Glasses after cataract surgery: when and which ones?

4 wks

before the final prescription for glasses after cataract surgery, counted from the last eye operated on

99 %

of implanted lenses are monofocal: reading glasses then remain necessary

3 years

validity of a glasses prescription in France after the age of 42

Will you still need glasses after cataract surgery?

The honest answer is: usually yes, for at least one distance. The operation removes the clouded lens and replaces it with an implant whose power has been calculated for you. But a standard implant has only one point of focus: it does not refocus the way your young crystalline lens did. Whether you need glasses after cataract surgery therefore depends first on the type of implant chosen with your surgeon.

Monofocal implant set for distance

The choice of the vast majority of patients. You see clearly at distance without correction: driving, television, faces. Reading glasses remain necessary for near work and often for the computer screen. It is the most predictable scenario and the least exposed to night-time halos.

Monofocal implant set for near, or monovision

Some patients, keen readers or long-standing myopes, prefer to keep unaided near vision and wear glasses for distance. Monovision — one eye for distance, the other for near — reduces the need for glasses after cataract surgery, at the cost of less refined depth perception.

Toric implant

It corrects astigmatism at the same time as the cataract. Without it, an astigmatic patient keeps blurred vision at every distance and depends on glasses even for distance. With it, the need for glasses after cataract surgery is limited to reading.

Extended depth of focus or multifocal implant

These so-called premium implants restore useful vision at distance and near. The Cochrane review comparing them with monofocals confirms markedly greater spectacle independence, but also more halos and glare. They do not suit every eye, and a back-up pair sometimes remains useful for small print or dim light.

In other words, the question of glasses after cataract surgery is settled before the operation, when the implant is chosen, according to your activities: driving, reading, screens, DIY, sport.

Dedicated page—cataracte.fr Intraocular lenses: monofocal, toric, EDOF, multifocal

When to get your glasses after cataract surgery: the settling period

Not the next day. In the first few days the cornea is slightly swollen by the incision and the ultrasound, and the implant is still settling into the capsular bag. The refraction still moves a little. An Australian study of uncomplicated operations measured a refraction that was stable from the first week in most patients; in practice, Dr Gozlan prescribes glasses after cataract surgery 4 weeks after the operation, once the eye is quiet and the measurement reliable.

The 4-week check-up

This is the appointment at which the ophthalmologist measures your final refraction and writes the prescription. An earlier appointment serves to check healing, not to prescribe glasses after cataract surgery.

If both eyes are operated on

The prescription is written 4 weeks after the operation on the second eye, never in between: prescribing after the first eye, then remaking the lenses after the second, is expensive and pointless.

Temporary glasses

In the meantime, a pair of ready-made reading glasses from a pharmacy or supermarket works very well for reading. It does the operated eye no harm whatsoever: it simply magnifies, like a magnifying glass.

One special case: after a complicated operation, a capsular rupture or combined retinal surgery, settling can take two to three months. Your surgeon will then tell you the right time for your glasses after cataract surgery.

Dedicated page—cataracte.fr Recovery after cataract surgery, day by day

Between the two eyes: the awkward phase

When both eyes need surgery, they are almost always operated on a few weeks apart. During that period, the operated eye sees clearly at distance without correction while the other still has its cataract and its old correction. It is the situation that raises the most questions about glasses after cataract surgery.

Anisometropia

The two eyes temporarily have very different corrections. The brain tolerates a large difference between the two lenses poorly: images of unequal size, a feeling of imbalance, sometimes headaches. It is transient and disappears with the second operation.

What to do with the old pair

The simplest solution: have your optician remove the lens on the operated side, or replace it with a plain lens, and keep the old lens in front of the eye not yet operated on. Many patients simply go without glasses until the second operation.

The interval between the two eyes

The second eye is generally operated on one to four weeks after the first. Shortening the interval limits the discomfort; lengthening it allows the implant for the second eye to be fine-tuned according to the result of the first.

Further reading—docteurgozlan.fr Cataract: operate on one eye or both? How long between the two?

What to do with your old glasses?

Once both eyes have been operated on and have settled, your old glasses no longer match anything: the implant has replaced the correction they provided. Wearing them gives blurred vision and a sense of dizziness, with no danger to the eye. Three situations are worth knowing about.

The long-standing myope

They have always read without glasses by taking them off. With an implant set for distance, they discover that they see clearly at distance for the first time, but need reading glasses. This reversal is surprising: it must be anticipated before the operation, and an implant set for near, or monovision, can be discussed.

The hyperope

They wore glasses for every distance. Surgery often frees them from distance correction; their glasses after cataract surgery then come down to a pair of readers, far lighter than their old varifocals.

The contact lens wearer

Contact lenses are stopped before the preoperative measurements and during healing. Once the eye has settled they become possible again to correct any residual error, but most patients no longer have any use for them.

Which lenses to choose for your glasses after cataract surgery?

The type of lens follows from what the implant does not cover. A few pointers for the discussion with your optician.

Single-vision reading lenses

After a distance monofocal implant, a single-vision near pair is all that reading requires. It is the cheapest choice and the most comfortable for long reading.

Varifocal lenses

Useful if you want a single pair for the screen, reading and a slight residual distance error. They take a few days to get used to, especially if you did not wear them before.

Anti-reflective coating

Recommended: the implant reflects a little more light than a crystalline lens, and the coating reduces the nuisance of headlights and screens. It is also a requirement of class A lenses under the 100 % Santé scheme.

Sun protection and “blue light”

The implant already filters ultraviolet light. Sunglasses remain pleasant in the first weeks, while the eye rediscovers light. “Blue light” filters have shown no benefit for the retina: they are not necessary.

Reimbursement of glasses after cataract surgery

Glasses prescribed after the operation follow the rules of any pair of glasses: there is no cataract-specific cover, but three mechanisms are worth knowing, under the French system.

100 % Santé

A frame from the 100 % Santé range and class A lenses — anti-reflective coating included — are fully covered by the national health insurance and your top-up insurer, with nothing left to pay. Every optician is obliged to offer you this option.

Class B lenses

Freely priced, they are reimbursed only marginally by the national health insurance. What remains to pay depends on your top-up insurance contract, which generally provides an allowance every two years.

The prescription

It is valid for 3 years after the age of 42. Lens renewal is covered every two years, and sooner when vision has changed — which is precisely the case after cataract surgery, on the ophthalmologist’s prescription.

If you chose a premium implant, the extra cost concerns the implant itself, never the glasses after cataract surgery: these remain reimbursed normally if they prove necessary.

Dedicated page—cataracte.fr Cost and reimbursement of cataract surgery

If vision stays blurred despite glasses

Well-fitted glasses after cataract surgery should give clear vision. If they do not, or if the clarity obtained deteriorates after a few months, the cause is not in the lenses. Four explanations predominate, and all of them can be treated.

Secondary cataract

The capsule holding the implant clouds over months or years after the operation. Vision becomes veiled again, as before. A YAG laser session of a few minutes, in the consulting room, restores it permanently.

Refractive surprise

The optical result differs from what was calculated: residual myopia or hyperopia, astigmatism. Glasses correct it in most cases; if the discrepancy is large, other solutions exist, from laser to an additional implant.

Macular oedema

Swelling of the centre of the retina, a few weeks after surgery, gives blurred or distorted central vision that glasses do not improve. It is diagnosed by OCT and treated with eye drops.

Dry eye

Common after the operation and the drops, it makes vision fluctuate: clear one moment, blurred the next. Artificial tears are usually enough.

Further reading—docteurgozlan.fr Secondary cataract and the YAG laser

Frequently asked questions about glasses after cataract surgery

No, not always, but most often yes for at least one distance. With a monofocal implant set for distance — the case for the vast majority of patients — reading glasses remain necessary. Extended depth of focus or multifocal implants reduce that need considerably without removing it in every situation.

Four weeks after the operation: that is the time for the final prescription, issued at the check-up. If both eyes are operated on, glasses are prescribed 4 weeks after the operation on the second eye, as a single balanced pair.

On the operated eye, the old lens no longer matches: it blurs vision instead of helping it. Between the two operations, the simplest solution is to have the lens on the operated side removed, or replaced with a plain lens, and to keep the old correction in front of the eye not yet operated on.

Yes, like any prescribed pair. In France, the 100 % Santé scheme provides a frame and class A lenses with nothing left to pay. Class B lenses, freely priced, are reimbursed only marginally by the national health insurance and covered according to your top-up contract. The prescription is valid for 3 years after the age of 42.

They are useful in the first weeks, because the operated eye receives far more light than it did through a clouded lens and glare is common. They are not a medical obligation: the intraocular implant itself filters ultraviolet light.

Glasses after cataract surgery: when, which ones, and what for?