About Cataracts and Cataract Surgery


     Cataract surgery is an incredible opportunity to customize your vision for your new life. Because of all the recent advancements in technology there are many options available that fit many different lifestyles so we want to make sure you fully understand them all. Here is a Table of Contents to help you navigate the material covered here:

Table of Contents

How Does the Eye Work?

     The eye is like a camera. A camera uses lenses to focus light onto film and our eyes use lenses (the cornea and the lens) to focus light onto the retina. The retina is similar to film in that it’s the light-sensing part of the eye that sends the images to the brain.

What is a Cataract?

     As we age, the clear lens we’re born with starts to become cloudy. Certain diseases can make this process happen faster, like diabetes. A cloudy lens is called a cataract. Like the Cataract Hotel in Niagra Falls or the Old Cataract Hotel in Egypt, cataract also means “waterfall.” Unlike smooth water, water moving over a waterfall is white and difficult to see through, just like a cataract. There are different types of cataracts but they are all treated essentially the same.

     Instead of focusing light on the retina like a clear lens, a cataract scatters light and causes glare and blurry vision.

What Happens Before Surgery?

    Every eye is unique! On the day of your appointment, you will be greeted at the front desk and using information from the account you created when making the appointment, we can skip most of the paperwork and registration.
     Our skilled team will perform a series of measurements on your eyes before checking your current vision and prescription. You will be dilated but don’t worry, we will “un-dilate” you before you leave. After reviewing your scans, either Dr. Hirabayashi or Dr. Virdi will examine your eyes and talk to you about the lens and surgery options.    
     The measurements we take are heavily influenced by the health of your tear film (the layer of tears that covers the front of your eye). You can help us by optimizing your tear film. How do you do this? Use preservative free artificial tears at least 4 times a day the two weeks before your consultation. These can be purchased at most drug stores. You can also run a washcloth under warm water and apply it to your eyelids for 15 minutes every night to keep your eyelids healthy. These small steps don’t just feel good, they also help make your cornea healthy to ensure we obtain the most accurate measurements possible. 
     If you wear contact lenses, this can also affect the quality of these measurements. Please stay out of your contact lenses for at least 7 consecutive days before your consultation. If you wear rigid or hard contact lenses, several measurements might be necessary to ensure the best possible outcome.
     After developing a plan, you will speak to our surgery schedulers so you can start counting down to the big day! 

What is Cataract Surgery Like?

     Cataract surgery involves replacing the old, cloudy lens with a brand new one called an Intraocular Lens, or “IOL” for short. This lens sits in the same place as your old lens and has a built in prescription. You will be very comfortable but awake enough to follow instructions such as looking into the microscope lights. It’s also very common not to remember many details of the surgery after it’s over. The entire procedure usually take under 10 minutes.

     Select the numbers below to learn about the individual steps of cataract surgery!

What is a Refractive Target?

     Like a camera lens, the natural lens has the ability to change focus which is why you can (or could at a younger age) see things far away but also up close. IOLs cannot effectively change focus like the natural lens (yet). While modern IOL technology do not perfectly replicate this, there are many options to provide freedom from glasses.

     All IOLs primarily focus light at one length: distance (far away, like street signs), intermediate (arms length, like a computer), or near (up close like a book). This length where things are most in focus is called the refractive target. Golfers or pilots might enjoy distance vision but quilters or model-makers might enjoy near vision. The eyes can be set at any of these distances. It’s very important to start thinking about your refractive target and what would work best with your personal lifestyle.

Distance Vision

Intermediate Vision

Near Vision

     The two eyes can also be set at different refractive targets. This is called “Blended Vision” and can provide a wide range of useful vision and freedom from glasses by using both eyes. The dominant eye (the eye you would use to look through a telescope or camera) is set to distance and the non-dominant eye is set a littler closer but such that the eyes can still work together. If you have never tried Blended Vision before, a “contact lens trial” can be an effective way to “test drive” Blended Vision to see if it’s right for you. There are lenses with more advanced technologies we will discuss shortly.

Dominant Eye

Non-Dominant Eye

Video on Blended Vision

Play Video

What is Astigmatism?

     You may have been told you have astigmatism. In fact, one third of people have enough astigmatism to affect vision. This is an important topic because IOLs can correct astigmatism and cataract surgery can be a perfect time to eliminate your astigmatism.

     To understand astigmatism, let’s think of pairs of light rays. One pair (RED) is oriented vertically and the other pair is oriented horizontally (GREEN). The cornea is normally very round like a soccer ball which essentially means that both the RED and GREEN pairs of light will experience the same amount of curvature and focus in the same place since curvature determines where light is focused. Astigmatism means your cornea (or lens) is shaped more like a football than sphere which means the red and green pairs of light rays don’t experience the same amount of curvature so they don’t focus in the same place. Because the optics of this can be confusing, here are some animations:

Pair of Light Rays

Normal Cornea


     Notice in the Astigmatism animation, the red and green light rays are no longer focusing in the same place because they are experiencing different amounts of curvature when passing through the cornea with astigmatism. It’s the fact that these light rays don’t meet in the same place that causes the blurry vision with astigmatism. One important caveat is that we have described regular astigmatism. Even though the two sets of light rays aren’t focusing in the same place, the astigmatism still treatable. Irregular astigmatism, while rare, is little more complicated and not easily treatable. Examples of conditions that may cause irregular astigmatism include but are not limited to keratoconus, corneal scars, or corneal dystrophies. Your surgeon will carefully study your measurements to make sure you have the treatable, regular astigmatism we have discussed here.

What are My Surgery and Intraocular Lenses Options?

     There are many IOL options to fit a variety of lifestyles. Cataract surgery is a perfect time to customize your eyes. With so many modern technologies, the options can be intimidating but here are the packages we offer. It’s helpful to start thinking about which might be best for you. Unfortunately, advanced lens technology (including astigmatism correction) is not covered by insurance which means there is a cost associated with the majority of these IOLs.

     Most of our cataract surgery packages include our “On-Target” promise. This means if for some reason your refractive target isn’t what we planned before surgery, we’ll work with you to make it right. Most also include the use of a very precise laser for certain steps of the surgery.

Customized Lenses

Included in this package:

     These lenses are adjusted after surgery to ensure a customized result to your specific eye. They also allow “trialing” different distances. For example if you change your mind on the refractive target after surgery, there is some wiggle room to adjust the lens to a new target. You will need to come back to the clinic several times to “fine tune” the lens and one final time to “lock” it in. It is changed using UV light and the adjustments take only a few minutes in each eye. Because they’re adjusted using UV light, you’ll need to wear eye protection until the “lock in” so the sun or other sources of UV light don’t interfere with your results. These lenses are excellent for anyone with a history of laser vision correction which can make the measurements of your eye less reliable. They’re also great for stereotypical “Type A” personalities who desire extremely precise vision.

      The eyes can be set to any distance with these lenses but the most common option is blended vision. 

Multifocal Lenses

Included in this package:

    These lenses provide the best chance for freedom from glasses. Because of the way they’re made to create such a range of vision, they may cause halos around lights that the brain can usually learn to ignore over weeks to months. Some people don’t ever experience these halos. These lenses are designed such that no matter where an object is, some of the light is focused onto the retina for a clear image. Because they primarily focus things that are far away, an intermediate distance, and near, there may be “gaps” where things are less sharp but moving you will learn to find the “sweet spots” over time. Many people never need to wear glasses with these lenses but again, each eye is unique. The halos are like your nose. You don’t notice it most of the time but if you pay attention to it, you see it. The brain needs to learn to ignore the halos so the more you pay attention to them, the longer they’ll stick around.


Extended Range Lenses

Included in this package:

      These lenses provide vision with an improved range over basic lenses with some freedom from glasses but not quite as wide as the multifocal lenses. They achieve this by splitting light in such a way that avoids ever creating rings or halos like the multifocal lenses but may reduce contrast sensitivity. This means you might find it somewhat difficult to read a menu in a dim restaurant for example.


Laser-Based Surgery

Included in this package:

     This package uses a lens to correct vision at one distance but also eliminate astigmatism either through the lens or laser. Glasses will likely be required at some distances after surgery. These are also great options for those who require extremely sharp, extremely high contrast vision but might not want to come in for amount of adjustments and appointments the Customizable lenses require. If you’re mostly bothered by glare and halos and don’t like the idea of seeing rings around lights for even a short time, these are also great options. No lens is perfect and it’s not unusual to see some dysphotopsias (optical phenomena) as your eye gets used to the IOL but these nearly always go away on their own and again, most people never experience this. 


Basic Manual Surgery

    This package uses a basic lens to correct vision at one distance but does not eliminate astigmatism so wearing glasses full-time is often required after surgery. As mentioned previously, this option is usually fully covered by insurance because insurance doesn’t yet cover correction of astigmatism or use of the more advanced optical technologies. We always try our best and treat every eye as though we’re treating family, but for insurance reasons we cannot guarantee a refractive target in the same way as the other packages and we cannot use a laser.


      Lastly, there are special lenses used in rare circumstances but we can discuss them in person if we think you might be a good candidate.

Summary of Lens Options

     This is a lot of information and we encourage you to visit Bimini.Vision/Cataracts for more detailed explnanation. We believe in making you informd of all the possible options for this life-changing moment. To make things more simple, here is a summary of the most common lens options and refractive targets with Basic Manual Surgery included for comparison.

The Right Fit

     We will take great care before surgery to make sure your eye is healthy. If you have existing problems (e.g., glaucoma, problems with your retina, etc.) then we may decide some of these lenses with more advanced technology are not ideal for your eye. Some of lenses work by splitting or spreading light to give you greater ranges of vision and if your eye has an existing disease, a different lens might be a better choice. Please let us know your preferences and we will do our part to make sure the lens you choose is a good fit for your unique eyes.

What do the Different Lenses Actually Look Like?
(Vision Simulator)

     Some of these concepts can be abstract so we have prepared a vision simulator that attempts to demonstrate the performance of these lenses. This is a theoretical and approximate simulation of lens performance based on manufacturer information using both eyes together and without wearing glasses. Every eye is unique and your results may vary. Individual healing and neuroadaptation (the way your brain adjusts to seeing multiple distances at once) are not predictable. The purpose of this simulator is to provide a practical example to some of the complicated optics topics we discussed and is for education and entertainment purposes only. It is not a substitute for speaking with your surgeon about which option is best for you. Click the tabs to see the simulation below.

Vision Simulation WITHOUT Glasses Using BOTH Eyes Together

DISTANCE vision allows you to see far away clearly. You will likely need glasses to see up close.
INTERMEDIATE vision allows you to see clearly at arms length (like using the computer). You will likely need glasses to see far away or read.
NEAR vision allows you to see up close without glasses (like reading) but you'll likely need glasses to see far away.
MULTIFOCAL lenses correct THREE distances in EACH eyes. A similar effect can be achieved with BLENDED VISION using the EXTENDED RANGE lenses but using BOTH eyes set to different refractive targets.
EXTENDED RANGE lenses can allow you to see far away and arms length clearly without glasses in BOTH eyes but you'll likely need glasses to read. BLENDED VISION can also achieve this effect using both eyes set to different refractive targets.
EXTENDED RANGE lenses can be set to the intermediate range in BOTH eyes which can allow you to see the computer clearly and also read. You will likely need glasses to see far away.

What is Recovery Like?

     Many people have better vision immediately after surgery! It’s not uncommon for your vision to blurry at first though and recover over the next week or so. It’s also not uncommon to have a scratchy feeling in your eye that should be better by the next day. If your vision is getting worse or you’re having increasing pain, it’s important to let your surgery team know.

     We will see you one day after surgery, one week after surgery, and one month after surgery. We typically wait one week before your cataract surgery in the other eye and will make sure everything is as expected in the first eye.

     You will need to take it easy for the first week after surgery and take just one eyedrop over the next month to help your eye heal. If you use our VIP iOS app, you can receive reminders and/or easily track your drop schedule. Generally, plan to use the eyedrops 4 times a day for the first week after surgery, 3 times a day for the second week after surgery, 2 times a day for the third week after surgery, and 1 time a day for the fourth week after surgery. If your eyes are a week apart, the schedule might seem confusing but the app can help you never miss a drop. It’s extremely important to talk to your surgeon about your specific situation (remember, every eye is different) because this information is not comprehensive but here are some general dos and don’ts:

What are my Risks and Expectations?

     Modern cataract surgery is extremely safe and results in excellent outcomes. In fact, about 4 million cataract surgeries are performed in the U.S. alone every single year! Everything in life has risks though that your surgeons take every measure to minimize. Thankfully, the incredible benefits of cataract surgery often outweigh the remote risks. These risks are not a substitute for carefully reading the consent provided by your surgeon. The rare but serious risks for cataract surgery include but are not limited to:


     These are all so rare that they’re hard to accurately quantify. We provide links to literature (click the blue links above to view the source) to give a rough idea of risk but certain conditions can affect risk. For example, experiencing swelling of the back of the eye is much more common with a history of diabetes. It’s also even more rare that if something happens, an additional surgery cannot recover your vision if addressed in a timely fashion. These problems are also of significantly varying severity. For example, high eye pressure or swelling of some structures frequently resolves quickly with no longterm problems. 

     We don’t mean to scare you with this information and the overwhelming majority of the time, the surgery takes under 10 minutes with no problems so this should not detract from the excitement of a new life with new vision. We believe in keeping you informed of all facets of this procedure though so it’s important to discuss the risks, no matter how rare.

     For each surgery, 20/20 vision and as much freedom from glasses possible is our goal. However, it’s very important to understand that despite the most modern technology, the most advanced equipment, and the very best efforts of your surgeons, there is never a guarantee for 20/20, perfect vision. Even if the refractive target is perfect, something else about your eye might be preventing perfect vision. If you have a pre-existing eye disease (examples include but are not limited to history of a “lazy eye” as a child or a problem with the retina), your eye might not be capable of seeing 20/20. Before surgery, we screen for several diseases that could limit the vision but it’s important to talk to your surgeon about your best visual potential and continue regular and routine eyecare. Despite all the advances of modern medicine, in rare cases healing can also be unpredictable but rest assured, we will be with you every step of the way.

Resources and Disclaimer

     This is a lot of information and we hope you find it helpful. It’s very, very important to talk to your surgeon about your specific situation as nothing on this website constitutes medical advice nor is a substitute for professional medical advice, diagnosis, or treatment. Remember, every eye is unique and only you and your surgeon know your eyes and the exact care they require. You can find a summary of this information in your Cataract Surgery packet and we’ll be ready to answer any questions you have when we meet!

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