What Is Cataract Surgery?
Cataracts are cloudy areas that form on the lens of one or both of your eyes. The lens, a normally clear part of your eye located just behind the colored iris, helps your eye focus light. As cataracts develop, they blur your vision and can make it hazy and less colorful, among other symptoms. These symptoms get worse over time.
If your vision gets bad enough that you have trouble with driving, reading, or other everyday activities, only cataract surgery can correct it. This is an outpatient procedure, meaning you don't have to stay in the hospital. You can return home shortly after surgery.
What Happens During Cataract Surgery?
During cataract surgery, your eye doctor (ophthalmologist) removes the lens from your eye and replaces it with an artificial lens, called an intraocular lens (IOL). An IOL is made from plastic, acrylic, or silicone. There are several different types of IOL, and you and your doctor will discuss what works best for you. Your options include:
Fixed-focus monofocal IOLs. This is the most basic and common type of IOL. It can sharpen only one type of vision — distance, close-up, or midrange. If you pick a distance vision IOL, as most people do, you likely will need reading glasses to see things close up. If you need cataract surgery in both eyes, another option is monovision. You’ll have a distance vision IOL placed in one eye and a close-up IOL in the other. It will take time for your eyes to adapt to this setup, and it’s possible you won’t ever get used to it. Before you go for monovision IOLs, you can try monovision contacts for a few weeks to see how well your eyes adapt.
Multifocal IOLs. These improve both your distance vision and your near vision by using different zones to focus your vision. You’ll probably need time to adapt to them, but once you do, you may no longer need glasses at all, even reading glasses. One potential problem is that you may see rings or halos around lights, such as street lamps, when driving at night.
Extended depth-of-focus (EDOF) IOLs. These improve both your distance vision and your midrange vision. However, you’ll likely still need reading glasses.
Accommodative IOLs. Just like the lenses in your eyes, these IOLs adjust themselves to allow you to see things clearly whether close up or far away. You may still need reading glasses to stay focused on close-up objects for longer periods.
Toric IOLs. Your doctor may recommend these if you have astigmatism -- a problem with the curvature of your eye that causes blurred vision. They help correct the way your eye responds to light.
Light-adjustable IOLs. These IOLs allow your doctor to adjust and refine your vision correction after your cataract surgery. This improves your vision, but you still may need glasses when you drive or read.
Who Should Have Cataract Surgery?
If you have a cataract, that doesn't necessarily mean you need surgery right away. You may not notice any change in your vision at first. Some people who have this condition see just fine if they wear prescription glasses, use a magnifying lens, or rely on brighter lighting.
But as cataracts grow, your vision will worsen. You may start to notice that:
- You have blurred, clouded, or dim vision.
- You have difficulty seeing clearly at night, making it less safe to drive.
- Colors appear faded.
- Your affected eye or eyes become more sensitive to light.
- You have double vision in your affected eye (which may go away as the cataract continues to grow).
- Halos appear around lights.
- Your contact lens or glasses prescription requires frequent changes.
These problems can make it hard to read, work on a computer, and do anything else that calls for clear eyesight. People with advanced cataracts can even fail the vision part of a driver's test. Light sensitivity and the halo effect may keep you from being outdoors as much as you'd like. It also makes it harder to engage in some outdoor sports, such as skiing or golf.
If you have any of these symptoms, cataract surgery may help.
Sometimes, you might need to get surgery even if your cataract doesn't affect your vision. Your doctor may suggest it if the cataract is large enough to crowd the inside of the eye, which can increase pressure in the eye.
You may need to have your cataracts removed so that your eye doctor can examine the back of your eye. This allows your doctor to address other eye conditions, such as diabetic retinopathy or age-related macular degeneration (AMD).
Cataract Surgery Cost
The average cost of cataract surgery is $3,500 for each eye. However, the cost could climb to $7,000, depending on several factors, including:
- The type of intraocular lens you and your doctor select
- The technology used during your surgery. Laser-guided surgery, for example, could add about $1,500 to the cost.
- The surgeon you choose. Some surgeons charge more than others based on factors such as their experience.
- Your location. Depending on where you live and the costs charged by the medical facility where your procedure will take place, you could pay more or less than the average.
- The complexity of your surgery. Your cost will go up if the condition of your eye makes surgery more difficult, requiring additional care.
Paying for cataract surgery
If you are enrolled, Medicare will cover a significant portion of the cataract surgery cost. You should expect to pay about $250-$450 of your own money unless you have a Medicare supplement plan that lowers out-of-pocket costs. Before surgery, you will first take a vision test to prove you need the procedure.
If you are enrolled in Medicaid, check your plan. Coverage for vision care varies from state to state.
Private insurance typically covers cataract surgery. Check your plan both for what’s covered and how much of the cost you’ll be required to pay out of pocket.
Preparation for Cataract Surgery
Preparing for cataract surgery is very important for a smooth procedure and optimal recovery. Here's a breakdown of the key things you need to do:
Pre-op exam: Before surgery, you’ll undergo a thorough eye exam. This will allow your eye doctor to identify any eye problems that could complicate the procedure. During this appointment, your ophthalmologist also will measure your eye to properly fit your intraocular lens. You may be prescribed eye drops to help prevent infection and curb swelling during and after your procedure.
Stop wearing contact lenses: Your doctor will tell you how long before your surgery you need to stop wearing contact lenses. It's usually a few days to a few weeks, depending on what type you wear.
Medications: Your doctor will review the medications you take. They may tell you not to take certain medications on the day of your surgery.
Fasting: Your doctor may tell you not to eat for up to 12 hours before surgery.
Transportation: You'll need to arrange to have someone drive you home after your surgery. Your vision will be blurry and you may feel groggy from the sedative.
Cataract Surgery Procedure
You’ll remain awake during cataract surgery, but you won’t be able to see anything except for light and movement around you. You won’t be able to see what your surgeon does to your eye. Right before the procedure begins, your doctor will use medicated eye drops to numb your eye so that you feel little or no discomfort. You also may be given a sedative to help you relax. This may make you feel groggy. The procedure will last anywhere from 10 minutes to an hour.
The first step of surgery involves removing your clouded lens. The eye doctor will use one of two methods to remove your lens:
Phacoemulsification, or small incision cataract surgery. This is the more commonly done procedure. Your doctor makes a tiny hole in your eye, then inserts a device that uses ultrasound waves to dissolve the hardened center of your lens. After that, a suction device removes the rest of the lens.
Extracapsular surgery. In this procedure, the doctor makes a longer opening on the top of your eye and removes the hardened center of your lens before using a suction device to remove the rest.
Once your lens has been removed, the doctor inserts your IOL into the opening, where it becomes a permanent part of your eye. The openings don’t need to be stitched closed. They will heal on their own.
After your cataract surgery, you’ll be monitored for up to 30 minutes, then you’re free to go home.
If you have cataracts in both eyes, you'll probably get two separate surgeries, typically a few weeks apart. This gives the first eye a chance to heal.
Cataract Surgery Side Effects
Expect your vision to be blurry after surgery, but colors may appear brighter. It will get better in the following days or weeks. You may experience other temporary side effects, including:
- A gritty feeling in your eye
- Bloodshot or red eyes
- Watery eyes
- Sensitivity to light
- Dryness
- Itching or burning
Cataract Surgery Complications
Cataract surgery is the most commonly performed surgical procedure and one of the safest. But like all surgeries, it does have risks, particularly if you have preexisting eye conditions or other health problems. Be sure to discuss your risks with your doctor before surgery. Some of these are:
- Bleeding or swelling in your eye
- Lasting eye pain
- Blurred vision or vision loss
- Glare, halos, shadows, and other visual disturbances
- Your new lens moves out of place
- Retinal detachment
- Clouding of the membrane that holds your new lens in place
- Infection
- Nerve damage
- Drooping eyelid
Cataract Surgery Recovery
Before you head home, you’ll be given eye drops and an eye shield or special glasses to protect your eyes. You also may be told to avoid certain activities such as touching your eye, bending over, and heavy lifting. Your eye doctor will advise you on how long to avoid these things.
Because of your vision changes and possible imbalances between your two eyes, driving can be risky until your eyes adjust. Ask your eye doctor when you can drive safely.
Your eye doctor can tell you when you’ll be able to do other activities, such as:
- Swimming
- Applying eye makeup
- Exercising
- Returning to work
Don't do them until you get your doctor's go-ahead.
The following tips can help with your recovery:
- When you bathe, avoid getting shampoo and soap in your eyes.
- Avoid rubbing your eyes or otherwise putting pressure on them.
- Wear sunglasses when outdoors.
- Wear your eye shield as directed, such as while you sleep.
- Use your eye drops as directed.
A full recovery can take 4-8 weeks. To monitor healing during your recovery, you will see your eye doctor a few times — within a few days after surgery, a week or so later, and again after a month. If you experience any of the following, call your doctor right away:
- Vision loss
- Ongoing pain despite taking pain medication
- Increased redness of your eye
- Swelling of your eyelid
- Light flashes or floaters, which are multiple spots of light in front of your eye
- Mucous discharge or crusting around your eye
While cataract surgery should improve your vision significantly, you likely will need to wear glasses at least sometimes. Your doctor will test your eyesight and give you a new prescription in 1-3 months after your surgery.
Posterior Capsule Opacification
Sometimes after cataract surgery, you may find that things start to look cloudy again. It happens because a lens capsule -- the part of your eye that holds your new artificial lens in place -- begins to thicken up.
You may hear your doctor call this by its medical name: posterior capsule opacification. The problem may not show up right away. You may notice it months or years later.
Your doctor may suggest a procedure called a YAG laser to fix it. This surgery takes a few minutes and is painless. A surgeon uses a laser to open up the thickening around the lens capsule and let more light get through your artificial lens. That will clear up your cloudy vision.
Takeaways
Cataracts cloud your vision and make everyday activities, such as driving, difficult. Surgery to remove them can help you see much better. Though not without risks, the procedure is considered quite safe for most people. Certain eye conditions, however, can make it more complicated and risky. Talk to your eye doctor about whether it’s right for you.
Cataract Surgery FAQs
How long does it take to recover from cataract surgery?
A full recovery takes 4-8 weeks. However, you’ll likely be able to drive and engage in other activities much sooner than that. Your eye doctor will provide the best estimate, based on your circumstances.
How painful is cataract surgery?
Your eye doctor will numb your eye, so you should feel little or no pain during the procedure. You may feel some discomfort after surgery. Over-the-counter painkillers should help.
Is there a downside to cataract surgery?
Cataract surgery can greatly improve your vision, and it’s successful in 97% of people. However, it does come with risks, including vision loss. But that is very rare. Discuss the risks with your doctor.
