Cataract Surgery Regrets: 7 Mistakes to Avoid Before Your Procedure

Published: 11 Nov 2026

Most people assume that if cataract surgery is safe and the cataract is gone, they'll be happy with the result.

But Dr. Ilan Cohen regularly meets patients whose surgery was technically successful, yet who still feel stuck with the wrong glasses, the wrong lens, or the wrong surgeon. These are the regrets that don't appear on the consent form.

Dr. Cohen is a cornea and cataract specialist who has spent more than 25 years helping patients in Manhattan, Queens, and New Jersey fix or avoid these problems. This article covers the seven regrets he sees most often and how better planning and communication with your surgeon can prevent them.

A Simple Way to Think About Your Eye: Window and Lens

Two parts of the eye matter most here:

The cornea is the clear front "window" of the eye, like the front glass of a camera.
The intraocular lens (IOL) is the artificial lens that replaces your cloudy natural lens during cataract surgery. It acts as the camera lens inside the eye.

Most of the regrets below come down to the window, the lens, or the surgeon guiding you through both.

Regret #1: Not Correcting Astigmatism During Cataract Surgery

Astigmatism means the cornea isn't perfectly round. If the front glass of a camera is shaped more like a football than a soccer ball, light can't focus to a sharp point, and vision looks blurred or smeared at all distances.

Cataract surgery is often the ideal time to correct significant astigmatism. Surgeons can often use a toric IOL or precise corneal incisions to sharpen focus. Laser-assisted cataract surgery can add further precision to incisions and astigmatism control.

The regret comes when this step is skipped. Patients wake up with a clear lens but still need glasses for basic distance tasks. They can drive and function, but their vision never feels truly sharp. Everything looks a little off, and they expected more.

In his practice, Dr. Cohen spends a lot of time measuring the cornea and deciding how much astigmatism is worth correcting. Patients should understand whether their astigmatism is mild, moderate, or high, and what options exist for them.

Regret #2: Nearsighted Patients Losing Their Natural Near Vision

This one hits nearsighted patients the hardest.

If you've been nearsighted your whole life, you may take a special superpower for granted: you can take off your glasses and read up close with no effort. Your phone, a book, tiny print are all crystal clear.

A standard monofocal lens is usually set for one main distance, most often far away. When both eyes are targeted for distance, that natural close-up ability disappears. You see well far away, but you may need reading glasses all day for phones, laptops, menus, and labels.

Many nearsighted patients are never told this clearly. They expect surgery to keep the near vision they enjoy and add better distance vision on top. Instead, the contrast can feel like a loss, even when the surgery went perfectly.

When Dr. Cohen sees a nearsighted patient, they talk through daily life. Do you read a lot? Do you spend hours on a computer? Do you want to see your phone without glasses? They also discuss options such as multifocal and EDOF lenses. A candid conversation up front, with a full understanding of possible outcomes, prevents a lot of regret later.

Regret #3: Having LASIK Just a Few Years Before Cataract Surgery

Here's a common story. Someone in their late forties or fifties is tired of glasses and has a little lens clouding, but not "bad enough" for cataract surgery. They decide on LASIK, sometimes with encouragement from an overzealous LASIK surgeon.

LASIK can work very well. But a few years later the cataracts progress and cataract surgery is needed anyway. By then, the earlier LASIK has changed the math. Calculating the right power for the new lens is more complex after the cornea has been reshaped, and some premium lens options become less predictable. Patients can still do very well, but there is less margin for error.

Many of these patients feel they went through two procedures when one well-timed surgery might have been enough. Closer to true cataract age, cataract surgery alone can address both the cloudy lens and the prescription.

When someone in their fifties asks Dr. Cohen about LASIK, he looks carefully for early cataract changes. If cataracts are on the horizon, they discuss whether planning for cataract surgery makes more sense. For patients who have already had LASIK, that's fine, but their surgeon should use advanced formulas and measurements and spend extra time explaining what to expect.

Regret #4: Choosing an Inexperienced or Non-Refractive-Focused Surgeon

Most cataract surgeons are skilled, caring physicians. The issue isn't good doctors versus bad ones. It's focus and volume.

Some surgeons concentrate on basic cataract removal. They do an excellent job clearing the cloudy lens, but may not emphasize fine-tuning the prescription, correcting astigmatism, or matching the lens to the patient's lifestyle. Others focus on premium cataract surgery, investing in extra diagnostics, premium lenses, and longer conversations about how patients actually use their eyes.

Patients often choose the first available surgeon or the closest office, and only later realize more options were possible.

It's reasonable to ask:

How many cataract and premium lens surgeries do you perform?
What technology do you use to measure the cornea and the length of the eye?
How often do you use toric lenses or advanced lens options?

Ask respectfully, and never try to push a doctor into something they're not comfortable with. The goal is a good match between your goals and their experience.

Regret #5: Not Treating Dry Eye or Corneal Surface Disease Before Surgery

Back to the window and lens idea. If the window is scratched, dirty, or dry, even the best lens can't give you a clear picture.

Dry eye and other surface problems can distort the measurements used to choose lens power. They can also make vision fluctuate through the day, with moments of sharpness and moments of blur that don't match what the patient was promised. Patients sometimes feel their vision is "not as sharp as promised" even though the surgery went well. The underlying problem is the corneal surface.

Dr. Cohen's approach is to treat the surface first, with lubricating drops, prescription medications, or other therapies depending on severity. Once the cornea looks smoother and more stable, he repeats the measurements before finalizing the lens choice. This can delay surgery slightly, but it often improves both accuracy and comfort.

Regret #6: Choosing the Wrong Lens Type for Your Lifestyle and Eye Health

Not every eye is the same, and not every lifestyle is the same. Lens choice should reflect both.

Standard monofocal lenses can be excellent choices, but they aren't designed to reduce dependence on glasses. They usually provide one main focus point, most often distance, so patients will likely still need glasses for near work.

To reduce or eliminate glasses for reading, or in some cases even for distance, a specialized lens and often extra measurements are needed. Options include:

Multifocal lenses
EDOF (extended depth of focus) lenses
Toric lenses for astigmatism
Light Adjustable Lenses (LAL), which allow the prescription to be adjusted after surgery

Some of these come with trade-offs, such as more sensitivity to light or reduced contrast in certain situations. And if there's disease in the retina or macula, some of these lenses aren't a good idea at all.

The regret comes when the lens doesn't match the eye or the lifestyle. Sometimes options are never discussed. Other times a lens is chosen without a clear explanation of what the patient gains and what they give up.

Dr. Cohen starts with the health of the eye. If the retina, macula, and cornea are healthy, a wider range of choices can be considered. If there are problems in the back of the eye, he tends to choose simpler lenses that maximize quality, even if that means more glasses. Then lifestyle is layered on top: Do you drive at night often? Work at a computer? Read for hours?

How RealSight™ Helps

To support these decisions, Dr. Cohen developed a detailed measurement protocol called RealSight™. It takes multiple measurements using a variety of biometric instruments, covering everything from the front of the eye to the back. These measurements show which lens is the best match for the patient's eye and which types to avoid. They also help fine-tune the exact type and power of the lens, as well as its optimal placement within the eye.

Regret #7: Shopping by Price or Convenience Instead of Surgeon, Technology, and Communication

Many patients choose a surgery center because it's close, fits their schedule, or has the lowest out-of-pocket cost. Those factors matter, but they aren't the only ones.

If a practice has limited technology, fewer lens options, or very short visits, patients may not get the level of planning they want. They may leave with a standard solution for a non-standard set of eyes and goals. Later, when they learn about other lens options or more detailed planning, they may feel their decision was rushed or that they didn't have all the information. That frustrating feeling is often preventable.

You're not asking too much when you want to see well after cataract surgery. You're not being difficult when you want clarity at distance and comfort at near, within what your eyes can realistically support. You're simply asking for modern cataract surgery to be planned around your life.

A Simple 4-Step Plan to Avoid Cataract Surgery Regret

Make sure the window is healthy. Ask whether you have dry eye, surface disease, or significant astigmatism, and how your surgeon plans to handle it.
Talk through how you use your eyes all day. Are you nearsighted now? Do you rely on taking your glasses off to read? Be clear about how you feel about reading glasses and distance glasses.
Choose a lens that fits both your eye health and your lifestyle. Understand what you gain and what you give up with each option.
Choose a surgeon whose experience, technology, and communication style match your goals. It's reasonable to get a second opinion if you feel rushed or unclear. You never want to push a doctor beyond their comfort zone, but you do want someone comfortable delivering the kind of result you're hoping for.

Cataract Surgery in Manhattan, Queens, and New Jersey

Cohen Eye Institute provides premium cataract surgery in Manhattan, with additional offices in Queens and Old Bridge, NJ. The practice also sees patients from across Central Jersey, and offers virtual consultations for those who live farther away.

Frequently Asked Questions

1. Can I still get good vision after cataract surgery if I have astigmatism?

Often, yes. Significant astigmatism can frequently be addressed with a toric lens or precise corneal incisions at the time of surgery. The key is measuring the cornea carefully and discussing how much correction is worthwhile for you.

2. Will I need reading glasses after cataract surgery?

With a standard monofocal lens, most likely yes, since these lenses are usually set for distance. Multifocal, EDOF, and other advanced lenses can reduce dependence on reading glasses, with trade-offs worth discussing.

3. Why do nearsighted patients often feel disappointed after cataract surgery?

Nearsighted people can often read up close without glasses. If both eyes are set for distance, that ability goes away, and many patients weren't told this clearly beforehand.

4. Does having LASIK before cataract surgery cause problems?

Patients can still do very well, but LASIK changes the cornea, which makes lens power calculations more complex and some premium lenses less predictable. The surgeon should use advanced formulas and take extra time to explain what to expect.

5. Why does dry eye matter before cataract surgery?

Dry eye and surface problems can distort the measurements used to choose the lens and cause fluctuating vision afterward. Treating the surface first often improves accuracy and comfort.

6. What questions should I ask my cataract surgeon in Manhattan?

Ask how many cataract and premium lens procedures they perform, what technology they use to measure your eye, and how often they use toric and advanced lenses. Always ask respectfully.

7. Should I get a second opinion before cataract surgery?

It's reasonable if you feel rushed or unclear about your options.

Considering cataract surgery in New York or New Jersey? Schedule a consultation with Dr. Cohen at Cohen Eye Institute to talk through your options before you decide. Book an appointment online or call the office nearest you:

Manhattan: 160 E 56th St, 9th Floor, New York, NY 10022. (212) 764-2020
Queens (Ridgewood): 5650 Myrtle Ave, Ridgewood, NY 11385. (718) 456-9500
Old Bridge, NJ: 28 Throckmorton Lane, Suites 103-104, Old Bridge, NJ 08857. (732) 679-6100

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