Question 1

What is cataract surgery?

Accepted Answer

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.

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. “If only one eye is truly affected, then the opposite eye can wait until such time that a clinically significant cataract develops,” says Dr. Emilio Justo, an ophthalmologist in Sun City West, Arizona.

Beyond restoring vision you’ve 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.

“Cataract 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 remember—especially those who wore strong prescriptions,” says Dr. Justo.

That was the case with Baoqin Zhang, a RealSelf member whose cataracts got so bad, she became legally blind. “The second day after the surgery, my sight was restored to 20/25. I could see everything—my husband’s smile and the colorful expressions on my grandchildren’s faces. It was magic!”

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 ‘pick’ an eye problem to have, a cataract is your best choice. Treatment is quick, safe, painless, and—with the addition of numerous implantable lens options—the visual results are typically awesome… and, yes, permanent!”—Dr. Anthony Kameen, a retired Baltimore ophthalmologist, in a RealSelf Q&A

Question 2

What are the pros and cons of cataract surgery?

Accepted Answer

Pros

Cataract surgery is safe and effective. About 95% of people who have the surgery have better vision afterward.
Most people see better almost immediately, and vision improves steadily over the following weeks.
The procedure is quick (less than an hour) and painless. The eye is numbed, but you won’t require anesthesia.
Recovery takes only a few days.
The new artificial lenses typically last a lifetime, and because they don’t form cataracts, there’s no risk that a cataract will come back after surgery.
You don’t have to rush into surgery. In most cases, waiting won’t damage your eye or make the surgery more difficult. “I tell patients that the time for cataract surgery is when you cannot see to do what you want to do,” says Dr. Mark Golden, an ophthalmologist in Chicago, in a RealSelf Q&A.
Complications are usually minor and can be successfully treated.
Age is not a factor (68 is the median age for the surgery), but your surgeon should be aware of your medical history.
If necessary, contact lenses can be worn after cataract surgery, as long as the eyes have had enough time to heal.
Cataracts cannot grow back—once you have the surgery you won’t need to have it again.
The need to revise a cataract procedure is rare. If medically necessary, most intraocular lens implants can be removed and replaced.

Cons

If you have cataracts in both eyes, surgery typically is performed on one eye and then, a few days or weeks later, performed on the other.
The capsule left behind to hold the implant in place becomes cloudy in up to half of cases, causing vision to become blurry again. This “second cataract” is treated with a minor laser procedure.
Post-surgery, you may need new glasses or contact lenses.

Question 3

How much does cataract surgery cost?

Accepted Answer

The price you pay will depend on the type of intraocular lens (IOL) that's implanted in your eye, your provider's technique, their credentials, and a few other key factors.

See our complete guide to cataract surgery costs

Question 4

How do you know when it’s time to have cataract surgery?

Accepted Answer

If you have cloudy, dim or blurry vision, or things don’t 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 life—for 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.

“The 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,” says Dr. Justo. “Once 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.”

Patients also need to be counseled on whether the degree of clouding is consistent with the visual blurring they’re experiencing. Your provider will need to rule out any other vision problems or eye diseases—such as macular degeneration, diabetic retinopathy, glaucoma, and epiretinal membranes—that may cause similar symptoms.

Question 5

How long can you postpone cataract removal?

Accepted Answer

In most cases, there’s no harm in delaying cataract surgery for a while. But don’t wait too long: untreated cataracts can harden and become “hypermature,” 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.

“After waiting far too long, I finally had my cataracts taken out and the Crystalens put in both eyes. In one word—amazing! Why I waited, I do not know. The entire process went so smoothly, my recovery went so well, and I can’t 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, it’s even better.”—MSarris, RealSelf member

Question 6

How painful is cataract surgery?

Accepted Answer

“There should truly be absolutely no pain during or after cataract surgery,” 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 don’t feel anything abnormal post-operatively.

Question 7

Which lens is best for cataract surgery?

Accepted Answer

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 “toric” lenses that correct for astigmatism and lenses that correct for near vision.

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, “Premium 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 ‘out of pocket upgrade.’” 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 won’t wear out or require attention. You won’t be able to feel or see it.

Question 8

What happens during cataract surgery?

Accepted Answer

Because contact lenses alter the shape of the cornea’s surface, the clear covering on the front of your eye, you’ll need to be out of contact lenses—usually a week, if you wear soft lenses; three to four weeks, for hard lenses (which change the shape of the eye more)—prior to getting pre-op measurements for the surgery. It’s 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.

The surgery is usually an outpatient procedure, though it can be done in a hospital. You’ll be awake during the procedure, but your eye will be numbed and you’ll 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.

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.

The incision doesn’t require stitches—it 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.

After resting for a short while after the procedure, you’ll be ready to go home. You may be able to see well enough to drive, but you’ll probably still be groggy from the surgery, so be sure to arrange for someone to take you home.

Question 9

Is laser cataract surgery safer?

Accepted Answer

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.

However, “using the term ‘safer’ may be a slight exaggeration, as I’m 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,” says Dr. Justo.

One upside to having cataract surgery with a surgeon who uses a laser: there’s 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 patient’s 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.

“It’s always beneficial to at least educate each patient and explain to [them] what advanced technologies may benefit them and for what specific reason,” says Dr. Justo. “Realistically, 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.”

Question 10

How much downtime do you need after cataract surgery?

Accepted Answer

How much downtime is required post-procedure varies from patient to patient, says Dr. Justo. “I typically recommend having the ability to take off work for 24 to 48 hours, to give your eye a chance to recover.”

You’ll 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.

“Dry eye is the enemy of great results,” 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.

Some doctors ask that you don’t 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 aren’t any physical restrictions like not bending, lifting, or exercising, says Dr. Justo. “We simply want to avoid any underwater swimming [or] any dirty water, chlorine, or bacteria getting into the eye,” he says. Follow your doctor’s instructions.

There are no restrictions on airplane travel after cataract surgery. “You can fly the next day,” says Dr. Justo.

RealSelf Tip: Plan ahead, for your safety, advises Dr. Justo. “Many 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,” which usually occurs the following day.

Question 11

What are the side effects of cataract surgery?

Accepted Answer

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, they’re 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.

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.

Question 12

How long after cataract surgery will you have blurry vision?

Accepted Answer

How long your vision will be blurry depends on the density of the cataract. “Thicker, denser cataracts may require more ultrasound energy to emulsify the cataract,” explains Dr. Justo. “This may cause some postoperative corneal edema that may take anywhere from one to several days to clear.”

If a cataract is mild to moderate, a patient’s 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, there’s 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.

“It’s been two days since I had my second eye operated on, and the results are amazing. I can’t believe how a 20-minute procedure could so immediately and drastically change my vision...and therefore my life!”—AnatoliDolgov, RealSelf member

Question 13

Can a cataract grow back?

Accepted Answer

No, once a cataract is successfully removed, it can’t grow back.

However, about 40-50% of patients develop posterior capsular opacification (PCO), a clouded tissue layer behind the lens implant that can cause blurry vision. “This is considered a normal consequence, not a complication,” 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. “A 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,” says Dr. Justo.

RealSelf Tip: Once your cataract surgery is complete, it’s important to resume regular eye exams, to be sure you don’t develop other eye health problems—such as glaucoma or macular degeneration—that can lead to vision loss, says Dr. Justo.

Question 14

Sources & studies

Accepted Answer

“Eyeglasses & Contact Lenses.” Eyeglasses Coverage

McKinney, J Kevin. “What Can I Use for My Red, Itchy Eyes after Cataract Surgery?” American Academy of Ophthalmology, 19 July 2018

CATARACT SURGERY

Emilio M. Justo, MD

Karyn Repinski

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Emilio M. Justo, MD

Karyn Repinski

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