Cataract surgery corrects vision problems by replacing a cloudy lens with a transparent one. The lens of the eye must be clear in order to focus light properly onto the retina.Â
A clouded lens (called a cataract) can make your vision blurry or seem out of focus, or create halos around lights. This can make seeing at night especially difficult. Cataracts tend to be age-related and generally develop in both eyes, though not always evenly. The position and density of the cloudy area in the lens determine the amount and quality of vision impairment you have.
During cataract removal surgery, your natural lens is removed and an artificial lens is implanted. The eyes are treated separately, usually within a few weeks of each other. âIf only one eye is truly affected, then the opposite eye can wait until such time that a clinically significant cataract develops,â says Dr. Emilio Justo, an ophthalmologist in Sun City West, Arizona.Â
Beyond restoring vision youâve lost to cataracts, the new lens can correct nearsightedness, farsightedness, and astigmatism (with a toric lens implant) and even provide both distance and near vision simultaneously (with a multifocal or trifocal lens implant), so you may not need to wear reading glasses afterward.
âCataract surgery is an opportunity to dramatically improve your vision, given all the new technology available. Many people experience vision far better than they can even rememberâespecially those who wore strong prescriptions,â says Dr. Justo.
That was the case with Baoqin Zhang, a RealSelf member whose cataracts got so bad, she became legally blind. âThe second day after the surgery, my sight was restored to 20/25. I could see everythingâmy husbandâs smile and the colorful expressions on my grandchildrenâs faces. It was magic!âÂ
More than 3 million cataract surgeries are performed each year in the U.S., making it one of the most common types of eye surgery.
If you had to âpickâ an eye problem to have, a cataract is your best choice. Treatment is quick, safe, painless, andâwith the addition of numerous implantable lens optionsâthe visual results are typically awesome⊠and, yes, permanent!ââDr. Anthony Kameen, a retired Baltimore ophthalmologist, in a RealSelf Q&A
Pros
Cons
If you have cloudy, dim or blurry vision, or things donât look as bright or colorful as they used to, one or both of your eyes may have a clouded lens. Many people say that their vision with cataracts is similar to the effect of looking through a dirty car windshield.
Cataracts need to be removed only when the change in your vision begins to interfere with your everyday lifeâfor instance, making it more difficult to drive, read, or watch TV. In some cases, simply changing your eyeglass prescription may temporarily improve your vision, the cataract becomes more significant and you need surgery.
âThe proper time to consider cataract surgery is when significant enough clouding of the natural lens develops and causes blurring of vision, glare, halos, starbursting, difficulty seeing street signs, and difficulty with small print,â says Dr. Justo. âOnce the patient feels that their vision is compromised significantly enough and that their vision cannot be corrected with eyeglasses readily, that is the time to consider cataract surgery.â
Patients also need to be counseled on whether the degree of clouding is consistent with the visual blurring theyâre experiencing. Your provider will need to rule out any other vision problems or eye diseasesâsuch as macular degeneration, diabetic retinopathy, glaucoma, and epiretinal membranesâthat may cause similar symptoms.
In most cases, thereâs no harm in delaying cataract surgery for a while. But donât wait too long: untreated cataracts can harden and become âhypermature,â which makes them more difficult to remove and more likely to cause surgical complications. If left untreated for long periods (usually years), cataracts can lead to blindness.
âAfter waiting far too long, I finally had my cataracts taken out and the Crystalens put in both eyes. In one wordâamazing! Why I waited, I do not know. The entire process went so smoothly, my recovery went so well, and I canât believe how wonderful it is to wake up and never have to wear my contacts again! My vision is 20/20, and in one eye, itâs even better.ââMSarris, RealSelf member
âThere should truly be absolutely no pain during or after cataract surgery,â says Dr. Justo. Occasionally, some patients may feel a little minor irritation or a scratching sensation for a few days (like having an eyelash in your eye). But most patients donât feel anything abnormal post-operatively.
All cataract surgery operations include an artificial lens (called an intraocular lens, or IOL) that corrects your distance vision, giving you clearer, sharper vision from afar. There are also premium âtoricâ lenses that correct for astigmatism and lenses that correct for near vision.Â
Newer multifocal lenses are now available, to correct both near and distance vision simultaneously, reducing or eliminating the need for reading glasses.
According to Dr. Justo, âPremium IOLs such as toric and multifocal lens implants are not covered by any insurance plans in the U.S., Canada or Europe, and are considered an âout of pocket upgrade.ââ Your surgeon can help you decide if the benefits of the upgrade will be worth the cost, for your particular situation.
Whatever type of lens you receive, it will become a permanent part of your eye and wonât wear out or require attention. You wonât be able to feel or see it.
Because contact lenses alter the shape of the corneaâs surface, the clear covering on the front of your eye, youâll need to be out of contact lensesâusually a week, if you wear soft lenses; three to four weeks, for hard lenses (which change the shape of the eye more)âprior to getting pre-op measurements for the surgery. Itâs important to comply with this order, says Dr. Ahad Mahootchi, an oculoplastic surgeon in Zephyrhills, Florida, in a RealSelf Q&A. The surface measurements need to be accurate so that your surgeon can select the proper focusing power of your new lenses.Â
The surgery is usually an outpatient procedure, though it can be done in a hospital. Youâll be awake during the procedure, but your eye will be numbed and youâll be given a sedative to help you relax. During the surgery, one or more small incisions will be made at the edge of your cornea. A small probe is then inserted, to break the lens up into tiny fragments using ultrasound waves. The pieces are then gently suctioned out.Â
Once the particles are removed, the intraocular lens implant (IOL) is placed. This procedure, known as phacoemulsification (phaco, for short), is the most common cataract surgery technique performed.Â
The incision doesnât require stitchesâit will heal by itself over a few days. A clear shield or patch may be placed over your eye in order to protect it during this process. After the first day, you may be asked to wear the shield (which is secured in place with paper tape) only at night, for up to two weeks.Â
After resting for a short while after the procedure, youâll be ready to go home. You may be able to see well enough to drive, but youâll probably still be groggy from the surgery, so be sure to arrange for someone to take you home.
In a laser cataract procedure, the surgeon uses a femtosecond laser, instead of handheld surgical tools, to make the incision, lens opening, and fragmentation of the cataract. The procedure is more controlled and precise than being fully performed manually, explains Dr. Justo.
This can potentially reduce certain risks and improve the visual outcome of cataract surgery.Â
However, âusing the term âsaferâ may be a slight exaggeration, as Iâm not sure this has been actually proven scientifically. And clearly, there are highly experienced surgeons who do not use laser and still may be excellent surgeons who get excellent results,â says Dr. Justo. Â
One upside to having cataract surgery with a surgeon who uses a laser: thereâs a great likelihood that they also offer other advanced cataract surgery technologies, such as ORA (Optiwave Refractive Analysis, which takes super-highly accurate measurements of the patientâs eye during surgery to determine the power and strength of the lens implant), Verion (an image-guided system that allows the surgery to be customized specifically to your eyes), and advanced lens implant options.Â
âItâs always beneficial to at least educate each patient and explain to [them] what advanced technologies may benefit them and for what specific reason,â says Dr. Justo. âRealistically, you only get one chance to achieve your vision goals, so the better educated the patient, the greater the likelihood they will make good decisions.â
How much downtime is required post-procedure varies from patient to patient, says Dr. Justo. âI typically recommend having the ability to take off work for 24 to 48 hours, to give your eye a chance to recover.âÂ
Youâll be prescribed eye drops, to prevent infection and reduce inflammation. Typically, antibiotic drops are used for about a week, while the anti-inflammatory drops are used three to six weeks or longer.Â
âDry eye is the enemy of great results,â says Dr. Mahootchi, so lubricating eye drops can be used to quell irritation and soothe the eye.
The American Academy of Ophthalmology recommends purchasing a new bottle of artificial tears or preservative-free tears, to avoid placing contaminated drops in the eye. Steer clear of products with vasoconstrictors to relieve redness and avoid using lubricating drops within 15 minutes before or after your medicated surgical eye drops, so as not to dilute the medication and reduce its effectiveness.Â
Some doctors ask that you donât read or watch TV at all during the first day of your surgery, while others give the OK to resume light daily activities and chores, including reading, writing, watching TV, and walking.
After that, there usually arenât any physical restrictions like not bending, lifting, or exercising, says Dr. Justo. âWe simply want to avoid any underwater swimming [or] any dirty water, chlorine, or bacteria getting into the eye,â he says. Follow your doctorâs instructions.Â
There are no restrictions on airplane travel after cataract surgery. âYou can fly the next day,â says Dr. Justo.
RealSelf Tip: Plan ahead, for your safety, advises Dr. Justo. âMany of my patients are able to see and drive the day after surgery. However, gauge your level of comfort before you do so. To be safe, you may want to be sure you have everything you need and no big plans immediately following the procedure, outside of your post-operative exam,â which usually occurs the following day.
The most common side effects of cataract surgery are temporary blurriness and foreign-body sensation. You may also experience glare and halos after surgery.
Usually, theyâre only a short-term problem, and most patients find that the effects resolve themselves after three months. Occasionally, mild glare may continue, but most patients find that they can easily adapt to it. Polarized sunglasses have a special filter that can help reduce glare, and antireflective coatings can be added to prescription lenses to decrease it.Â
As with any surgery, there are potentially serious risks, such as infection, retinal tears/detachment, intraocular lens dislocation (when the lens moves out of place), and others that are statistically highly unlikely, though the risk is never zero.Â
How long your vision will be blurry depends on the density of the cataract. âThicker, denser cataracts may require more ultrasound energy to emulsify the cataract,â explains Dr. Justo. âThis may cause some postoperative corneal edema that may take anywhere from one to several days to clear.âÂ
If a cataract is mild to moderate, a patientâs vision is usually fairly good within 24 hours or less, although it may still take several days to reach its maximum potential. Typically, with a smooth surgery and no other underlying ophthalmic abnormalities, the final vision is achieved in one to two weeks or less.
Assuming that there are no preexisting ocular conditions at the time of cataract surgery, thereâs a very good chance that the patient can achieve 20/20 vision, although some patients may require some degree of refractive correction with eyeglasses or contact lenses.
âItâs been two days since I had my second eye operated on, and the results are amazing. I canât believe how a 20-minute procedure could so immediately and drastically change my vision...and therefore my life!ââAnatoliDolgov, RealSelf member
No, once a cataract is successfully removed, it canât grow back.Â
However, about 40-50% of patients develop posterior capsular opacification (PCO), a clouded tissue layer behind the lens implant that can cause blurry vision. âThis is considered a normal consequence, not a complication,â Dr. Justo says.
This so-called secondary cataract, which may occur soon after surgery or many years later, can be permanently removed with a minor laser surgical procedure called YAG laser capsulotomy.
The second surgery to correct posterior capsular opacification is very straightforward, though ideally it should be delayed for several months after cataract surgery, to allow the new lens to settle into the proper position. âA YAG laser procedure takes just a couple of minutes to perform, and the patient can even drive himself to and from the office, although the eye will be dilated to perform the procedure,â says Dr. Justo.
RealSelf Tip: Once your cataract surgery is complete, itâs important to resume regular eye exams, to be sure you donât develop other eye health problemsâsuch as glaucoma or macular degenerationâthat can lead to vision loss, says Dr. Justo.
Updated August 14, 2023