Long Eye Syndrome

  My husband had cataract surgery recently.He is only 46 but had an orbital blowout (April 98) which apparently accelerated a cataract. He has a long eye (27mm front to back). Should this have any effect on the success of his surgery? At his first follow up appointment, he couldn't see well at all out of the new eye but he could see better during the pinhole test. Is this significant? How long does it take for the eye to settle in with the vision he can expect? His distance acuity is horrible. Is it likely that this will improve? On in an unrelated area, is the reason people in their 40's need reading glasses due to the lens hardening or the muscles weakening. Regarding my vision, my dad has glaucoma and has a weird cupping of the optic nerve which apparently means he can't tolerate as much pressure as some people can in their eyes. I was just tested with 20 pressure in my left eye, 18 in my right. (Two years ago it was 17-15). I am 46. Should I be concerned. Why is this cupping significant. The doctor mentioned I have slight cupping. Thank you for your time.

[HFHS MD JL]

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I will attempt to answer all of your questions.  
It sounds as though your husband is very near sighted since you mentioned his eye is very long.  It is likely that a lens was implanted to match the correction in his other eye.  This means his vision will likely not be good until he gets glasses.  Glasses are usually prescribed one month after surgery.  If you have any concerns please discuss this with his doctor.
Presbyopia is the inability to see up close without the aide of magnification.  This usually occurs during our 40's and it is a result of aging changes of the lens of the eye as well as the internal eye muscles.  Some people may be able to take there glasses off to read but most will need a reading add or bifocal.
Glaucoma is a process where the optic nerve is damaged over time because the pressure is too high for the eye.  Normal eye pressure is 21 or less.  Risk factors for glaucoma include elevated pressure, optic nerve cupping, family history, and others.  Man people are born with optic nerves that appear suspicious for glaucoma but they actually do not have glaucoma.  These people are termed glaucoma suspects and they are followed over several years on a regular basis to make sure that the optic nerve does not appear to suffering damage.  Periodic visual field tests are usually done.
Good Luck.
Sincerely,
HFHS M.D.-JL