vision with mild astigmatism. Now I wear soft contact lenses and everything’s perfect again.

You get glasses or contact lenses, to correct your vision on top of the correction supplied by the inserted lens to compensate for your changing vision.

That is the only solution.

That makes sense.

Tell me if this makes sense: My cataract is causing double vision, like everything has a drop shadow on it. I’ve worn glasses my whole life and don’t mind wearing them. They’re not Coke-bottle-thick or anything. I’m thinking I might opt for cataract surgery that only corrects the cataract, not my vision, especially since it’s only one eye that has a cataract for now, so I’d be wearing glasses anyway.

Removing the cataract (lens) changes the eye, and a lens-less eye requires a very strong (coke-bottle-thick) lens to compensate (and has very poor vision without correction).

Better to get the cataract removed and lens replaced, so you have close to normal vision in the eye (with a small amount of correction, maybe), so you can at least see if you don’t have your glasses on.

I doubt that your surgeon will give you the option - outcomes are almost certainly better with the replacement corrective lens inserted.

I meant replace the bad natural lens WITH a lens, but just not a lens that attempts to correct my vision.

Which is, I think, what you meant here:

We’re saying the same thing, right?

ETA: I can see right now without my glasses (even with the cataract) and have always been able to (that’s what I meant by glasses not coke-bottle-thick). Didn’t express that very precisely.

A set of lenses lasted me a few years, until I started to develop cataracts. Then it was every 6 months. I was very nearsighted, with sharp focus at about ten inches. Very handy for close work though.

My misunderstanding.

However, to be clear, any lens that gets inserted into the eye following the cataract operation will change the eye regardless of your existing glasses prescription. The surgeon just selects the best lens for your eye - the fact that it will probably correct some existing deficiencies is a happy side-effect. If you have a significant existing defect, the new lens will correct that as much as it is possible. It is a risky procedure (like any surgery), so why not get the best possible outcome.

There is a choice between monofocal and multifocal lenses. Monofocal lenses give good distance vision, but reading glasses or bifocals may be required for close work. Multifocal or accommodating lenses can give good close and distance vision (but about 68% of patients still require glasses following fitting of these lenses, according to the NHS, compared with 95% of monofocal lenses).

Of course, there may be a cost differential in some health systems, so there may be a choice. But regardless of the choice you make (mono- or multi- focal), I expect the surgeon will select the best lens for the task - you can’t change it later.

[quote=“si_blakely, post:16, topic:657808”]

My misunderstanding.
If you have a significant existing defect, the new lens will correct that as much as it is possible. It is a risky procedure (like any surgery), so why not get the best possible outcome.
QUOTE]

If by “best possible outcome” you mean best uncorrected vision, this is not strictly true. In the case of someone who has a large refractive error (i.e. high eyeglass prescription) and only one eye with a significant cataract, surgeone will often leave the treated eye with a similar prescription post-cataract. They do this due to the difficulty in adjusting to having two eyes with different prescriptions post-cataract surgery.

Thanks, Si. I’ve worn progressive bifocals since 1997. I’m thinking I would only want a monofocal lens to go directly in my eye. And I’m understanding from what you’re saying that there may wind up being some correction of my vision, a “happy side-effect.” I’m fine with that. Also the cost doesn’t matter. I’m not one to go bargain-basement on something this important. (Like a guy doing cataract surgery out of the trunk of his car–hehe… “Just got some *great *lenses in. Won’t have 'em for long.”)

The thing about not being able to change it later was what got me started on this line of inquiry.

I understand that the best possible outcome is not the same as best uncorrected vision. This is why some people still get mono-focal lenses - the multifocal lenses may generally be “better”, but they are not always appropriate.

My father is in his 80s. He had a ministroke and lost the vision in one eye. The other eye had a developing cataract and macular degeneration. For a long time (18 months or so) the balance was against having the cataract removed - the risks were high and the benefit considered minimal. Eventually the cataract got bad enough that the balance swung the other way, and it was removed. The macular degeneration is pretty stable, so it has been good for him, while it lasts.