What to Expect with Cataract Surgery

Key Takeaways

• Cataract surgery is one of the safest and most effective procedures in the U.S. It treats cataracts by removing the clouded lens and replacing it with a clear artificial lens.
• There are different types of cataract surgery, but phacoemulsification is the most common. There are also several types of intraocular lenses (IOLs). 
• Cataract surgery usually results in clearer vision after a few days. Some people experience a secondary cataract, which is easily treated with another type of eye surgery.

What is Cataract Surgery?

Cataract surgery is the most common surgical procedure in the U.S.⁵ It’s an extremely safe and effective treatment for cataracts.

During cataract surgery, the cloudy lens is removed from the eye and replaced with an artificial lens. This new lens is called an intraocular lens (IOL).

The purpose of the lens is to bend (refract) light rays entering the eye. The lens is normally clear, but a cataract makes it cloudy. Eventually, this leads to vision problems, such as:

• Blurred vision
• Hazy vision
• Colors that appear less vivid

Surgery is the only way to remove a cataract. Many people who have cataracts use eyeglasses to manage vision changes without surgery. Your eye doctor may recommend cataract surgery when symptoms interfere with normal activities like driving and reading.

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Cataract Surgery

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What to Expect with Cataract Surgery

Cataract surgery is typically an outpatient procedure, which means you can go home afterward. 

Depending on the severity of your condition, a cataract procedure should take 10 to 20 minutes to complete. You should plan to spend about 30 minutes recovering from the sedative before having someone drive you home.

Here’s what you can expect:

Before the Procedure

About a week before cataract surgery, the eye doctor uses ultrasound to measure the eye’s shape and size. This helps determine what type of IOL to use during surgery. 

The eye surgeon will discuss the risks and benefits of cataract surgery before setting an appointment date and time.

During the Procedure

The procedure details vary slightly based on the cataract surgery you need (described above). In general, you should expect the following:

1. The eye surgeon will dilate your pupils with special eye drops. This helps them see inside your eye.
2. You’ll get local anesthetics to numb the area and possibly a sedative medication to help you relax. You’ll be awake during surgery.
3. Your surgeon will use a blade or laser to make an incision in your eye.
4. They’ll use phacoemulsification or extracapsular cataract extraction to remove the cloudy lens.
5. They’ll place an IOL in the empty lens capsule.
6. Stitches are usually only necessary for larger incisions. Your doctor may place an eye shield over your eye while it heals.

If both eyes have cataracts, your doctor will likely schedule the second surgery after the first eye has healed.

After the Procedure

You should experience clearer vision and brighter colors within a few days after surgery.

For the first couple of days, it’s normal to experience:

• Blurry vision
• Mild discomfort
• Itching

Avoid rubbing or pressing on your eye. Your doctor may prescribe eye drops and recommend wearing an eye patch or shield.

Discomfort and blurry vision should disappear after a couple of days. It usually takes eight weeks for your eye to heal fully. Your eye doctor will tell you when it’s safe to resume exercise and strenuous activities.

When to Call Your Doctor

Call your doctor right away if you experience:

• Loss of vision
• Very red eyes
• Eyelid swelling
• Pain that doesn’t go away with over-the-counter pain medicine
• Light flashes or floaters

What are the Types of Cataract Surgery?

There are different ways to perform cataract surgery, either with a blade or laser. Your ophthalmologist will recommend the best approach for you.

Phacoemulsification

This type is also called small incision cataract surgery, the most common method of cataract extraction.

The eye doctor makes a very small opening in the eye. They use a tiny probe that produces ultrasound energy to dissolve the cataract. Then, another tool removes the cataract with suction. 

Extracapsular Extraction

Extracapsular cataract surgery requires a larger incision. The eye doctor removes the cataract in one piece through an opening in the top part of the eye.

Laser Surgery

This technique uses laser energy instead of a blade to make the incisions. The rest of the procedure is similar to phacoemulsification. 

The laser softens the cataract, which leads to less need for ultrasound energy than with traditional surgery. Laser surgery also offers greater precision and accuracy.

What are the Types of Intraocular Lenses?

There are many types of intraocular lenses (IOLs) available. Not every type is covered by insurance, so check with your provider. 

Depending on your needs, your doctor may recommend:

Monofocal IOLs

Monofocal lenses correct one type of vision. Typically, people with monofocal lenses have them set for distance vision and use eyeglasses for reading.

Monofocal lenses are the most common type of lens used in cataract surgery. Medicare usually covers them. 

Multifocal IOLs

Multifocal lenses have different zones built in for both near and distant vision. These lenses can also correct mid-range vision. This lets you see clearly at all distances without eyeglasses or contact lenses.

While multifocal lenses remove the need for corrective lenses, they’re expensive and often not covered by insurance.

Accommodative IOLs

Similar to monofocal lenses, accommodative lenses only correct a single focus strength. 

These lenses respond to eye muscle movement, allowing a shift in focus between near and distant vision.

Researchers believe advances in eye care will lead to accommodative lenses that provide the level of clear vision experienced during childhood.⁴

Toric IOLs

Toric lenses correct astigmatism, which is abnormal eye curvature that leads to blurry vision. A toric lens is a good option for people with cataracts and astigmatism.

What are the Risks of Cataract Surgery?

While cataract surgery is one of the safest and most effective surgeries in the U.S., there are some risks. 

Posterior Capsular Opacification

If your vision gets cloudy or blurry after cataract surgery, you might have posterior capsular opacification (PCO).

PCO is sometimes called a “secondary cataract.” It’s a common complication that can occur weeks, months, or years after cataract surgery. 

PCO isn’t an actual cataract but a growth of cells on the capsule of your eye where the IOL sits. It is easily treated with a 5-minute outpatient procedure called yttrium-aluminum-garnet (YAG) laser capsulotomy. 

Other Potential Complications

Other complications of cataract surgery include:

• Bruising and swelling of the eyelid
• Increased eye pressure (glaucoma)
• Allergic reaction to the medicated eye drops (steroids)
• Bacterial infection 
• Bleeding in the eye
• Retinal detachment
• IOL detachment
• Seeing glare, halos, and dark shadows
• Blurred vision
• Droopy eyelid
• Vision loss

Cataract surgery won’t restore vision lost from other eye conditions, such as macular degeneration or diabetic retinopathy.

What is the Cost of Cataract Surgery?

Cataract surgery costs are usually covered by private insurance or Medicare. 

However, even if your surgery is covered, you may have some out-of-pocket costs. Special intraocular lenses (IOLs) cost more and typically aren’t covered by insurance.

You may also pay more if you get cataract surgery before you meet certain age or vision requirements.

If you don’t have Medicare or private insurance, these options may help reduce your out-of-pocket costs:

• Health savings account (HSA)
• Flexible spending account (FSA)
• Payment plans through your doctor’s office

Discuss costs and payment options with your ophthalmologist before undergoing cataract surgery.

Are There Alternatives to Cataract Surgery?

Surgery is currently the only way to remove cataracts. 

However, researchers are working on alternative treatments, including eye drops, to remove cataracts.⁷ 

You can take steps toward slowing the progression of cataracts and vision loss, including:

• Get a routine comprehensive eye exam
• Wear anti-glare sunglasses and eye protection 
• Install brighter lights around the house
• Use a magnifying glass to read the small print