Lens Options

Why You Might Still Need Glasses After Cataract Surgery

Written and edited by Todd Driver, MD · Board-Certified Ophthalmologist · Cataract and Refractive Surgeon, Irvine, CA

Published March 14, 2026 · Updated August 20, 2026 · Medically reviewed by Todd Driver, MD

Most people think cataract surgery just removes the cloudy lens. Here's what many patients don't realize: if you have astigmatism and you don't treat it during surgery, you'll probably still need glasses afterward. Below is exactly what astigmatism is, and the three ways we can correct it during cataract surgery.

What astigmatism actually is

A normal eye is shaped like a golf ball: nice and spherical. With astigmatism, the eye is shaped more like a football. That shape means light can't focus to one clean point; it focuses in multiple places, which creates blur.

Why does this matter for cataract surgery? The standard lens that insurance covers is perfectly spherical. Put a spherical lens in a football-shaped eye and you get only partial correction. The cataract is gone, which is great, but the astigmatism remains, and that generally means glasses are still needed for your sharpest vision.

Option one: relaxing incisions

If part of the cornea is steeper than the rest, we can make tiny, strategically placed incisions that relax the steep area and make the eye more spherical. This can be done manually, or, as I usually do it, with a femtosecond laser that maps the eye and places the incisions with precision. Relaxing incisions work well for smaller amounts of astigmatism, but they have limits: they aren't strong enough for higher amounts and aren't as predictable as the options below.

Option two: a toric lens

A toric lens is specially shaped to cancel out the football shape of your eye. Rather than reshaping the cornea, we place a customized lens inside the eye that neutralizes the astigmatism. Toric lenses come in monofocal versions, which sharpen vision at one distance, and multifocal or extended-depth-of-focus versions, which also give you a range of near and far vision.

Two honest caveats. First, these are premium lenses that insurance doesn't cover; insurers pay for the basic lens and consider glasses the fix for anything sharper. Second, a toric lens only works properly if it's rotated into a precise position inside the eye. Traditionally we mark the eye by hand, which works but carries some variability. Today, laser technology with iris registration maps your unique iris pattern and places extremely precise alignment marks. In my experience it gives noticeably more accurate placement, though it's an additional non-covered cost and not strictly necessary.

Option three: the Light Adjustable Lens

This is the only option we can fine-tune after surgery. With traditional lenses, we predict how your eye will heal and choose the lens power ahead of time. The Light Adjustable Lens flips that: we place the lens, let your eye heal, measure your actual prescription, and then use a light delivery device to fine-tune the lens while it's already in your eye. Instead of an educated prediction, we customize your vision after the fact. Here is how the Light Adjustable Lens works at my Irvine practice, including candidacy and the visit schedule.

The trade-offs are cost and a few extra visits after surgery. But if your goal is to fine-tune the result rather than predict it, it's the only lens that lets us do that, and it's what I would personally choose for my own eyes.

The bottom line

Astigmatism means your eye isn't perfectly round, and standard spherical lenses don't fully fix it. Relaxing incisions, toric lenses, and the Light Adjustable Lens all let us correct it during cataract surgery. For many patients, treating astigmatism is the difference between pretty good vision and the truly crisp vision they brag to their friends about.

Related reading: the Light Adjustable Lens explained · ORA technology during cataract surgery · or call to arrange a cataract consultation in Irvine.

Two tools that may help you think this through: the 60-second lens quiz, and the vision simulator, which shows how each lens sees by day and at night.

This article is for educational purposes and is not a substitute for a medical examination or personalized medical advice.