Cataract surgery is now very accurate, but it isn’t perfect. Some people are left with a little short-sightedness, long-sightedness or astigmatism, and find they still reach for glasses to drive, watch TV or read. Laser eye surgery can often fine-tune that leftover prescription.

First, check which problem you have. If your vision was clear after cataract surgery but has gone cloudy or hazy months or years later, that’s usually posterior capsule opacification (PCO), and the fix is a quick YAG laser, not laser eye surgery. See our guide to YAG laser after cataract surgery. This post is about the other problem: a glasses prescription left over after your eye has healed.

QuestionShort answer
Can laser fix glasses after cataract surgery?Yes, LASIK or TransPRK can correct leftover short-sight, long-sight or astigmatism.
Is it accurate?Reviews describe laser as the most accurate way to correct small leftover prescriptions.
When?Once your prescription is stable and your eye has healed.
Cost?Free for two years if your lens surgery was at Focus Vision; otherwise standard laser prices.

Why some people still need glasses after cataract surgery

During cataract surgery, your cloudy natural lens is replaced with an artificial lens (an intraocular lens, or IOL). Its power is chosen from measurements of your eye, using formulas that predict where the lens will sit. Those predictions are very good, but small differences in how each eye heals mean the final result can land slightly off target.

How often does it happen? The UK’s benchmark standard is for 55% of eyes to finish within 0.50 dioptres of the planned result and 85% within 1.00 dioptre (Gale et al., 2009). Across 282,811 operations in the European cataract registry, about 73% of eyes were within 0.50 dioptres (Lundström et al., 2018). So most people land close to target, but a meaningful minority are left with enough prescription to notice.

Other reasons you may still need glasses:

  • Astigmatism. A standard lens doesn’t correct astigmatism. Toric lenses do, but if a toric lens turns after surgery, it loses about 3.3% of its correction for every degree it rotates (AAO EyeNet).
  • Previous laser eye surgery. Lens calculations are harder in eyes that have had LASIK or PRK. See cataract surgery after LASIK or PRK.
  • Reading. With a standard monofocal lens set for distance, most people need reading glasses for close work. That’s expected, not an error.

Rule out the other causes first

Blurry vision after cataract surgery isn’t always a prescription problem. In a study of patients unhappy with blurred vision after multifocal lenses, the most common cause was capsule clouding (PCO) in 54% of eyes, followed by leftover prescription in 29% and dry eye in 15% (Woodward et al., 2009). Reviews of laser after cataract surgery recommend a thorough check for other causes of poor vision before any enhancement (Moshirfar et al., 2021).

Before laser, your surgeon checks for:

  • Capsule clouding (PCO), treated with YAG laser. YAG laser is free, with no time limit, for patients whose cataract surgery or lens replacement was at Focus Vision.
  • Dry eye, which becomes more common with age (TFOS DEWS II) and is treated before any laser.
  • Retina and macula problems, which glasses or laser can’t fix.
  • Lens position, including whether a toric lens has turned.

How laser fine-tunes your vision after cataract surgery

The artificial lens stays exactly where it is. The laser reshapes the cornea, the clear window at the front of the eye, to correct the leftover prescription, just as it does in people who have never had cataract surgery.

  • LASIK creates a thin flap in the cornea and reshapes the tissue beneath. Vision recovers quickly, and most people are back to normal activities in a day or two.
  • TransPRK reshapes the surface of the cornea with no flap. Recovery takes longer, but it can suit thinner corneas or drier eyes.

What the evidence shows. A review in the Journal of Cataract and Refractive Surgery found that laser vision correction, whether LASIK or PRK, gives more effective and predictable results than surgery inside the eye (Sáles & Manche, 2015). Another review concluded LASIK is the most accurate procedure for correcting leftover prescription after cataract surgery (Alió et al., 2014), and a third found corneal procedures are the safest and most accurate option for mild leftover prescriptions (Moshirfar et al., 2021). In a series of PRK after premium lenses, every eye finished within 1.00 dioptre of the intended correction (Fan et al., 2018).

If you have a multifocal or extended depth of focus lens, even a small leftover prescription can noticeably blur both distance and near, so fine-tuning often makes a bigger difference than it would with a standard lens.

Can laser help with reading after cataract surgery?

Sometimes. If you have standard lenses in both eyes, laser can set one eye slightly for near so you can read without glasses, a form of monovision. It suits some people better than others, so it’s often trialled with a contact lens first. See monovision vs blended vision. Another option is a multifocal upgrade lens added in front of your existing lens; see the 1stQ AddOn upgrade lens.

Laser or another option?

OptionHow it worksUsually best for
Glasses or contact lensesCorrect the leftover prescriptionAnyone; no surgery
LASIK or TransPRKReshapes the corneaSmall to moderate leftover prescriptions, healthy cornea
Supplementary lensA second lens placed in front of your existing oneLarger errors, corneas unsuitable for laser, adding near vision
Rotating a toric lensTurns a toric lens back to its planned positionA toric lens that has rotated; best done early
Lens exchangeReplaces the artificial lensLarge errors or a lens that needs replacing; best done early

Reviews find laser the most accurate option for small leftover prescriptions. Large long-sighted, short-sighted or astigmatic errors are better managed with lens-based procedures, and where a second lens is needed, adding a supplementary lens is generally safer and more accurate than exchanging the original lens (Moshirfar et al., 2021; Alió et al., 2014). Rotating a toric lens and lens exchange are best done in the early weeks after surgery (Moshirfar et al., 2021).

When can I have laser after cataract surgery?

Your prescription settles quickly. In an Australian study of 86 patients after uncomplicated cataract surgery, vision and prescription were stable from two weeks after surgery (McNamara et al., 2019), and another study found refraction stable from one week (Caglar et al., 2017).

Laser fine-tuning is planned once your surgeon has confirmed your prescription is stable on more than one visit, your eye has healed, and any dry eye or capsule clouding has been treated. If you have both eyes done, it’s common to wait until both have settled so the plan takes your two eyes together into account.

What it costs

  • If your cataract surgery or lens replacement was at Focus Vision: laser fine-tuning that your surgeon judges safe and worthwhile is free for two years from your original lens procedure, under our enhancement policy. Prescribed drops are charged separately.
  • If your cataract surgery was elsewhere: standard laser prices apply, at $4,250 per eye for LASIK and $3,500 per eye for TransPRK, all-inclusive except prescribed drops. See the costs page.

Medicare doesn’t cover laser done to correct your glasses prescription, and Medicare’s lens surgery items exclude “surgery performed to correct a refractive error” (MBS item 42701).

Ask us at a free assessment

Start with a free assessment with our optometrist in Woolloongabba, who measures your prescription and checks your cornea, lens position and tear film. Bring the details of your cataract surgery if it was elsewhere, including the lens type if you have it. If laser looks suitable, you then see Dr Brendan Cronin or Dr David Gunn to confirm the plan; the consultation fee comes off your surgery price.

Call (07) 3239 5005, email hello@focusvision.com.au or book online.

References

  1. Gale RP, Saldana M, Johnston RL, et al. Benchmark standards for refractive outcomes after NHS cataract surgery. Eye (Lond). 2009;23(1):149-152. pubmed.ncbi.nlm.nih.gov/17721503
  2. Lundström M, Dickman M, Henry Y, et al. Risk factors for refractive error after cataract surgery: analysis of 282 811 cataract extractions reported to the European Registry of Quality Outcomes for cataract and refractive surgery. J Cataract Refract Surg. 2018;44(4):447-452. pubmed.ncbi.nlm.nih.gov/29685779
  3. American Academy of Ophthalmology. Toric IOLs: Four Options for Addressing Residual Astigmatism. EyeNet Magazine. aao.org
  4. Woodward MA, Randleman JB, Stulting RD. Dissatisfaction after multifocal intraocular lens implantation. J Cataract Refract Surg. 2009;35(6):992-997. pubmed.ncbi.nlm.nih.gov/19465282
  5. Moshirfar M, Thomson AC, Thomson RJ, et al. Refractive enhancements for residual refractive error after cataract surgery. Curr Opin Ophthalmol. 2021;32(1):54-61. pubmed.ncbi.nlm.nih.gov/33122488
  6. Stapleton F, Alves M, Bunya VY, et al. TFOS DEWS II Epidemiology Report. Ocul Surf. 2017;15(3):334-365. pubmed.ncbi.nlm.nih.gov/28736337
  7. Sáles CS, Manche EE. Managing residual refractive error after cataract surgery. J Cataract Refract Surg. 2015;41(6):1289-1299. pubmed.ncbi.nlm.nih.gov/26096522
  8. Alió JL, Abdelghany AA, Fernández-Buenaga R. Management of residual refractive error after cataract surgery. Curr Opin Ophthalmol. 2014;25(4):291-297. pubmed.ncbi.nlm.nih.gov/24865171
  9. Fan YY, Sun CC, Chen HC, Ma DH. Photorefractive keratectomy for correcting residual refractive error following cataract surgery with premium intraocular lens implantation. Taiwan J Ophthalmol. 2018;8(3):149-158. pubmed.ncbi.nlm.nih.gov/30294528
  10. McNamara P, Hutchinson I, Thornell E, et al. Refractive stability following uncomplicated cataract surgery. Clin Exp Optom. 2019;102(2):154-159. pubmed.ncbi.nlm.nih.gov/30380588
  11. Caglar C, Batur M, Eser E, et al. The Stabilization Time of Ocular Measurements after Cataract Surgery. Semin Ophthalmol. 2017;32(4):412-417. pubmed.ncbi.nlm.nih.gov/27082151
  12. Australian Government. MBS Online, item 42701 (intraocular lens insertion). health.gov.au
B

Brendan Cronin

MBBS (Hons), DipOphthSci, B.Com, LLB, FRANZCO, FWCRS

Dr Brendan Cronin is a corneal, cataract and refractive surgeon and co-founder of Focus Vision in Brisbane. He is the Director of Education at the Queensland Eye Institute, completed his corneal fellowship at the Manchester Royal Eye Hospital in the UK, and teaches corneal and refractive surgery techniques to ophthalmologists internationally. He co-created the CAIRSPlan surgical planner and the free Focus Vision Refractive Outcomes Analyzer.

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