What is cataract surgery?

Cataract surgery helps you see better. It replaces your natural lens, which has become cloudy, with a clear artificial one.

Types of cataract surgery include:

• Phacoemulsification. This is the most common type of surgery. The doctor makes a small cut in your eye and uses an ultrasound tool to break your cloudy lens apart. The small pieces of the lens are removed and replaced with an artificial lens.
• Extracapsular extraction. This uses a larger cut to remove the lens in one piece. It is replaced with an artificial lens.
• Femtosecond laser-assisted cataract surgery (FLACS). This uses laser technology and replaces the natural lens with an artificial lens.

Before surgery, you may be given medicine to help you relax. Medicine will be used to numb your eye. After surgery, you may have a bandage or shield on your eye.

Most people will see better in 1 to 3 days.

Cataract surgery is successful for most adults. Surgery may also improve vision in infants who have cataracts.

Both phacoemulsification cataract surgery and femtosecond laser-assisted cataract surgery (FLACS) work about equally well for treating cataracts in adults. FLACS is more expensive, but it may be a better option in some cases. For example, people who are going to have multifocal lenses placed may choose FLACS.

People who have surgery for cataracts usually have:

• Improved vision.
• Increased mobility and independence.
• Relief from the fear of going blind.

Surgery can be stressful. This information will help you understand what you can expect. And it will help you safely prepare for surgery.

Preparing for surgery

• Be sure you have someone to take you home. Anesthesia and pain medicine will make it unsafe for you to drive or get home on your own.
• Understand exactly what surgery is planned, along with the risks, benefits, and other options.
• If you take a medicine that prevents blood clots, your doctor may tell you to stop taking it before your surgery. Or your doctor may tell you to keep taking it. (These medicines include aspirin and other blood thinners.) Make sure that you understand exactly what your doctor wants you to do.
• Tell your doctor ALL the medicines, vitamins, supplements, and herbal remedies you take. Some may increase the risk of problems during your surgery. Your doctor will tell you if you should stop taking any of them before the surgery and how soon to do it.
• Make sure your doctor and the hospital have a copy of your advance directive. If you don’t have one, you may want to prepare one. It lets others know your health care wishes. It’s a good thing to have before any type of surgery or procedure.

Although the risk is low, surgery for cataracts does involve the risk of partial to total vision loss if the surgery is not successful or if there are complications. Some complications can be treated and vision loss reversed, but others cannot. Complications that may occur with cataract surgery include:

• A torn lens covering (posterior capsule rupture).
• Infection in the eye (endophthalmitis).
• Swelling and fluid in the center of the nerve layer (cystoid macular edema).
• Swelling of the clear covering of the eye (corneal edema).
• Bleeding in the front of the eye (hyphema).
• Detachment of the nerve layer at the back of the eye (retinal detachment).

Complications that may occur some time after surgery include:

• Problems with glare.
• Clouding of the back portion of the lens covering (capsule) that remains after surgery. (Your doctor can easily treat this using a laser.)
• Retinal detachment.
• Glaucoma.
• Astigmatism or strabismus.
• Sagging of the upper eyelid (ptosis).

Before you leave the outpatient center, you will get the immediate eye care that you need after surgery. The surgeon will review the symptoms of possible complications, eye protection, activities, medicines, and required visits. They will also tell you what to do for emergency care if you need it.

The eye that was operated on may be bandaged for 1 night after surgery. You may wear a protective shield over the eye at night for about a week. There is normally no significant pain after surgery.

You most likely will need to see the doctor for checkups 1 or 2 days after surgery, and again within a few weeks after surgery. If you have any complications, you should visit sooner and more often.

Most people get a new eyeglass prescription about 6 weeks after surgery.

When should I consider having surgery?

• You may want to consider cataract surgery if your vision is blurry or causing other problems that interfere with things you want or need to do each day. Examples include reading and driving.

Where should I go for surgery?

• The most important factor to consider is the skill and experience of your eye surgeon. If you need a recommendation for a surgeon, talk with your family doctor or optometrist.
• Try to choose a convenient location. Then you can easily get follow-up eye exams and be seen if you have problems.

Which procedure will be done and why?

• Phacoemulsification (small incision surgery) is the most commonly performed type of cataract surgery. The surgeon uses ultrasound to break up the cloudy lens. Other types of surgery are usually reserved for special situations.
• Ask your surgeon how experienced they are with the procedure. Ask if the surgeon will use a laser during part of the surgery. Also find out how many procedures the surgeon has done and what the outcomes were.

What type of anesthesia is planned?

Cataract surgery in otherwise healthy people can usually be done on an outpatient basis with local anesthesia or topical anesthetic eyedrops. (General anesthesia is only needed for a few people.)

What type of lens replacement is best?

• Lenses that are placed inside the eye during surgery (intraocular lenses, or IOLs) are used in many cataract surgeries for adults and children. Depending on the type of IOL that is used, adults may not need glasses. But most children who have an IOL will need glasses. The doctor may wait until a child is older than 6 months before using an IOL.
• Ask your doctor about the different types of lenses and what would be best for you. Some types may cost more than others.
• If an IOL can't be placed, contact lenses or thick glasses may be needed. But this is very rare.

What should I do if I have cataracts in both eyes?

• For adults, the reason to have cataract surgery on the second eye is the same as for the first eye. The reason is that vision loss caused by the cataract is interfering with your daily activities and adversely affecting the quality of your life.
• Often, cataract surgery is done on one eye at a time. Discuss with your doctor how long you need to wait after the first surgery before you can have cataract surgery on your other eye.
• You may be able to have cataract surgery on both eyes at the same time. You and your doctor should decide if this is a good option for you.

You had cataract surgery. It replaced your cloudy natural lens with a clear artificial one.

After surgery, your eye may feel scratchy, sticky, or uncomfortable. It may also water more than usual.

Most people see better 1 to 3 days after surgery. But it could take 3 to 10 weeks to get the full benefits of surgery and to see as clearly as possible.

Your doctor may send you home with a bandage, patch, or clear shield on your eye. This will keep you from rubbing your eye. Your doctor will also give you eyedrops to help your eye heal. Use them exactly as directed.

You can read or watch TV right away, but things may look blurry. Most people are able to return to work or their normal routine in 1 to 3 days. After your eye heals, you may still need to wear glasses, especially for reading.

• Follow the instructions exactly about when to stop eating and drinking. If you don't, your surgery may be canceled. If your doctor told you to take your medicines on the day of surgery, take them with only a sip of water.
• Take a bath or shower before you come in for your surgery. Do not apply lotions, perfumes, deodorants, or nail polish.
• Take off all jewelry and piercings.

At the hospital or surgery center

• Bring a picture ID.
• The area for surgery is often marked to make sure there are no errors.
• You will be kept comfortable and safe by your anesthesia provider. The anesthesia may make you sleep. Or it may just numb the area being worked on.
• The surgery will take about 20 to 40 minutes.

The decision to have this surgery is based on whether:

• Your work or lifestyle is affected by vision problems caused by the cataract. For example, you may want surgery if you need to drive, especially at night.
• Glare caused by bright lights is a problem.
• You have another vision-threatening eye disease, such as diabetic retinopathy or macular degeneration.