What is cataract surgery?
Cataract surgery is used to restore cataract-related vision loss. During the procedure, the clouded lens inside your eye will be replaced with a clear artificial lens. Cataract surgery itself is painless. A typical procedure doesn’t take very long — only about 15 minutes. It’s usually an outpatient procedure and doesn’t require an overnight stay in a hospital.
It might sound scary at first, but cataract surgery is one of the safest and most effective surgical vision procedures performed today. Millions of cataract surgeries are completed every year in the U.S., and the vast majority have excellent visual outcomes.
The potential need for cataract surgery goes up as you age, when cataracts are most likely to develop or worsen. Only about 5% of people aged 50-54 have cataracts, but they affect nearly 50% of people aged 75-79 — and almost 70% of those over age 80, according to the U.S. National Institutes of Health (NIH).
SEE RELATED: What causes a cataract to form?
What happens during cataract surgery?
The cloudy lens inside your eye will be removed and replaced with a clear artificial lens, called an intraocular lens (IOL). The new lens helps restore the clear vision you had before the cataracts developed.
During any form of cataract surgery, special precautions are taken to ensure that you’re completely relaxed and pain-free. At worst, patients can experience a slight sensation of pressure, but this is not painful.
Here are the basic steps in a typical modern cataract surgery:
A small incision is made along the side of the cornea.
A high-frequency ultrasound device or laser is used to carefully break up the cloudy lens into small fragments.
The lens fragments are gently removed from the eye using suction.
After all fragments have been removed, the surgeon inserts the artificial lens securely behind the pupil and the colored part of the eye (iris) in the same location your natural lens occupied.
The incision heals on its own without the need for stitches.
A protective shield is placed over the eye to keep it safe during the early stages of recovery.
If you need surgery in both eyes, your cataract surgeon will typically wait one to three weeks between procedures to give the first eye a chance to heal.
SEE RELATED: Different ways cataracts can be treated
Two different options for cataract surgery
The most common type of cataract removal surgery is called phacoemulsification, or simply phaco. A phacoemulsification procedure uses high-frequency ultrasound to break up the lens.
The phaco operation is now performed with smaller incisions than ever before, so healing is faster and the risk of complications is greatly reduced.
There are three main types of IOLs that can be implanted during cataract surgery:
Monofocal lenses are the standard options for most surgeries. These may still require the use of eyeglasses or reading glasses after surgery. If prescription glasses are needed, your eye doctor will prescribe them about a month after surgery. Optionally, presbyopia can be treated by adjusting the power of one of your monofocal IOLs to create a condition called monovision.
Accommodating lenses and multifocal lenses are available for patients with presbyopia. These lenses can correct your reading vision without sacrificing your distance vision. Both of these IOLs provide a greater range of vision after cataract surgery than conventional monofocal lenses.
Extracapsular surgery is also an option. Instead of breaking up the cloudy lens with ultrasound, a surgeon will remove the core in one piece, then the rest with suction. Extracapsular surgery involves a longer incision and antibiotic eye drops before the operation. This type of cataract surgery is typically only performed in complicated cases.
Laser cataract surgery, or Refractive Laser-Assisted Cataract Surgery (ReLACS), is a newer option that uses newer technology.
Instead of ultrasound energy, a special laser is used to break up the existing cataract. The laser uses less energy than ultrasound, which can further reduce the risk of complications.
Laser cataract surgery can also improve visual outcomes in some cases.
Laser surgery is typically more expensive than standard phaco cataract surgery. During your cataract surgery consultation, your surgeon can help you decide which procedure is best for your specific needs.
Preparing for cataract surgery
Before you schedule cataract surgery, your eye doctor will perform a comprehensive eye exam to check the overall health of your eyes and decide if anything will prevent you from having surgery.
A refraction test also will be performed to determine your nearsightedness, farsightedness and/or astigmatism measurements before surgery. Additional measurements of your eyes will be taken to determine the shape of your eye and which type of implantable lens you need.
Prior to cataract surgery, you will be advised about what to expect before, during and after your procedure. This information is meant to help you make an informed decision about proceeding with surgery.
Your eye doctor will ask about medications and supplements you are taking; some of these can increase your risk of complications and may need to be discontinued temporarily.
If you have any questions or concerns about cataract surgery, be sure to discuss them with your eye doctor and cataract surgeon before signing the "informed consent" documents that authorize surgery.
Cataract surgery recovery
An uncomplicated cataract surgery typically only takes about 15 minutes, but expect to be at the surgical center for 90 minutes or longer, since extra time is needed for preparation, along with a post-operative evaluation and recovery instructions.
You will need to have someone drive you home after cataract surgery. To protect your eyes from sunlight and other bright light as your eye recovers, you will be given a special pair of post-operative sunglasses.
Medicated eye drops will need to be used for a few weeks, and you will need to wear your protective eye shield while sleeping or napping for about a week.
While your eye heals, you might experience some eye redness and blurred vision during the first few days or even weeks following the procedure.
During at least the first week of your recovery, you need to avoid:
Strenuous activity and any lifting over 25 pounds.
Bending, exercising and activities that can stress the eye.
Exposing your eye to water. Since it can cause an infection, you’ll need to keep your eye closed while showering or bathing. Avoid swimming or sitting in hot tubs for at least two weeks.
Any activity that would expose your healing eye to dust, grime or other infection-causing contaminants.
Your cataract surgeon may give you additional instructions, depending on your specific needs and the type of procedure performed.
Page published in February 2019
Page updated in April 2021