Clear vision for sports and life: The impact of cataract surgery

You line up a 4-foot putt. After sinking it, you reach for your reading glasses to record your score. At dinner that evening, you slip them off to look across the table, only to put them back on a moment later to read the menu.

For millions of Americans, switching between glasses and clear vision has become part of everyday life. What many people do not realize is that modern cataract surgery can often reduce that dependence while restoring the clarity lost from cataracts.

More than 4 million cataract surgeries are performed each year in the United States, making it one of the most common and successful operations in medicine. Today’s cataract surgery is no longer just about removing a cloudy lens. It is also an opportunity to reduce dependence on glasses by selecting the lens that best matches a person’s lifestyle.

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Almost every patient asks the same question: “Will I still need my glasses?”

For many patients, the answer is “less than you do today,” but the degree of freedom depends largely on the type of lens you choose to have implanted during cataract surgery. Each lens offers a different balance of distance, intermediate and near vision.

A personalized approach to cataract surgery
Every cataract surgery involves replacing the eye’s cloudy natural lens with a clear artificial lens called an intraocular lens, or IOL. The artificial lens is designed to remain clear permanently and stays in the eye for life. Because the artificial lens remains in the eye permanently, choosing the right lens before surgery is one of the most important decisions patients make.

The exciting part is that there is no longer just one type of lens available. Modern cataract surgery has become increasingly personalized, allowing patients to choose an option that best matches their daily activities.

Standard monofocal lenses
The most commonly implanted lens is the standard monofocal lens. Since the earliest days of modern cataract surgery, monofocal lenses have provided excellent vision at one distance, most commonly for driving and other distance activities.

Patients who choose this option generally enjoy sharp distance vision but still require supplementation with glasses for many near and intermediate activities, including reading, using a smartphone and working on a computer. For many people, this remains an excellent choice because it provides outstanding image quality with a long track record of success.

Enhanced Depth of Focus lenses
Over the past several years, Enhanced Depth of Focus, or EDOF, lenses have become an increasingly popular option.

Enhanced Depth of Focus lenses occupy a unique middle ground. They provide a broader range of vision than a standard monofocal lens while preserving the crisp, natural quality of vision and visual side effect profile associated with a standard monofocal lens. Unlike multifocal lenses, which are discussed later, they are designed to minimize glare and halos. Reading glasses are still often needed for fine print, but many patients find they can comfortably perform much of their everyday routine without constantly reaching for them.

In my practice, most patients do not have demanding near vision requirements. Instead, they want the flexibility to enjoy golf, use a computer, or simply go about their day with less dependence on glasses or contact lenses. For these patients, an Enhanced Depth of Focus lens often provides an excellent balance by extending their range of vision while preserving the visual quality of a standard monofocal lens.

Multifocal lenses
For patients seeking the greatest degree of freedom from glasses, multifocal lenses offer another option.

These lenses are designed to provide a broader range of vision, including distance, intermediate and near, allowing many patients to drive, use a computer and read without glasses most of the time.

Like any technology, there are trade-offs. Some patients notice halos or glare around lights at night. For that reason, careful patient selection is important, and these lenses are not the best choice for everyone.

Some patients, however, have greater near vision demands. I have implanted multifocal lenses in a mechanic who wanted to comfortably see the small parts of an engine without relying on reading glasses and in a nurse who wanted greater freedom from glasses while placing IV lines. For carefully selected patients whose daily activities depend on excellent near vision, multifocal lenses can provide a greater degree of freedom from glasses.

Golfers often appreciate being able to follow the flight of the ball while also seeing the scorecard in the golf cart without glasses.

Tennis and pickleball players frequently value crisp distance vision for tracking the ball while maintaining enough intermediate vision to comfortably see the scoreboard.

While cataract surgery will not fix your slice, improve your backhand, or magically lower your handicap, clearer vision can certainly make the game more enjoyable.

By now, you may be wondering, “If these newer lenses offer so many advantages, why doesn’t everyone choose one?”

Not every patient is an appropriate candidate, and some of these newer lens technologies involve additional out-of-pocket costs. Ultimately, the best lens is the one that best fits your eyes and visual goals.

“Can my cataract come back after surgery?”
Another question I frequently hear is, “Can my cataract come back after surgery?”

The answer is no. Once the cloudy natural lens is removed during cataract surgery, it cannot grow back. However, the thin membrane that holds the artificial lens in place can become cloudy months or even years later. This condition is called posterior capsular opacification, although many people simply refer to it as a secondary cataract.

When this occurs, vision may gradually become blurry again or patients may notice increased glare, much like they experienced before cataract surgery. Fortunately, treatment is straightforward. A quick, painless laser procedure called a YAG laser capsulotomy creates a small opening in the cloudy membrane, restoring clear vision for most patients. The procedure is performed in the office, takes only a few minutes and typically requires little to no recovery time.

If you notice that your vision has become blurry again several months or even years after cataract surgery, schedule an appointment with your ophthalmologist. If the cause is posterior capsular opacification, a simple office laser procedure can often restore the clear vision you enjoyed after surgery. Fortunately, posterior capsular opacification is common, easily diagnosed during an eye examination, and highly treatable.

Perhaps the greatest benefit of modern cataract surgery is not simply seeing more clearly. It is spending less time reaching for your glasses and more time doing the things you enjoy.

Joshua Paul, MD, is a physician and president of The Cataract and Vision Center of Pittsburgh, which is located at 1326 Freeport Road in Pittsburgh. You can contact the office at 412-963-0414.