Cataract Surgery & Lens Implant Focal Distances

Question: I am considering cataract surgery and concerned about what distance to focus the lens implant for.. I am very nearsighted with slight astigmatism and with eyeglass prescription of R -9.50 and L -7.75 and +1.50 bifocal can correct to 20/60. I am 72 with mild diabetes and had surgery in 2004 for severe Retinal Detachment on my left eye and have had retinal laser repair of both eyes. I don't care to risk the possible problems for multifocal implants, since I am willing to wear bifocal glasses. If I get monofocal implants, would I be likely to be most comfortable with implants that focus in distance (20 feet or more), medium 6-20 feet, 2-4 feet, or closer? I use computer a lot, watch TV, and hike a lot so want to see my feet as I easily can now thru main lens or the bifocal. My bifocals do not let me focus within 6 inches, so I remove my glasses for really fine print and some precise hobby work. I think most people get distant or medium focus implants and use bifocal glasses for close up. On the other hand, I'm used to wearing strong glasses to see in distance. A related issue is that I would like to correct which may affect focal-distance choice is that with my +1.75 bifocals, I have difficulty reading and viewing computer because my left eye focuses most clearly at 20" and the right at 15".


Answer: You have a number of pretty complex questions and issues here regarding Cataract, Cataract Surgery and Lens Implants. Although it isn't really possible to answer them thoroughly in this medium we can offer some suggestions to consider when you have a consultation with a top Cataract Surgeon who is also a Refractive Surgeon. We would strongly suggest seeking an opinion from the best Cataract Surgeons who are ALSO accustomed to solving refractive error correction problems in complex visual situations. First you are a relatively high risk Cataract Surgery candidate due to your history of Retinal problems. it is not clear what level of vision you were correctable to after your retinal surgery. Your Cataract & Refractive Surgeon may suggest that you get clearance from your Retinal Specialist prior to your Cataract removal. Second, the path of selecting a more simple Lens Implant type such as a monofocal, or perhaps even better an aspheric lens implant is probably a good choice. The aspheric lens implant-if carefully selected-may offer considerable optical advantages over your myopic spectacle correction in terms of aberrations and depth of focus-these may actually surprise you in their benefit. However, this really depends on careful measurement and proper selection of a focal distance as you suggest. To help your Cataract and Refractive Surgeon get you the best possible result-BEFORE your consultation-just as you have done above, list the various distances you need to have clear vision for. Then list which ones you would be happy wearing glasses for and which ones you would prefer not to wear glasses for. Finally, take that list and put it in order of decreasing importance for your everyday activities and desires. From your rank ordered list, your Cataract & Refractive Surgeon will have a discussion and refine the list and be best able to help select the proper focal distances. Please be aware, it may entirely be the case that NOT every priority can be met and that you need to have realistic expectations and goals.

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