Cataract Surgery and Intraocular Lens Implantation

Yesterday, 2022-08-17, I had the second of two surgeries to replace cataract-afflicted lenses in my eyes. Assuming all continues to go well, that should take care of that problem all the way to the checkered flag. Here is a video made by an eye surgeon in Austin, Texas showing the complete process of removal of the natural lens and implantation of an intraocular lens to replace it. If you are squeamish, you might want to give this one a pass. The entire process is essentially painless and takes between 15 and 30 minutes; both of mine were toward the low end of this range.

The following animation showing the procedure was produced by Zeiss medical products, who made the microsurgery equipment used in my procedure.

I opted for the basic monofocal lens, which provides sharp vision only at one specified distance, just like the natural lens in people who have lost visual accommodation with age (usually around age 45). The implant was chosen to provide sharp vision at reading/computer screen distance, so I would not need glasses for what I spend most of my time doing, and would require glasses only for driving or outdoor activities. Since I’ve worn glasses for everything since age 7, this seemed the best tradeoff to me.

In the consultation before the surgeries, the surgeon warned me that in cases of extreme myopia like mine, (I was −11.75 dioptre in one eye and −10.25 in the other before the cataracts developed), it is difficult to achieve a precise correction by the interocular implant, and you may end up off by as much as two dioptres after things settle down over a month after the operation. I went into it knowing this, but there’s nothing that can be done about it.

In fact, coming up on a month after the first surgery, that eye has settled at around −1 dioptre myopic, which comes to a focus about two and half metres from the eye. This is inconvenient for reading or computer use, but a CHF 20 pair of generic reading glasses perfectly corrects vision for those activities. The good news is that this gives me vision which, on the old U.S. scale, is around 20/30 without glasses, which is good enough to drive without glasses almost everywhere in the world. I will get driving glasses, of course, because why risk anything less than perfect, but for everyday activities I’ll have no need for glasses.

This assumes the situation stays where it is at this writing. The surgeon also said that it is not unusual for the correction to weaken slowly over the six months after the implant, but that it was unlikely in a case like mine that it would go so far as to exceed 20/40 equivalent (the usual criterion for driving without glasses).

I chose a monofocal lens instead of the fancy multifocal kind because the latter inevitably results in reduced contrast, haloes of light, and other crud which is anathema to an amateur astronomer, while by many reports doesn’t do a particularly good job of simulating natural accommodation to a variety of distances. I’ve tried progressive lenses in eyeglasses and have never been satisfied with the results compared to separate driving and reading glasses (which usually cost less together than a single progressive pair), so I wasn’t about to have something like that permanently implanted in my eyeball.

Apart from complete removal of the blurriness of cataracts, the most striking thing is the perception of colour. The natural lens doesn’t just lose optical quality with age, it also yellows. When the first eye was done, I was immediately startled by the blue of the sky: with the other eye, the sky was the sickly green-yellow colour to which I had been accustomed, but now it was almost a cartoon blue. Over the month between surgeries, I observed numerous stunning differences in colours between the fixed eye and the one with original factory equipment.


That is a fascinating observation, seldom commented upon.

Glad that your surgery went well. It is difficult not to be squeamish about anything involving the eyes!


My father-in-law’s color vision change was obvious because he did his own color photo developing as his cataracts were developing, and you could see his photo prints getting more and more blue. My wife’s family are also high myopes, with my wife peaking at -14 after two pregnancies (yup, she got more nearsighted during pregnancy) and now coming down to -12 as we approach age 50. She’s looking forward to eventual cataract surgery so she won’t have to wear glasses for some activities.


Congratulations and it will hopefully stabilize and serve you well for many years to come.

I wonder why this type of surgery is not used more often - at earlier ages - for vision correction.


Perfect for putting a pair of 4k monitors just beyond the foot of your bed


Answer: because insurance (& Medicare) won’t pay for it until the cataracts are “ripe”; that means until your vision is seriously impaired.


I just learned today, in the process of researching this post, that there is a treatment for severe myopia called a phakic intraocular lens (PIOL). This is a plastic lens which is implanted, depending on the type, before or after the natural lens in the eye. When performed on people who have not lost accommodation due to age, they preserve their ability to focus over a range of distances (done by the natural lens), while the implanted lens provides refractive correction.

PIOLs are mostly used to treat extreme myopia beyond the limit of LASIK or other refractive surgery (usually greater than −8 to −10 dioptre).

The surgery to implant the lens is comparable to regular cataract surgery, but there are a number of complications which the PIOL may create, including provoking the formation of cataracts in the natural lens and damage to the cornea.

PIOLs are sometimes called “implantable contact lenses”, but the risks and uncertainties involved cause them to be used mostly for extreme myopia which cannot be treated well with contact lenses or glasses.


I had mine done about 5 years ago. It was quite easy. When mine was done, the technique was somewhat different. Rather than as in the video, the ophthalmologists here did not use a knife to make an incision in at the corneo-scleral angle, they use a laser to both make that incision, to morcellate the old lens and to correct astigmatism of the cornea. In the video, the lens is removed using phaco-emulsification (ultrasound vibration), instead of using a laser. (Remember the old detergent ad": “Do you know what it means to be emulsified”??

There is a back story. The laser technique was offered to me as an option - at an extra cost of $1250 per eye. I said, “I never spend that kind of money on myself. I prefer the time-tested way”. He then offered to do both for the price of one and I agreed. Of course, at the time, I was still covered by commercial insurance via my employer - so he was better paid than he would have been with Medicare. Soon, my wife - now covered by Medicare - will have hers done. I am curious to see how he handles her as to options.


The whole eye implant thing was a byproduct of WWII. Some Flight Surgeon noted that pilots whose canopies (made of plexiglass) had shards in their eyes that didn’t seem to cause a bodily reaction. From thence we have come to modern eye. surgery, a HUGE money maker for ophthomologist. who do them.

Much change has occurred over the years. For a while LASIK was the hot item, although it doesn’t fix cataracts, only visual distortion. The Air Force is adamant about NOT accepting anyone into pilot training because of (a) the strange effects night flying can cause, and (b) because there has been no long term study of possible negative effects. I believe both of those still stand.

OTOH, things like contacts have evolved to where you can get turning contacts - that is, they get darker with more light and lighter in less light. So just like the turning sunglasses. I await some such development in cataract replacement.


There is a Web site, “LASIK Complications”, which is full of horror stories about people’s experiences with LASIK. The most common result is ghost images, haloes, glare intrusion, and loss of contrast. Among the amateur astronomy community, there is a widespread belief that the consequence of “successful” LASIK is a substantial loss in the ability to perceive detail in low contrast objects. Here is a letter on the site from an ophthalmologist on the reasons he does not perform LASIK.

I and many prominent corneal specialists share a deep and perhaps too passive concern about the lack of knowledge regarding the long term response of the cornea to laser ablation. We simply do not have the experience to rest assured that the cornea will not respond to the loss of substantial amounts of its ablated stroma. Will these centrally thinned corneas eventually become distorted with ectasia ( a bowing forward of the cornea) and eventually require corneal transplantation? What is the long term effect on the other critical layers of the cornea? Will the cornea’s natural barrier to infection be impaired? How will the cornea withstand injuries? We have already witnessed the unintended consequence of radial-keratotomized eyes rupturing upon airbag impact. Myopic eyes are more prone to retinal detachment, cataracts and glaucoma over the years. How will these eyes fare as they face these inevitabilities? While I hope current presumptions hold, I would feel better to see a greater degree of experience before the procedures are hawked on every street corner by every self-proclaimed laser specialist. It is particularly upsetting to see the level of interest in these procedures, fueled not by sober scientific inquiry, but by personal testimonials inspired by public relations experts and distributed to the targeted media of the “disposable-income classes”. I suspect the recent, favorable run of articles in Barrons, the Wall Street Journal and similar publications are part of this process.


ALL new technology runs these risks. Some are mitigated by good testing practice before release into the general public; some (the vaccine) are not. I had my right ACL repaired by the Navy in 1969. It was the avant guarde procedure. No one knew then that the repair would collapse for lack of a proper blood supply to the ligament. I have had a crazy positive “drawer sign” which I used to show med students so they would know what it looked like. But I also skied and played handball. I had discovered that the vast majority of the knee’s stability was provided by leg muscle strength.


I looked into PIOL (I wear -13.5 and -11 corrective lenses) and was told I was a good candidate after evaluation, but I just didn’t feel justified in spending over $6000 and undergo the risks. Contacts + reading glasses in the last few years do very well for me.


I read up a bit more on this and it appears manual surgery is better than femtosecond laser surgery.


I learned another trick today that may be useful for extreme myopes after cataract surgery that brings them closer to normal vision. All my life, I’ve taken advantage of myopia in that I have a built-in magnifying glass/microscope any time I need one. Just take the glasses off, hold the thing close to your eye, et voilà, you can see that pesky solder bridge or bent contact that’s vexing you.

Post-operation, you lose that. But you don’t lose the instinct to take off your glasses and hold the thing up close to see it better which, of course, now only makes it worse.

After a little research on the kind of magnifier headset I used to use when building and debugging a lot of circuit boards back in the Marinchip era, I ordered a pair of reading glasses from with the maximum correction of +3.5 dioptres. With my post-surgery vision without glasses of −1 dioptre, this gives a distance of sharp focus of around 20 cm, which is equivalent to that of a close work magnifying headset. Plus, and this is a big plus, since both eyes are corrected about the same (at least for the moment—they may drift over time), I have binocular vision at that distance, whereas before I could use only one eye at a time since their focal distance was sufficiently different I couldn’t bring both into focus simultaneously.

If you opt for this trick, the only thing I’d recommend that I didn’t do is order the frames in a different colour or style from your regular reading glasses so you don’t confuse them when picking them up.

Yes, these glasses do make me look like Clark Kent. Go ahead and make fun—bullets bounce off.


Or not. Get a few spare pairs:


I had Lasik done twenty years ago. Corrected -5 diopters of myopia and 1.5 diopters astigmatism.

Perfect results, and still perfect. I still developed presbyopia some years ago, but cheap readers from Walmart or drugstores work just fine.

Pre-Lasik, I wore contacts most of the time, foregoing the astigmatism correction in favor of comfort and peripheral vision. I would switch to glasses in the evenings, and especially for night driving. Lasik yielded better vision than either pre-Lasik correction method. I’m pretty sure that’s because the astigmatism correction included in my treatment was computed for every 1° increment, where traditional lenses with astigmatism correction are just the four quadrants.

And no ghosts, haloes, glares, or loss of contrast. Simply perfect.

Getting Lasik was the single most valuable item I’ve ever spent on myself, in terms of results for my life. I recommend it to all but extreme myopes.


For a long while I had kept track of the correction statistics for RK and then Lasik. Eventually it reached a satisfactory level. I went to the ophthalmologist and then found out that my corneas were too thin for Lasik.


An associate’s child was diagnosed around age 7 with rapidly progressing myopia - increases of about 1 diopter per year. The treating optometrist prescribed daily diluted atropine drops in each eye in the morning. This approach worked well at controlling the progression, and it was remarkably stable. The dilution is around 0.01%.

Eventually, by the time the patient reached age 12, the treatment plan shifted from corrective lenses to daily disposable dual focus soft contacts (Cooper Vision MiSight) and less frequent eye drops.

Here is a paper that reports on the first part of this approach using a sample of Korean children.


The one thing that held me back from getting LASIK done when younger was the observation I rarely came across optometrists or ophthalmologists that had the procedure done themselves.



That is about what I had – 1 diopter per year from 2nd grade. My Ghanian optometrist recommended I immediately start with contact lenses to slow the progression. He also told me to stop reading while lying on my back, he said that that would cause the eyeball to grow longer and worsen the myopia.

When we returned to the USA, the American-trained optometrist said he had never heard of such a thing and wouldn’t prescribe them (so that insurance would cover them).

Once I did start with soft contact lenses my prescription did not change for almost 10 years. Three decades plus later I’m still only 1.5 and 2 diopters over where I started with contact lenses.