 The
desired refractive result is, simply, usually the best possible
visual acuity attainable. However, the patient’s prior
refractive state --- whether he or she has been nearsighted
(able to see near better than far), farsighted (able to see
far better than near), or astigmatic (irregularly shaped eye
surface) previously --- becomes a factor when determining
the desired post-operative target refraction.
For example, many nearsighted patients have enjoyed the ability
to see clearly up close without the use of eyeglasses for
most of their lives. For that reason, many of these patients
still desire to remain nearsighted after cataract surgery
so that eyeglasses will mainly be necessary only for far visual
tasks such as watching TV, movies or driving an automobile.
On the other hand, many farsighted patients have become used
to very good uncorrected distance visual acuity and do not
mind (or are used to) their lifelong dependence of reading
glasses (magnifiers!). As such, many of these patients choose
this target result after cataract surgery. Finally, some patients
have a unique combination of mild  nearsightedness
and astigmatism that has permitted them to be naturally less
dependent on eyeglasses for most visual tasks. In these cases,
the target refraction is made to simulate this original refractive
state of the eye before a cataract developed.
The cataract surgeon and patient will discuss this aspect
of the examination in detail in order to fully understand
and determine the most desirable target post-operative refractive
result. Only in this way are appropriate surgical expectations
developed and attained.
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