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Cataracts and Refractive Surgery

Cataracts are clouding of the eye’s lens and are the main cause of blindness in the world. Their primary cause is sun exposure although air pollution and certain medications have been linked to their accelerated development. Trauma and some medical conditions such as diabetes can cause cataracts to develop early in life, and on occasion babies are born with them.

Apart from any of these factors, cataracts are also age-related, and many people develop them to some degree by the time they reach their sixties or seventies.

Symptoms of cataracts include:

  • Blurry vision
  • Double vision
  • Light sensitivity
  • Glare
  • Changes in color perception
  • Frequent changes in corrective lens prescriptions

Cataract treatment with vision improvement
Cataracts do not mean that you are automatically ineligible for LASIK or other refractive surgery. However, your ophthalmologist may recommend cataract surgery instead, to treat both the cataracts and the refractive error.

Refractive surgery reshapes the cornea (clear front part) so as to give clear vision.
Cataract surgery gives clear vision also, but not by reshaping the cornea. Instead, it replaces the lens with an artificial intraocular lens (IOL).

Please see our article on LASIK vs. Clear Lens Exchange for more detail.

Four IOL choices
All four brands of IOL give relatively clear vision at all distances. This is a big improvement over the past cataract surgeries, which used a monofocal lens. People were rid of the cataracts, but had to wear glasses to correct their refractive error (myopia, hyperopia, astigmatism) because a monofocal lens gives clear vision only at one set distance.

Technology has now given us:

  1. Crystalens™ -- an accommodating IOL which is controlled by the same eye muscles which controlled the natural lens. It moves forward to mimic a natural lens becoming steeper for close-up vision; and it moves back to mimic a natural lens becoming flatter for far vision.
  2. ReSTOR® -- a multifocal IOL with concentric steps built in to its structure, each step refracting light differently. Combined, they give clear vision at most distances.
  3. ReZoom™ -- a multifocal IOL with five concentric zones built in which use a different technology to give clear vision at most distances.

  4. Tecnis™ -- a multifocal IOL based on Wavefront data that is used for people who particularly need better vision in dim light.
  5. You can read more on these IOLs at our page on Accommodating and Multifocal IOLs.

LASIK First or IOLs?
Most cataracts grow very slowly, and for some people it may be more appropriate to have refractive surgery first, putting off cataracts surgery until it is truly necessary. After refractive surgery it can be difficult to collect the proper measurements for the IOL, so the measurements should be taken prior to refractive surgery for use later in life when and if cataract surgery becomes necessary.

Cataracts eventually happen to virtually everyone and left untreated they can lead to blindness. For people with mild, slow-growing cataracts, refractive surgery may be an appropriate treatment for refractive error, especially astigmatism.

If you have both cataracts and refractive error, ask your eye doctor if LASIK surgery is right for you.


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