Story By Michael Mahr, M.D., Ophthalmology, Mayo Clinic, Rochester, Minn. | Chicago Tribune Lifestyles
DEAR MAYO CLINIC: I need to have cataract surgery, but I also have astigmatism. Is it possible to have them both fixed at the same time? If so, what will the recovery be like?
ANSWER: In many cases, it is possible to correct astigmatism during cataract surgery. The specific technique for how it’s done depends on your individual situation. It is typically a straightforward procedure that minimizes the need for eyeglasses. Recovery usually is brief. Most people can return to their daily activities a day or so after surgery.
A cataract affects the natural lens inside your eye. The lens is positioned behind the colored part of your eye, called the iris. It focuses light that passes into your eye, producing clear, sharp images on the retina. Normally, the eye’s lens is transparent and clear. When the lens becomes cloudy, that’s a cataract. Cataract surgery involves removing the clouded lens and replacing it with a plastic lens implant. The replacement lens sits in the same place your natural lens had been.
The artificial lens placed during cataract surgery can provide correction, if needed, for either distance or close-up vision, as well as remove the cataract. To correct astigmatism requires a few more steps.
Rather than affecting the lens of the eye, as nearsightedness and farsightedness do, astigmatism usually affects the eye’s cornea — the dome-shaped transparent tissue at the front of the eye. The cornea functions as a type of front window for your eye. Normally, the cornea is shaped like a basketball. With astigmatism, the shape of the cornea is skewed, and it’s more like a football. Astigmatism blurs vision at all distances.
To correct astigmatism during cataract surgery, a surgeon can change the shape of the cornea with the incisions made in the cornea during surgery, so it becomes more like a basketball shape, matching the implanted lens and improving vision.
An alternative approach is to use a lens that has a football-like shape similar to the cornea, but to implant it in an orientation opposite to that of the cornea’s shape. That type of lens placement negates the effect of the misshapen cornea and reduces the vision problems of astigmatism. Your surgeon can determine which approach is best for you based on an evaluation of your eye prior to cataract surgery.
Rarely, astigmatism can result from a problem in the natural lens. When that happens, cataract surgery alone will correct astigmatism without any further intervention needed. If this is the case for you, your surgeon will be able to determine that before your surgery takes place.
In almost all cases, cataract surgery is an outpatient procedure that takes less than 20 minutes. Astigmatism correction generally adds just a few more minutes to that time. After surgery, your surgeon places a shield and patch on your eye. They need to remain in place for less than 24 hours. Once the patch and shield are removed, most people can return to their usual activities. A return appointment is scheduled for several weeks after surgery to check the eyeglass prescription. No further follow-up visits are usually needed after that.
Talk to your eye surgeon about your interest in correcting your astigmatism during cataract surgery. The options available for doing so are safe and, for many people, they offer a reliable way to improve vision.
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Story By Michael Mahr, M.D., Ophthalmology, Mayo Clinic, Rochester, Minn.