Cataract Surgery: Preparation, Procedure, Costs, Aftercare

Cataract surgery is a type of eye surgery to remove a cataract (cloudy lens). Your eye, like a camera, has a lens for focusing light. This lens is normally clear. When this lens turns cloudy, it's called a “cataract.” Cataract surgery removes the cloudy lens and replaces it with a clear artificial lens, restoring your vision.

In vision, light passes through a clear lens on the eye. The lens focuses the light so your brain and eye can process information into a picture. When a the lens becomes cloudy, the eye can’t focus light. You end up with blurry vision or other symptoms like glare an halos around bright lights.

Cataract surgery

What is an intraocular lens?

The intraocular lens (IOL) is an artificial lens that replaces the cloudy natural lens. It is flexible and often rolled to be placed into the eye through a smaller incision.

Are there different kinds of intraocular lenses (IOLs)? Can an IOL eliminate my need for glasses?

Intraocular lens are available with different focusing powers. Depending on the type of lens you select, you may or may not need glasses if you wore them before your cataract surgery. Types of IOLs includes:

• Monofocal IOLs: These are precisely measured for close, medium range or long-range distance vision. Most people have them set for distance vision and then choose to wear reading glasses for close vision.
• Multifocal IOLs: These IOLs allow for both near and far focus at the same time.
• Accommodative IOLs: These IOLs allow for focusing at different distances.
• Toric IOLs: These IOLs are designed to correct the refractive error in people with astigmatism.

Talk with your ophthalmologist about different IOL replacement options and what might be best suited for you. Be sure to check with your insurance provider too. Usually only monofocal lenses are covered by insurance. If other lenses may a better choice for you, this would be an out-of-pocket expense.

Who needs cataract surgery?

You may need cataract surgery if cataracts are causing vision problems that interfere with your activities, like driving or reading.

Your provider also may need to remove a cataract to see the back of your eye and help manage other eye conditions, such as:

• Age-related changes in the retina (the tissue at the back of the eye).
• Diabetic retinopathy, an eye condition affecting people with diabetes.

How do I decide if it’s time for cataract surgery?

When you first notice cataract symptoms, a new prescription for eyeglasses or contact lenses might help. But cataracts usually get worse over time. Eventually, you and your healthcare provider may decide to do cataract surgery to help you see well enough to do all the things you want to do and need to do.

Cataracts are not an emergency. You can wait to have the surgery until it’s best for you.

How common is cataract surgery?

Cataracts and cataract surgery are very common in older adults. More than half of all Americans over 80 have cataracts or cataract surgery.

Who performs cataract surgery?

An ophthalmologist, a type of eye doctor, performs cataract surgery.

What happens before cataract surgery?

Before cataract surgery, your ophthalmologist:

• Will measure your eye to find the correct focusing power for your IOL.
• Will ask about medications you take.
• May prescribe eyedrops to prevent infection and reduce eye swelling.

What happens during cataract surgery?

You may have to fast (not eat or drink) for a few hours before the surgery. Your provider may also ask you to stop taking certain medications for a few days.

Cataract surgery is an outpatient procedure, so you go home shortly after the surgery. You’ll need someone to come with you who can drive you home.

Here’s what to expect during the surgery:

1. Numbing medication: Your provider numbs the eye with drops or an injection. You may also get medication to help you relax. You will be awake during the surgery and see light and movement. But you won’t see what the ophthalmologist is doing to your eye. The surgery won’t hurt.
2. Cataract removal: Your provider uses a special microscope to see your eye. They create tiny incisions to reach the lens. Then they use ultrasound waves to break up the lens and remove it. Finally, they place the new lens.
3. Recovery: You won’t need stitches. The tiny incisions close by themselves. Your provider will tape a shield (like an eye patch) over your eye to protect it.

How long does cataract surgery last?

The actual cataract removal only takes a few minutes. The entire procedure often takes less than 20 to 30 minutes.

What happens after cataract surgery?

Most people go home within about 30 minutes after the surgery. You can typically remove the eye shield by the next day, although you may need to wear it while you sleep. You will need to use special eyedrops for about four weeks after surgery.

It can take a few days to weeks for your vision to clear up. Other temporary side effects include:

• Blurred or double vision.
• Gritty feeling in your eyes.
• Red or bloodshot eyes.
• Watery eyes.

What are the advantages of cataract surgery?

Cataract surgery is the only way to get rid of a cataract and sharpen your eyesight again. No other medicines or eyedrops are proven to improve cataracts.

Cataract surgery has a high success rate in improving people’s eyesight. Around 9 out of 10 people see better afterward.

After surgery, you can expect to:

• See things clearer.
• Have less glare when you look at bright lights.
• Tell the difference between colors.

What are the risks of cataract surgery?

Cataract surgery is a safe, routine procedure. But like any surgery, it comes with risks, including:

• Eye infection, bleeding or swelling.
• Retinal detachment, when the retina separates from the back of the eye.
• Damage to other parts of the eye.
• Ongoing eye pain.
• Blurred vision or vision loss.
• Visual disturbances, such as glare, halos and shadows.
• IOL becoming dislocated and moving out of place.

What is posterior capsular opacification (secondary cataract)?

You may notice that your vision becomes cloudy or blurry after your cataract surgery — even months or years after the procedure. Providers call this posterior capsular opacification, or PCO, and it’s normal. It’s also called a secondary cataract.

PCO happens because a membrane called the posterior capsule becomes cloudy. The posterior capsule once held your eye’s lens and now holds the intraocular lens in place.

If your vision starts to blur again, you may need a posterior capsulotomy (laser procedure) to restore your vision. A laser makes an opening in the cloudy capsule. This procedure can give you clearer vision again.

What can I expect during recovery from cataract surgery?

Although it can take up to four to eight weeks to fully recover from cataract surgery, most people will notice their vision begin to improve much sooner, and typically there should little pain or discomfort during this period. You’ll have some follow-up appointments with your provider during this time. About 9 out of 10 people see better after cataract surgery.

During the days and weeks that follow surgery, follow your provider’s instructions to:

• Use eyedrops as directed.
• Use your eye shield, pad and eyeglasses.
• Read, watch TV and use the computer as usual.
• Use sunglasses when going outside.
• Resume your activities and routine.

Don’t:

• Rub or press the eye.
• Get water or soap in the eye.
• Do strenuous activities.
• Use eye makeup for one week.
• Drive until your provider gives you the all-clear.
• Swim for two weeks after surgery.
• Fly without getting the all-clear from your provider.

When can I get new glasses if I need them?

You'll need to wait until your eye has healed completely after cataract surgery, which usually happens about two to four weeks after surgery. You'll probably need a new prescription.

When should I see my healthcare provider after cataract surgery?

You’ll have a follow-up appointment with your provider after the surgery.

Seek medical help sooner if you experience:

• Pain or redness that gets worse despite pain medication.
• Stickiness around your eye.
• Worsening vision or vision loss.
• Flashes of light or seeing lots of small dark spots or squiggly lines that seem to float across your vision.

Can cataract surgery help with other vision problems?

No, cataract surgery can’t help restore vision due to problems from other eye conditions such as:

• Diabetic retinopathy.
• Glaucoma.
• Macular degeneration.

What if I need cataract surgery in both eyes?

If you have cataracts in both eyes, you’ll need two separate surgeries. Typically, you’ll have the procedures about two to six weeks apart. This way, the first eye has time to heal. Your vision can return in the first eye before the second surgery.

How do I put in my eyedrops?

Your provider will prescribe eyedrops to use before and after cataract surgery. The eyedrops help control inflammation. Follow your ophthalmologist’s instructions for how to use the eyedrops.

To put in eyedrops:

1. Wash hands thoroughly.
2. Look up at the ceiling.
3. Pull down the lower lid.
4. Squeeze the bottle until you feel a drop enter your eye. Don’t let the dropper touch your eye.
5. Close your eye.