✅ Medically reviewed by Dr Sharon Heng
Patient’s Query: I am short-sighted and told I have cataracts. Can I still have multifocal lenses?
Cataracts are a common condition that can significantly impact your vision, particularly as you age. Fortunately, cataract surgery is a highly effective procedure to restore clarity to your sight. Myopia which means short or near sightedness changes the dynamics of cataracts and cataract surgery.
Patients with high myopia defined as >-5D tend to get cataracts earlier as compared to their peers who are emmetropic or hyperopic.
Oftentimes, highly myopic patients are very happy following cataract surgery as it is their opportunity in a lifetime to get rid of thick lenses and spectacles. However, there are challenges and additional risks to surgery necessitating pre-operative planning and careful discussion.
What are Cataracts?
Cataracts are a common eye condition that causes clouding of the natural lens in the eye, leading to blurry vision and, if left untreated, potential blindness. As we age, the lens in our eyes gradually becomes less clear.
While cataracts are often associated with aging, they can also develop due to other factors such as genetics, injury, or certain medical conditions. In many cases, cataract surgery is the only solution to restore clear vision.
What is Cataract Surgery?
Cataract surgery is a procedure that involves the removal of the cloudy natural lens in the eye and replacing it with an artificial intraocular lens (IOL) to restore clear vision. This surgery is highly effective, with a high success rate in improving vision and quality of life for patients.
The procedure is typically performed on an outpatient basis, meaning patients can go home the same day. Cataract surgery can be performed under local anesthesia, which numbs the area around the eye while the patient remains awake during the procedure.
When Should I Have My Surgery Done?
When you have your assessment for cataracts, we will usually ask for your medical history, ophthalmic history, how long you have been affected by symptoms such as blurring of vision or worsening of night vision, what you do for a living, whether you drive and your hobbies and expectations of your vision.
As a rule of thumb, if you are symptomatic and vision has declined as a result of cataracts, then we will offer cataract surgery in the majority of cases. In myopic patients, you will find that your myopia will increase and you will find yourself needing to change your glasses more often.
What are the Risks of Cataract Surgery?
Cataract surgery today is in general very safe with advancements in technology. Most centers use phacoemulsification and intraocular lens implant for the majority of cases. Of course, there will be cases where the risk profile is higher than normal, and this needs to be assessed on a case by case basis.
In general, the risk of surgery are as follows:
1:10 need laser at some future point in time
1:100 risk of need for further surgery
1:1000 risk of severe or permanent visual loss
1:10000 risk of sympathetic ophthalmia
1:20 complications during surgery that can be rectified at time of surgery or following the operation
Infection
Double vision - need for glasses / patching
High pressure and glaucoma
Need for further surgery
Need for glasses or contact lenses
Need for laser treatment
Need for reading glasses
Posterior capsular opacification
Residual refractive error
In addition to the risks above, myopic eyes are prone to having refractive surprise or residual refractive error. Highly myopic eyes may have posterior staphyloma which will give erroneously longer axial length which is one of the key indicators when we measure the eye up for intraocular lens calculation.
This will then make the new intraocular lens calculation formulae less accurate and possibly a residual refractive error. Myopic eyes may also have astigmatism which may be corrected by toric lenses.
Can I Get Perfect Vision After Cataract Surgery if I Have High Myopia?
This depends on the status of your eye. Perioperatively and during your consultation, we will need to examine your retina in detail as myopic eyes have higher risks of retina pathologies such as retina breaks/ tears/ detachment or myopic choroidal neovascularisation.
If a patient does have retina pathology from high myopia, then their postoperative vision may be limited, we call this “guarded prognosis.” Further, as mentioned above, the intraocular lens calculation may be less accurate if patients have posterior staphyloma and may be left with residual refractive error.
Why is Cataract Surgery in Highly Myopic Patients Considered High Risk Surgery?
The surgical technique for myopic patients is slightly different to an emmetropic patient. Patients who are high myope should carefully select surgeons who have experience in managing complex patients with high myopia. Myopic patients are also at higher risk of postoperative retina detachment.
What Happens in the Postoperative Period? What Do I Have to Watch For?
After the surgery, patients will go home with topical steroids and antibiotics for a period of 6 weeks. In myopic patients, the post operative refraction may take some time to stabilise. If you do have increased floaters or a curtain covering part of your visual field or a visual field defect, then you need to contact your surgeon urgently for fundal examination to rule out breaks/ tears/ detachment.
There may also be a difference between the two eyes (anisometropia) which is also an imbalance between the two eyes until the fellow eye is corrected/ second eye surgery. The imbalance may cause dizziness, eye strain, and diplopia.
I Want to Be Spectacle Free – Is That Possible?
To address this issue, we must first understand the possible refractive outcomes with intraocular lens implant. Mainly, vision can be divided into:
Distance Vision – this is approximately 4 metres away and mainly for driving
Intermediate Vision – examples are using a computer screen, reading using gadgets such as iPad or kindle, gardening or cooking
Near Vision – reading newspapers or books, this is approximately 40cm away
We can optimise refractive outcomes in accordance to your needs for vision through several intraocular lenses which are artificial lenses that are implanted during cataract surgery.
Examples of intraocular lenses are as follows:
Monofocal Lenses: corrects for distance vision , you will need reading glasses for near or intermediate work
Multifocal/Trifocal Lenses: These lenses correct for distance, intermediate and near vision- negating the need for glasses. If glasses are needed, it is usually one of a small prescription. The drawback for these lenses is that it may induce glare or halos which is worse in dim light conditions which can be debilitating for some individuals and worsens for individuals with ocular surface or ocular problems.
Extended Depth of Focus (EDOF) Lenses: corrects for distance and intermediate vision but reading glasses are likely required for close or reading work. The advantage of this lens is that it induces less glare and halos as compared to multifocal lenses.
In fact, EDOF lenses are becoming increasingly popular for patients. The reason being much of our reading, work and meetings are on computer screens, and intermediate vision has become very important. Thus, having distance and intermediate vision may cover the vast majority of needs for many patients. These lenses are also more tolerant amongst patients with minor ocular surface disease.
Micro-monovision with EDOF lenses is where one eye is set for distance and intermediate vision using an EDOF lens.The fellow eye is then slightly offset so that the distance vision is mildly less, but that means the reading vision improves.The difference in power between the two eyes is very small so well within the human brain’s normal tolerance.
This can mean the overall range of vision with both eyes open can be extended.So,patients often have good distance vision, intermediate vision and some reading vision also. There are also toric lenses that correct certain types of astigmatism and can be particularly helpful in patients with high astigmatism.
The selection of patients for premium lenses is critical as not all patients are suitable for premium lenses. In highly myopic patients, depending on the status of their retina, if they have previous detachment surgery or myopic degeneration, then multifocal lenses would not be a suitable option. Patients with regular astigmatism may opt for toric lenses.
Another possible option is for monovision, ie, one eye – the dominant eye to be corrected for distance, the other eye corrected for near. However, not all patients may adapt to this as monovision may cause loss of depth and contrast perception. A contact lens trial is best conducted before considering this option.
What is Precision in Cataract Surgery?
Cataract surgery itself is a precise surgery, it is a microsurgery and we work in microns across layers of the eye. We do need to ensure every single of the 10 steps of cataract surgery is precise allowing the cataract to be removed and for the intraocular lens implant to sit nicely within the intraocular bag or translucent bag that held the cataracts and then the intraocular lens with minimal rotation. This is particularly important for premium lenses and toric lenses.
How Do I Prepare for Cataract Surgery?
Preparing Physically for Surgery
Physical preparation is a critical aspect of ensuring the success of your private cataract surgery.
Here are some key steps:
Medication Adjustments: Your doctor may ask you to stop taking certain medications, such as blood thinners, a few days before surgery. Always consult your doctor before making any changes to your medication regimen.
Pre-Surgery Eye Drops: You may be prescribed antibiotic and anti-inflammatory eye drops to use before the surgery. These drops help prevent infection and reduce inflammation.
Fasting Guidelines: You’ll likely be instructed not to eat or drink anything for a few hours before the procedure. This is to ensure safety during anesthesia.
Arrange Transportation: Since your vision may be impaired after the surgery, arrange for someone to drive you to and from the clinic on the day of the procedure.
Psychological Preparation
Feeling nervous before surgery is natural, but being mentally prepared can help you feel more at ease. Here’s how to reduce pre-surgery anxiety:
Educate Yourself: Understanding the steps involved in cataract surgery can help alleviate fear. Ask your doctor any questions you have about the procedure and recovery.
Relaxation Techniques: Practice deep breathing, meditation, or gentle yoga to calm your mind in the days leading up to the surgery.
Support System: Share your concerns with friends or family members who can provide reassurance and encouragement.
Practical Preparations
In addition to physical and psychological readiness, practical preparations are essential for a seamless experience. Consider the following:
Home Setup: Prepare a comfortable recovery area at home with pillows, blankets, and easy access to necessities like water and medications.
Stock Up on Supplies: Purchase any prescribed medications, over-the-counter pain relievers, and protective eye shields in advance.
Plan Time Off: Arrange for adequate time off work and limit strenuous activities during your recovery period.
What to Expect Following Surgery?
Post-Surgery Care: Setting the Stage for Recovery
Recovery is an essential part of the cataract surgery journey.
Follow-Up Appointments: Attend all scheduled follow-up visits to monitor your recovery and address any concerns.
Eye Care Instructions: Use prescribed eye drops as directed to prevent infection and manage inflammation. Avoid touching or rubbing your eyes.
Activity Restrictions: Refrain from heavy lifting, swimming, or strenuous activities for the first few weeks. Protect your eyes from bright light and dust by wearing sunglasses outdoors.
Report Issues Promptly: Contact your doctor immediately if you experience severe pain, vision loss, or other unusual symptoms.
Ms Sharon Heng is a proficient and experienced cataract surgeon and is an expert in high risk cataract surgeries and surgeries involving patients with multiple comorbidities such as diabetes,age related macular degeneration and high myopia.
She is very particular about patient selection for premium lenses and suitability of patients/expectations of outcomes is paramount in her consultation. She takes pride to ensure her patients understand what is involved in the surgery and expected outcomes.
Ms Heng believes in personalised and precise cataract advice and surgery and opts for nothing short of the best personalised outcomes for her patients.
For consultation, please contact us at info@retina-eye.co.uk
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