Cataract Surgery Procedure

Overview

Cataract surgery is one of the most performed eye surgeries worldwide. During this procedure, an ophthalmologist (eye doctor) removes the cloudy lens from the eye and usually replaces it with a clear artificial lens. People usually do not need to stay in the hospital after the operation.

Key Points:

Who performs it: Ophthalmologist (eye doctor).
Setting: Outpatient (no hospital stay required).
Purpose: To restore clear vision affected by cataracts.
Commonality: Widely done and considered safe.

This surgery helps people see better when cataracts start to make their vision cloudy.

Reasons for the Procedure

Doctors most often perform cataract surgery to help people see better when a cloudy lens causes vision loss or blurry vision. Cataracts are a common condition, especially with aging, and they can lead to problems with daily activities, such as driving, reading, or watching TV.

When these vision problems begin to interfere with normal life, doctors may recommend removing the cloudy lens to improve sight. Doctors may also recommend the procedure when a cloudy lens makes it difficult to check for or treat other serious eye conditions, like age-related macular degeneration or diabetic retinopathy.

Sometimes, doctors suggest cataract surgery even if the main issue is not vision loss, but instead the need for better access to the back of the eye for treatment or monitoring other eye problems. Common reasons for considering cataract surgery include:

Difficulty seeing clearly at work or while driving.
Trouble with tasks like cooking, shopping, or taking medicine.
Increased sensitivity to bright lights and glare.
Blurred or cloudy vision that limits independence.

Symptom	Possible Impact
Cloudy lens	Blurry vision, glare from lights
Vision loss	Trouble reading, driving, working
Eye conditions	Harder to monitor other eye diseases

Possible Problems After Surgery

Cataract surgery carries several risks, including infection, swelling, bleeding, and a drooping eyelid. Some people might see double vision or experience blurred vision after the operation.

Less common but serious issues can include the artificial lens moving out of place, retinal detachment, or even vision loss. Sometimes, a person can develop a secondary cataract, called posterior capsule opacification (PCO).

Other eye diseases, like glaucoma, age-related macular degeneration, or diabetic retinopathy can increase the chance of problems. Some might also notice halos or side effects from the surgery.

Steps to Get Ready

Eating, Drinking, and Medicine Guidelines

Doctors usually tell people not to eat or drink anything for about 12 hours before surgery. Some medicines, like those that could cause more bleeding, might need to be stopped.

Anyone taking medicine for prostate issues should let their eye doctor know, as it can make surgery harder. Doctors often give antibiotic eye drops to use one or two days before the procedure. Below is a table to help keep track:

Step	What to Do
Fasting	No food or drinks 12 hours before surgery.
Medicine Adjustments	Check with the doctor about your medications.
Eye Drops	Start using prescribed drops as advised.

Extra Safety Measures

Patients usually return home the same day, but should not drive after surgery, so they need to arrange a ride. Someone should help at home, especially because eye doctors might tell patients not to bend or lift heavy things for about a week.

Wearing an eye shield or sunglasses as instructed can protect the eye while it heals, and follow-up tests or exams may be scheduled to check recovery.

What You Can Expect

Before the surgery, the doctor will use ultrasound to measure the size and shape of the patient’s eye. This helps the doctor choose the best type of intraocular lens (IOL) for the individual’s needs. An IOL is a small lens implanted to replace the eye’s natural, cloudy lens.

Most people who have cataracts will receive an IOL. The IOL helps improve vision by focusing light correctly onto the retina. The IOL cannot be seen or felt, as it becomes a permanent part of the eye. Patients have a few types of artificial lenses to consider. These can include:

Type of IOL	Description
Monofocal IOL	Works best for distance vision; reading glasses may be needed.
Accommodative Monofocal IOL	Designed to shift focus for near or far vision, responding to eye muscles.
Multifocal IOL	Has several focusing zones for near, intermediate, and far vision.
Toric IOL	Offers astigmatism correction for those with this vision issue.
Extended Depth-of-Focus (EDOF)	Helps provide clearer vision at different distances.
Light-Adjustable IOL	Can be adjusted after surgery by using light treatments.

IOLs can be made of plastic, acrylic, or silicone. Some lenses are stiff and require a slightly larger incision and stitches. Flexible IOLs can be folded and inserted through small incisions that often do not require stitches.

Patients will discuss options with their doctor, including benefits, possible risks, and costs. Insurance may not cover all types of IOLs, so the patient’s budget may play a role in the decision.

During the Operation

The process usually takes less than an hour. Before surgery starts:

The care team uses eye drops to widen the pupil.
They give medicine to numb the area.
Some people receive a sedative to help them relax, but they usually remain awake.

The surgeon’s main goal is to take out the cloudy lens and put in the new artificial IOL. There are two major methods:

Small Incision Surgery (Phacoemulsification):
- The surgeon makes a small incision in the cornea (the front of the eye).
- A thin probe is placed through this incision.
- Using ultrasound waves, the surgeon breaks up the cloudy lens (cataract).
- The surgeon gently suctions out the pieces.
- The back part of the natural lens, called the capsule, stays in place to support the IOL.
- Often, the incision is so small that stitches are not needed.
Large Incision Surgery (Extracapsular extraction):
- Used less often and mainly for complicated cases.
- The surgeon makes a larger cut to remove the lens in one piece.
- The capsule at the back is still left to support the IOL.
- Stitches are needed for this larger incision.

After removing the cataract, the surgeon inserts the chosen IOL into the empty lens capsule. The artificial lens unfolds inside the eye.

In most cases, this ends the surgery. In rare cases, the surgeon does not place an artificial lens if there are certain eye problems. The doctor discusses this ahead of time with the patient.

What Happens Afterwards

After the procedure, the care team moves the patient to a recovery area for a short time. Most people notice improved vision within a few days. At first, vision may seem blurry or cloudy as the eye heals and adjusts to the new IOL. Bright colors may look stronger, since the old lens was cloudy and sometimes tinted yellow or brown.

Recovery Tips

Mild discomfort, itching, or a feeling that something is in the eye is normal for a day or two.
Avoid rubbing or pressing on the eye.
The doctor may recommend wearing an eye patch or a shield, especially during sleep, to protect the eye for a few days.
The doctor may prescribe eye drops or medicines to stop infection, lower swelling, and control eye pressure. Some medicines can be given during the operation.
Most discomfort goes away after the first day or two.

Typical Recovery Timeline

Healing is usually complete within 8 weeks.
The doctor schedules follow-up visits the next day, the following week, and about a month later.
Patients should report any severe symptoms, including:
- Loss of vision.
- Pain that continues after using over-the-counter pain medicine.
- Redness that gets worse.
- Swelling of the eyelid.
- Lots of new floaters or flashing lights.

Vision Correction After Surgery

Many people still need glasses, depending on the type of IOL used and personal vision needs.
The doctor will tell the patient when their eyes are healed enough for a final glasses prescription, usually 1 to 3 months after the operation.

If Surgery Is Needed on Both Eyes

The doctor usually treats the second eye after the first eye has healed.

Possible Laser Treatment

Rarely, months or years after surgery, the back of the lens capsule can become cloudy. If this happens, the doctor uses a quick and painless laser procedure called a posterior capsulotomy to restore clear vision.

Outcomes

Most people notice sharper vision soon after cataract surgery, often by the next day. Many can return to everyday activities like walking and light chores quickly. Blurry sight can happen at first but usually gets better over several days or weeks.

Occasionally, a person may develop cloudiness behind the lens implant—this is known as a secondary cataract or posterior capsule opacification (PCO). PCO can make vision blurry again.

Doctors treat it using a quick outpatient procedure called YAG laser capsulotomy. This laser makes a tiny opening in the cloudy area, helping light pass through clearly. The process is simple, takes only a few minutes, and does not cause pain.

People may still have vision issues like nearsightedness, farsightedness, presbyopia, or astigmatism after surgery, but these are not caused by the procedure itself. Some choose options like monovision lens implants to help reduce the need for glasses.