Choosing the Right Prescription for Cataract Surgery: Key Considerations

Cataract residual refractive error

Hello Dr.
He, I had cataract surgery on my right eye at the end of July last year, with a target prescription of +1.00 (post-operative refraction of +1.25).
I can see 0.3 (0.5 was the result from an examination in June this year).
My left eye also has cataracts.
I would like to ask: 1.
Should I aim for the same target prescription as my right eye (+1.00) for my left eye? 2.
Or can I choose to have it set to plano (0.00), without any prescription? 3.
Would this create a disparity between my two eyes, potentially leading to issues such as dizziness or imbalance? 4.
Personally, I prefer to have my left eye set to plano, but I am concerned about the issues mentioned in question 3.
I am quite troubled and unsure about how to make the best choice.
I would appreciate your guidance.
Thank you!

juyu, 50~59 year old female. Ask Date: 2022/07/08

Dr. He Jianxian reply Ophthalmology

It is recommended to choose zero degrees directly, as a parallax of around one hundred degrees will not cause any significant issues even when wearing glasses, as provided for your reference by Dr.
He Jianxian, Director of the Ophthalmology Department at Nantou Hospital.

Reply Date: 2022/07/08

More Info

When considering cataract surgery, particularly in your case where one eye has already undergone the procedure, there are several key factors to take into account regarding the prescription and potential outcomes. Let's address your questions step by step.

1. Should I aim for the same prescription as my right eye (100 degrees)?
It is common practice to aim for a similar refractive outcome in both eyes, especially if the first eye has been successful in achieving a satisfactory level of vision. If your right eye has a prescription of +1.00 (100 degrees) and you are comfortable with that vision, it may be beneficial to aim for the same in your left eye. This would help maintain a balanced visual experience between both eyes.

2. Can I choose to have the left eye set to plano (0)?
Yes, you can opt for your left eye to be set to plano (0), which means no refractive error. Many patients choose this option, especially if they prefer to be free from glasses for distance vision. However, this decision should be made with caution, as it can lead to a condition known as anisometropia, where the two eyes have significantly different refractive powers.

3. Will having different prescriptions cause visual disparity, dizziness, or imbalance?
Yes, having different prescriptions between your two eyes can lead to visual disparity, which may cause symptoms such as dizziness, headaches, or a sense of imbalance. This is particularly true if the difference in prescription is significant. The brain may struggle to fuse the images from both eyes, leading to discomfort. If you choose to have one eye set to plano and the other to +1.00, you may experience some of these symptoms, especially during the initial adjustment period.

4. What should I consider when making my decision?
When deciding on the prescription for your left eye, consider the following:
- Your lifestyle and visual needs: If you engage in activities that require sharp distance vision, having both eyes set similarly might be advantageous. If you prefer to be glasses-free for distance, then setting the left eye to plano could be appealing.

- Consultation with your ophthalmologist: Discuss your concerns and preferences with your eye surgeon. They can provide personalized recommendations based on your specific eye health, the severity of your cataract, and your overall visual goals.

- Trial with glasses: If possible, you might want to try wearing glasses that simulate the different prescriptions before making a final decision. This could help you gauge how you might feel with the different visual inputs.

In summary, while you have the option to choose between matching the prescription of your right eye or aiming for plano in your left eye, it is essential to weigh the potential benefits against the risks of visual disparity. Consulting with your ophthalmologist will provide you with the best guidance tailored to your unique situation. They can help you navigate these choices to achieve the optimal visual outcome post-surgery.

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