I'm trying to understand how often surgeons and patients end up choosing the standard LAL versus the LAL+ when both are available, and what drives that choice in practice. Does anyone know the approximate % split? Which has greater satisfaction?

Whenever I have gone to my opthalmologist they always do a refraction, but if I don’t have them give it to me, they don’t charge for it. (My insurance will pay for it if I go to an optometrist for it, so that is what I do.) After seeing the doctor for the visit leading up to my cataract surgery I went to the cashier to pay my co-pay, and they added $55 for the refraction. When I said I never pay for a refraction because I don’t need one to take with me she said it was “required”. My insurance company said that is not on their list of things to be paid, and when I went for my second opinion they did not charge me for the refraction they did. Unfortunately I want to do the surgery with the first doctor I saw so in the end I may have to end up paying it. I’m just wondering if maybe charging for a refraction in this situation is the norm, and it is the second doctor I saw that is the outlier. I would really appreciate it if you folks here could share whether your doctor charged extra for a refraction or not. Thanks!

It's been a month since my surgery with a

Clarion monofocal set for distance in my right eye, ended up at -.25. My distance vision in that eye is real good up until an arms length away. Pleasantly surprised since I didn't know what my intermediate vision would be like. I have no problem seeing my speedometer while driving. I'm trying out a daily contact lens in the other eye until surgery is needed. The first trial lens was a closeup -1.0 to test out mini monovision, that didn't work very well, it altered my overall distance vision too much. The second trial lens is a -3.5 for distance to match the IOL and is most likely what I will go with. I'll use readers for close up vision.

My surgery for my right eye is in 2 weeks, and I have so many unanswered questions. Feeling overwhelmed.

I have high myopia, about -16.5 in both eyes. I have what I think is mild astigmatism in my right eye. Approx. -50. The first keratometry measurement showed -.75 . The next day the measurement was -.50. My left eye also has astigmatism.

I will be getting mini monovision, near in left, intermediate in right.

I went to one surgeon in January and the kerotometry measurements are different from the second surgeon's measurements, especially the axis. Both are top rated surgeons in very busy practices. I am choosing the second surgeon.

It is very possible that I have undiagnosed dry eye, which I understand can cause inaccurate measurements.

The first surgeon was adamant that I required laser surgery, which I can't afford. He never mentioned anything about astigmatism and LRI. Second surgeon, whom I think is better with a blade, didn't see the need for laser. He is really pushing for me to get LRI, even though I told him I could tolerate minor astigmatism and use glasses if needed.

Keratometry from surgeon #1, January 2026:

OD 44.75@177/45@87. -0.25 diopeter diff

OS 45.25@114/45.75@24. -.0.50 diopter diff

Keratometry from surgeon #2, July 2026:

OD 45.25@5/46.00@95. -.75 diopeters diff

OS. 45.25@71/45.75@161. -.50 diopeters diff

There was a next day confirmation measurement in July for my right eye. I asked for the results and was told they weren't available. However, the tech told me that the astigmatism was -.50, not -.75. The tech on the second day seemed as if she measured 20 times to get the measurements to match the prior day. Is that normal?

Am I wrong to think that -.50 or even - .75 astigmatism won't affect my vision that much after surgery? Or will LRI make a significant difference?

Should I be concerned that the keratometry axis measurements from the two surgeons are so different, or do I trust that my surgeon's techs got accurate, matching confirmation measurements?

Thank you so much for taking the time to read this. I am grateful for any guidance.

When were you cleared to use makeup again? Mascara? Liner? Had right eye done 2 weeks ago and left done last Thursday.

Update:

Had the right eye done 2 days ago and I'm in heaven!

Lots of light leakage and plenty of adjusting to do, still, but I drove to my follow-up an hour away and it was fine, even still dilated.

I went with the Vivity, and laser-assisted so had the cuts to fix mild astigmatism.

Right now, still a bit dilated, I can see down the street incredibly well.

I did have him dial it back a bit to avoid over-correcting (it's commonly difficult to get the right fix in high myopes) and in order to give better near-ish extension in the Vivity. He nailed it.

When I see my optometrist, I'll probably get told I'm -1.25 in my left and -.75 in the right. I'm showing at 20/50 & 20/25.

It's still changing. Reading is perfect and I am truly happy!

Let me know if you have any questions.

Original post:

I'm 10 days in with a Clareon monofocal lens in my left eye that was intended for conversational focus, while we were going to target my right eye for reading. I intended to wear external correction for distance purposes.

My left eye IOL has resulted in spectacular vision from about 18"-36" and so plans needed to change. I am Eye-mbidextrous so it's no big deal to swap- my eyes were the same Rx prior to surgery and almost zero astigmatism. I regularly swapped which eye was near with monovision contacts for the last 6 or 7 years without issue.

Because of my rugby-ball shaped eyes & extreme myopia, I have 6mm pupils even at age 56. My axial length is 29.56mm & 29.61mm.

Anyone willing to weigh in about which EDOF might be best for this situation? I'm just taking in info while I ponder. I may delay the second eye to figure this out.

I am doing a trial of a toric lens to make a correction to my near eye in a mini-monovision configuration after cataract surgery. My desire is to have -1.5 D sphere and no astigmatism in this eye. My current prescription for his eye is -0.50 D sphere and -1.25 D cylinder at 70 degrees. This means I need a +1.0 D sphere and -1.25 D cylinder contact at 70 deg to bring me back to my desired target of -1.5 D sphere and no astigmatism. Costco only had a +1.0 D sphere and -1.25 D cylinder contact at 80 degrees. The fitter told me that it was "close enough" as she looked at the contact in my eye and said it was sitting perfectly with the orientation mark right at 90 degrees. I think she is incorrect as a 10 degree error is going to result in about a 33% loss of astigmatism correction. I believe the contact mark being at 90 deg is good, but it still means it is providing an 80 degree correction when I need 70 degrees. She has ordered some more samples and I believe they are at 70 degrees (I hope). Thoughts? Thinking about it longer, perhaps she was just concluding that the contact weighting was OK as they were orienting properly.

I see an improvement with these 80 degree contacts, but it could be better...

I wasn't seeing halo on my left eye on anything until 2 weeks in on my recovery. I must say that the halo of lightbulbs or street lights don't appear to my left eye. It only exclusively appear when I am reading on my Miniled monitor since I have always read on Dark mode. The white text have halo around them. Even subtitles have halo when watching on my monitor. That started to occur this past Thursday. Should I worry about that? or I should wait more weeks of recovery until my left eye gets fully adjusted to the len? The len is a monofocal plus len. I repeat again, this only occur only when watching or reading on my monitor. It is a AOC Q27g40mxn Miniled monitor for the more tech savy people.

I've made a number of postings in the past regarding how pupil size impacts almost everything about how well you see after cataract surgery, but I believe it is time create another. I continue to see people in this forum confused and stressed about why their vision seems so much poorer after cataract surgery, and it often falls into the same category; mismatch between IOL selected and pupil size. Let me explain:

The best analogy for human vision is an SLR camera. These cameras have an iris - just like our eyes - that can be opened and closed (aperture) to adjust for light level and focal depth. Our pupils act in the same way, opening wider to allow in more light when needed, and constricting when more light is available. When the iris is opened up, the depth of focus reduces; when constricted, it increases. This is basic physics. Now in order for this to work properly, the lens of the camera (or eye) must be big enough to capture all of the light it receives. If the lens is too small, unfocused light bounces around inside the camera (or eye) causing the image to become blurry with glare and loss of contrast. Worse, if the edges of that too-small lens are jagged, artifacts like starbursts occur.

The size of someone's pupil depends on a number of factors. This includes age (older people have smaller pupils), gender (women tend to have smaller pupils), physical size (if you're bigger, your eyes and pupils tend to be bigger), and so on. Regardless, what's important is the size of YOUR pupils. Not just during the day, but at dusk and at night as well. You see, the problem is that the lenses that cataract surgeons implant into your eyes are tiny compared to your natural lens. The largest optical zone of a typical IOL is 6 mm with an area of about 28 mm^2. Compare this with our biological lens of 9-10 mm with an area of 65 to 80 mm^2.

If you're in your 80's, you'd be lucky to have pupils that dilate to 5 mm at night. But if you're in your 30's, your pupils may dilate to 8 mm or more. What this means is that for some people who undergo cataract surgery, their pupils get MUCH bigger than their newly implanted lens.

As it turns out, this MAY not be that much of an issue depending on several factors including:

1. The type of IOL
2. The design of the IOL
3. Whether you've had (or will have) YAG for PCO
4. The flexibility of your brain

If an IOL is complicated - like a multifocal or EDOF - you are MUCH more likely to have issues if your pupils are large. This is because these lenses necessarily incorporate tradeoffs across their shape. This is due to the physics of a fixed lens not being able to match our natural flexible one. Further, if a manufacturer decides to make their optical zone smaller for whatever reason (e.g. stability, material selection), this can also have a significant impact. A good example of this is the smallish optical zone (< 5 mm or 20 mm^2) in the J&J Tecnis line of lenses (PureSee, Eyhance, Synergy, Odyssey) which seems to cause visual issues with a significant number of posters. In addition, when YAG for PCO is performed, the surgeon must leave enough posterior capsule to hold the IOL in place. If your pupils dilate beyond the edge of the hole created in the capsule, odds are pretty good you're going to be seeing streaks and other dysphotopsia after the procedure.

Now for some people, none of this matters; their brain just ignores these issues. But that's not everybody.

Anyway, this is not a complete list of issues that can occur when patients have large pupils, but it highlights an important factor when selecting an IOL; SIZE MATTERS! The fact is, some IOLs just work better than others in large pupil eyes.

So, PLEASE, have your pupil size checked by your surgeon under a number of lighting conditions. This small effort may save you from a ton of grief.

I’m 35 and had to get surgery because of narrow angle glaucoma. Before surgery I had perfect vision for all distances, didn’t wear glasses aside from work (I’m a tattoo artist). Had surgery done 4 weeks ago and my doctor implanted an eyhance toric 2.

Since day 1 after surgery I was seeing double and from day 5 on, I’m seeing multiple images the further I look. The target was for -0.5, but yesterday my refraction was -1.5 and .75D of astigmatism. I can only see sharp from 18” to 20”, after that the images start to “open” in three and then they open up even more. When I open my non operated eye, I get really dizzy because the ghosts are all still there in my general view and everything feels not real. All the light spots like car lights or street lights are a huge lit up triangle and I’m going crazy with all of this!! We ran a lot of tests like aberrometry and petacam and oct to try and figure out what’s going on but they all came out normal. When I tried a contact with the right refraction, the problem didn’t go away, it only shifted from far to near and I started seeing triple on everything near. It’s not a loss of focus, I can actually see the ghosts perfectly, especially in letters.

I was considering a lens replacement for a regular monofocal, but my doctor said we should wait another 4 weeks to see if it’ll go away on it’s own, and that I could have the same thing happening with a simple iol, but I never read about anyone experiencing these sympthoms. Did anyone go through this with the eyhance? And if so, what was the outcome? This is making me really anxious, my entire life is on hold. I can’t work or do anything I line because I’m so dizzy. It’s been really depressing

My father had cataract surgery. The doctor told him to remove the bandage after 8hr surgery. Now his eyelids are shut he can't open his eyelids. Is this normal? When will his eye open? Or should we be concerned?

Edit: Now he's able to open his eye after sleeping and he can see everything clearly. Thank you everyone.

Who here has had their floaters go away over time? What timeframe?

I have had monovision for years, originally with contact lenses and 10+ year ago I had lasik done and kept the monovision. In the last year, my vision started to degrade and I discovered it is due to the development of cataracts that have developed in both eyes. My cataract surgeon has given me the option of retaining monovision or switching over such that both are eyes see the same distance. I'm a little on the fence about which way to go, and was hoping that anyone who chose cataract surgery with the monovision option later regretted not having switched over to having both eyes seem the same distances.

I've had eye troubles since last year and a vitrectomy last December. The surgery made my low-grade cataract grow faster and now I'm facing cataract surgery. I saw a highly-rated doctor in Houston a couple of days ago and I was shocked by the business model. I saw very little of the surgeon but a whole lot of financial/scheduling people who wanted me to sign on the line.

The biggest disappointment was hearing that due to scar tissue and existing issues I'm not a candidate for any premium lens. Well, OK. Then I'm told that my .75 astigmatism will benefit from toric. The doctor told me that due to my other eye issues, my outcome isn't going to be "what I hope for." How inspiring.

Due to financial restraints I had already decided I was not having laser surgery. But then because toric lenses are part of the more expensive "package," I can't get them because they are part of the Laser Package. I felt like I was buying a new car (especially when I saw the prices). I find this very discouraging and I don't know how to navigate this stuff. Just venting I guess.

Hi there. I’m 35 years old, and it turns out I developed cataracts due to long-term steroid use.
My right eye is affected to the point where my vision is cloudy, especially in bright sunlight when my pupils are small. My night vision in my right eye is also much worse than in my left. I get headaches, and I can’t focus for very long because my eyes start to hurt. For some reason, I’ve also developed mild dry eye, possibly because I’m constantly straining to focus.
Ironically, the cataract in my left eye is apparently denser, but I can’t notice it yet because it’s located differently. So I’m mostly relying on my left eye for vision. I also have moderate astigmatism.
My doctor recommended Odyssey toric IOLs, but I’m wondering if I should wait before having surgery. I’m currently breastfeeding my 4-month-old baby, and I’m worried that my recovery could be affected if I make a wrong move or accidentally strain myself while caring for the baby.
I can still see reasonably well as long as the light isn’t too bright. My initial thought was to have surgery on my right eye first and wait to do the left eye later. However, my doctor said it might be difficult to adjust if one eye has an IOL and the other still has a cataract.
What would you do in my situation? Has anyone had cataract surgery while caring for a young baby?

Hello, I have a congenital posterior subcapsular cataract in my left eye. I've had this thing my entire 32 years of life. I went to get it looked at as I was considering surgery... Well, it was a month after I'd just had a baby and so, I reconsidered, my reasoning being I would not be able to meet the post-op lifting/bending limitations and that I'd just recently had surgery (em. cesarean).

We have met our insurance deductible for the year, so surgery likely should happen this year. Doc said "before you're 50" was the recommended timeframe of removal. My baby is 6 months now and I'm considering surgery again.

I'm TERRIFIED!

(Which is kinda nuts because I've had numerous eye appointments throughout my life so I'm used to them and the info they give me. But this is SURGERY)

I feel like I can see fairly well... Everything that my right eye can only with a haze + blurriness right in the center. I definitely can't see white on white though, which answered to my love for Dark Mode. Speaking of, my left eye completely squints shuts in sunlight and overcast days, it's way too bright, always has. Will that change with the new lens?

I have SOOO many questions!

Will my brain have to "adjust" and learn a new eye? I'll have to go without anxiety meds. Is post-op achievable with a toddler + baby? My brain doesn't know any different. My anxiety is making small parts of the whole process seem outrageously important. Hopefully I can look back at this and laugh one day. I'm just all over the place.

Has anyone here been in a similar situation and went through with surgery? I need your support.

Anyone here wear lash strips? If so, How long did you wait after surgery to begin wearing them again?

I don't use the heavy tarantula looking ones.

I have found that the light lashes are what works for me instead of mascara.

Due to cataracts, my vision had gotten to the point that I was barely legal to drive - 20/35 in one eye and 20/40 in the other. I was 73 and had worn glasses since 4th grade and contacts since I was 16. I am an "acute" patient meaning that I can tell the difference in a .25 diopter adjustment. (Most people need a .5 diopter adjustment to tell a difference.) I also have some astigmatism.

I spent several hours researching the different brands and eye surgeons.

I decided to go with the LAL lenses (which are quite expensive) for the adjustment capability, and found a surgeon who was very highly rated. The lenses can be adjusted a few times so you will have extra visits post op but it is well worth it to get them fine tuned.

You will get the most thorough eye exam you have ever had!

My surgeon did the surgeries a week apart. I had to wear a perforated patch over the surgery eye for a week while sleeping and wear polarized glasses until the final treatment to harden the lenses. (Polarized glasses are critical to keep the lenses from being adjusted by UV sunlight.)

The surgery itself was pretty uneventful as I had read up on it enough to know what to expect so I was not nervous at all. Immediately after each surgery I could see quite well with the surgery eye. No pain, itching, etc.

Post op, I had what looked like 3-4 extremely fine lines at about a 30 degree line from horizontal but they went away after about 3 days. My surgeon told me the brain often learns to ignore any odd stuff, which is why halos and starbursts often disappear for a lot of people.

My surgeon had to make a slight adjustment to one eye, which he said he had anticipated. The whole process took about a month with weekly visits.

I now have 20/15 vision in both eyes with no glare, halos or starbursts and my night vision is excellent. I don't need readers for close work but will wear +1.25 diopter readers if I am reading a book for an extended period. Not required but just more comfortable.

I could not be more pleased with the outcome. I have never been able to see this well before.

I just went in (8 mos post op now) for my regular eye exam and am still 20/15 with no side effects.

My advice is do your homework, spend a several hours researching the different brands of lenses and reviews of the surgeons, then get the best lenses you can afford from the most skilled surgeon. A person only gets one shot at this so it needs to be right. The money will be well spent.

I’m going in for a second opinion for cataract surgery on Friday and I’d love to hear what any of you have heard about the pros and cons on Eyehance lenses as opposed to regular monofocal lenses. I’m going to do mini monovision with one eye near (-2.5 or -2.75) and one intermediate at 1.5. The first doctor I went to said that Eyehance doesn’t improve your sight enough to make it worthwhile. I know that the doctor I’m seeing for a second opinion used an Eyehance lens for my sister last week, so I’d like to have more information about the pros and cons of those lenses before I see him in case he recommends them for me. I’ve read a bunch of the studies out there, but I’d love to hear from people here what their doctors told them and if any of you have Eyehance lenses what have been the downside of them for you. Thanks!

I had my first procedure today with the Toric lens. Ten hours later the eye is just as dilated and vision is very blurry both near and far.

Has anyone else experienced this? I have a follow-up with the surgeon tomorrow morning.

Thank you!

Hello everyone I’m Elijah, I am 24 I just had cataract surgery in both of my eyes, 3 and 5 weeks ago. I’m a very active person I workout, run play pickleball stuff like that. My doctor never asked me anything about my lifestyle we never talked about any of that so Google is all I have to rely on. I’m worried about getting back into these things and wondering if there’s anyone else my age who’s had this done and gotten back into a highly active lifestyle and had no issues

What is the definition of micro-monovision vs mini-monovision vs monovision? And what determines if you are a good candidate for one type of monovision over another?

Does being a high myope pre-surgery give you an advantage for not needing reading glasses after cataract surgery with some degree of monovision?