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Three essential decisions you need to make while planning your cataract surgery

Cataract surgery is a once in a lifetime opportunity to design the optics of your eye. You can get rid of problems like nearsightedness and astigmatism. You can recreate the ability to see near like you did when you were young. You can focus the eyes, like a camera, anywhere you want. Some decisions can bring side effects. Some may cost money.

Before walking into your preoperative exam, consider three questions:

Should I treat astigmatism?

Should I treat presbyopia?

Where would I like my eyes to focus best- distance, near, or something in between?


Possibly your most important decision before cataract surgery is whether to treat astigmatism. There is about a 1 in 3 chance that you have enough astigmatism to benefit from treating it during cataract surgery. Our current technology allows us to treat as little as 1.00 Diopter and, with some technologies, as little as 0.50 Diopter. Ask your doctor to estimate how much astigmatism he or she thinks you will have after your surgery.


Presbyopia is the loss of accommodation to near as we get older, requiring bifocals or reading glasses. Several strategies exist for reducing presbyopia during cataract surgery. All have side effects.

Presbyopia correcting lenses are most satisfying to patients with certain personal characteristics and certain anatomic realities. Not all eyes, and not all people, are ideal for this technology. Surgeons vary widely regarding their approach to presbyopia correction. Some offer it to the majority of their patients, others don’t offer it at all.

Custom Refractive Design: Where should you focus your vision?

Even if you do not opt for presbyopia correcting technology, you still have important decisions to make. Many eye surgeons will assume you want distance vision unless you tell them that something else would be more desirable for you. Yet studies have shown that we spend more time with near and intermediate tasks than distance. Would you rather drive with glasses, and read without glasses? Or are you fine wearing readers? A computer programmer and an avid skier might have different thoughts about this. How do you use your eyes? What is most important to you?

Before you walk in to your surgeon’s office for your cataract surgery preop, consider these three choices. You will have every waking moment for the rest of your life to thank yourself for the time and energy that you put in to these three important decisions. For more information about designing your vision, please visit my website .

Christopher Kuntz, MD has 20 years of experience performing cataract surgery and counseling patients regarding their individual refractive choices.

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