Herzig Eye Institute in Cataract Surgery on October 18, 2019

Cataract surgery has progressed greatly in recent years. Before the introduction of intraocular lenses (IOLs) to replace a patient’s cloudy lens (cataract), patients had to be satisfied correcting their vision after cataract surgery with very thick glasses or contact lenses.


The introduction of IOLs to restore vision as a routine during cataract surgery in the 70s made it possible for the patient to achieve clear vision and function with normal glasses. Modern IOLs are more sophisticated and not only give a cataract patient a clear lens to replace their cloudy lens but also provide an opportunity to potentially eliminate the need for glasses entirely. This of course appeals to many people and in order to achieve the best result it requires combining refractive surgery with their cataract surgery.

Cataract surgery is covered by provincial health plans. Refractive surgery – eliminating the need for glasses with a surgical procedure – is not covered by public insurance and has to be paid for by patients. Refractive surgery when combined with cataract surgery involves more refined and extensive measurements of a patient’s eyes to improve the accuracy in determining the correct IOL power to use in the patient’s eye that will reduce the chance of needing corrective glasses after the surgery.

Refractive surgery also involves occasionally using IOLs that not only correct distance vision but also reading vision thereby eliminating or reducing the need for reading glasses. These are known as presbyopia-correcting IOLs, presbyopia being the age-related loss of reading vision. There are several different types of presbyopia-correcting IOLs and surgeons in concert with their patient’s needs and lifestyle choose the IOL that will achieve the best result. It is important to be aware of the pros and cons of the presbyopia-correcting IOLs especially when it comes to night driving. This information should be readily available from your surgeon.

Many patients also have significant astigmatism which affects both the quality of distance and reading vision. Astigmatism means that the patient’s cornea has two different curves like a football as opposed to being spherical like a basketball. This requires the use of a toric IOL which itself has two different curves to correct the patient’s corneal astigmatism. Occasionally a laser is used with cataract surgery to treat or assist in treating the astigmatism. Without treating the astigmatism, glasses are almost always necessary after cataract surgery.

A more recent advance in refractive cataract surgery is the use of intraoperative aberrometry. This is technology that allows for the measurement of a patient’s eye after the cataract is removed while they are still in the operating room. The measurement is done before the IOL is inserted to confirm that the chosen IOL is the correct one thereby increasing the accuracy of the IOL to be inserted.

Cataract surgery combined with refractive surgery offers patients the most advanced technology for vision correction. The results of combining these two surgeries has reached a level of sophistication such that many are opting to have their natural lens removed before it becomes cloudy just to eliminate their need for glasses. This is known as Refractive Lens Exchange. Achieving independence from glasses whether it’s after cataract surgery or after lens exchange requires using specialized IOLs combined with the most advanced refractive surgery technologies. Today, cataract surgery should be a positive experience, combining it with refractive surgery to achieve a level of vision that often is better than it’s been for many years.

To learn more about refractive cataract surgery, download our free Consumer Guide to Advanced Cataract Surgery.