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Three 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. Ask your doctor to estimate how much astigmatism he or she thinks you will have after your surgery. Our current technology allows us to treat as little as 1.00 Diopter and, with some technologies, as little as 0.50 Diopter. Here is a link to my Astigmatism Simulator to help you understand the meaning of these numbers.


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. It is critical to appreciate these side effects before deciding to live with them for the rest of your life. For more information on the advantages and side effects of presbyopia correcting lenses, see my Presbyopia Correcting Lens Simulator.

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 and encourage them to adopt it, others don’t offer it at all. This is why you need to go into your preoperative evaluation knowing what you want- not what your surgeon wants.

Custom Refractive Design: Where should you focus your vision?

Even if you do not opt for astigmatic correction or 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 do you prefer to see at distance without glasses and wear 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 don't have to make any final decisions before your preoperative appointment, but considering these three issues ahead of time will allow you to use your time well during your appointment. 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.

Seattle based surgeon Christopher A. Kuntz MD has performed over 10,000 cataract surgical cases over the last 25 years. He is the principal author of, an international free website that helps patients make their best decisions before, during and after their cataract surgery.


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