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[Research Talk] Why Do Patients Who Were Nearsighted Before Cataract Surgery End Up Needing Reading Glasses More Often?

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2026.04.29

[Research Talk] Why Do Patients Who Were Nearsighted Before Cataract Surgery End Up Needing Reading Glasses More Often? (JRS Paper Analysis)

Scientific Evidence Behind IOL Satisfaction Based on Pre-Operative Refractive Status

Hello. I am Dr. Kim Jeong-wan, ophthalmologist at BGN Eye Clinic, Jamsil Lotte World Tower.

Cataract surgery has moved beyond simply improving blurry vision — it has now entered the realm of vision correction aimed at achieving 'a life without glasses.'

However, many patients wonder: "The surgery went well, so why do I still need reading glasses?" This tendency is particularly noticeable in patients who were nearsighted before surgery. We will clarify the reasons through a paper published in the Journal of Refractive Surgery (JRS), one of the world's leading ophthalmology journals, by the BGN Eye Clinic research team.

1. Research Background: What Is 'Mix-and-Match'?

This study was conducted on 102 patients (204 eyes) who underwent a 'Mix-and-Match' strategy combining two premium intraocular lenses (IOLs) from Carl Zeiss.

Dominant Eye: AT LARA (Continuous Focus EDOF)

Provides smooth, clear vision at far and intermediate distances with minimal nighttime glare and halos.

Non-Dominant Eye: AT LISA tri (Trifocal)

Supplements near vision to support reading and smartphone use.

Key Research Findings

Combining these two lenses is expected to deliver optimal vision at all distances. The study found that approximately 79.4% of all patients were able to live without glasses. But why did the remaining 20.6% of patients still require reading glasses?

2. Scientific Evidence: 2 Reasons Why Nearsighted Patients Rely on Reading Glasses

Statistical analysis revealed that the only factor influencing post-operative spectacle dependence was 'pre-operative refractive status (presence of myopia).' (Odds ratio: 1.397, P = 0.025)

① The 'Short Working Distance' Habit Unique to Nearsighted Patients

Before surgery, nearsighted patients are accustomed to removing their glasses and viewing objects at very close distances (approximately 20–30 cm). Intraocular lenses are typically designed to provide standard near vision at around 40 cm; however, patients who were previously myopic tend to desire vision at even closer distances, which leads them to reach for reading glasses more often.

② The Experience of 'Second Sight' Due to Cataracts

As cataracts progress, the lens hardens and a temporary increase in myopic power occurs, known as 'myopic shift.' During this period, patients may experience a phenomenon where near objects are surprisingly clear without reading glasses (sometimes called "second sight"). After surgery, when the IOL does not replicate this 'abnormally enhanced near vision,' patients may feel that their near vision has actually worsened.

3. The 'Decisive Difference' for a Highly Satisfying Outcome

According to the paper, what determines patient satisfaction is not simply the type of lens selected.

Residual Astigmatism Management

The group with low post-operative satisfaction had statistically significantly higher residual astigmatism (−0.22 ± 0.27 D) than the high-satisfaction group. In other words, precisely correcting even the most subtle astigmatism determines the success or failure of the surgery.

Pre-Operative Expectation Management

Patients who were significantly nearsighted before surgery should be fully aware that, even if near vision at 40 cm is provided after surgery, it may differ from the extremely close-range vision they were previously accustomed to.

Conclusion: Personalized Planning Is the Answer

This study once again confirmed that "there is no single lens that is equally ideal for everyone." For patients with significant myopia, it is important to either select a lens with enhanced near-power or to communicate their lifestyle habits (such as preferred reading distance) clearly with their physician through thorough pre-operative consultation.

Based on these research findings, BGN Eye Clinic analyzes each patient's pre-operative vision history to recommend the most personalized intraocular lens combination.

Reference: Increased Near Vision Spectacle Dependence of Patients With Preoperative Myopia After Mix-and-Match Implantation of Trifocal EDOF and Trifocal IOLs. Journal of Refractive Surgery, 2021.

What is the most suitable cataract surgery option for me? BGN Eye Clinic, Jamsil Lotte World Tower is cheering for your precious eye health.

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