Cataract Surgery: What to Expect and Before, During, & Post Surgery

Everything you need to know about Cataract Surgery and recovery!

A cataract is an eye disease that causes the lens of your eye to become cloudy and affect your vision. Cataract surgery is a common procedure. It can take anywhere from 15 minutes to one hour or more to complete, depending on the complexity of your individual case. During cataract surgery, the clouded lens of your eye (the cataract) is removed and replaced with an artificial lens. The artificial lens can be implanted at the time of surgery or placed inside your eye (intraocular lens). Your eye may need to be dilated (expanded) during surgery to give the doctor room to work.

Visual disturbances such as blurriness, double vision and glare from bright lights can often be improved after cataract surgery. Cataract surgery offers more than improved sight. It also improves quality of life because it is the first and only surgical procedure to truly address the loss of vision due to cataract. Cataracts and cataract surgery are common. In fact, one in four Americans over the age of 40 has a cataract. Your doctor will probably recommend cataract surgery if you have already had vision problems caused by a cataract or if you are at high risk for future vision loss due to a cataract. A cataract can occur at any age but is more common as you get older.

 Reasons you may start to develop cataract:

  1. Drinking too much alcohol. 
  2. Diabetes. 
  3. High blood pressure  
  4. Family history of members with cataracts
  5. Staying under the sun
  6. Smoking
  7. Obesity
  8. Previous eye inflammation

Why is cataract surgery considered?

Allowing you to see in color again, cataract surgery is one of the most common and successful procedures. It is also one of the simplest, safest and least invasive of all surgeries. In fact, vision-correcting procedures, such as cataract surgery or LASIK eye surgery are performed all over the world on a daily basis to help patients regain their vision.

If your cataract is interfering with the treatment of another eye problem, you may benefit from cataract surgery. For example, if you have eye inflammation caused by age-related macular degeneration (AMD), a cataract may make it difficult for your eye doctor to see inside your eye to monitor AMD or treat it. Cataracts also can interfere with the vision correction provided by clear or multifocal contact lenses.The result of cataract surgery is often clearer vision, without glasses or contact lenses. That's why it's also called clear lens replacement surgery.

     You may not need cataract surgery immediately. In fact, delaying it for a year or two may give you more time to adjust to the idea and make a more informed decision. Doctors call this the “hurdle effect”—when we take a leap we have to get over hurdles. Holding off on making this decision for another year or two makes sense, since in that time your odds of having surgery will still be very good.

        The best time to have cataracts removed is when they are still relatively small, so that the length of surgery can be kept to a minimum.

Possible Risks involved

Cataract surgery is a common and very safe procedure. For most people, the benefits of successful surgery outweigh the risks. Possible risks include:

  1. Bleeding
  2. Retinal detachment
  3. Infection including endophthalmitis
  4. Glaucoma
  5. Macular hole formation
  6. Inflammation
  7. Dry eyes
  8. Increased eye pressure
  9. Corneal specification which may affect your ability to read
  10. Drooping eyelid

   Cataract surgery, performed by an eye surgeon, can improve your vision by removing cloudiness from the eye caused by a damaged or weakened lens. While cataract surgery is very safe and effective, all surgeries have risks and potential complications that you should discuss with your eye surgeon prior to your procedure. If you are considering cataract surgery to improve your vision, it is smart to find out the other eye health issues that may be affecting your vision from another professional.

How do I prepare for cataract surgery?

In preparation for surgery, your doctor may ask you not to eat or drink anything for 12 hours before the surgery. This will help avoid vomiting during surgery and ensure a good fit for your lens. A group of medications called anti-inflammatories—including one known as ibuprofen (e.g., Advil) and another known as a prostaglandin—help decrease the amount of eye inflammation, swelling, and excess fluid that can interfere with complete cataract removal. Your doctor may recommend taking these drugs orally to help reduce eye inflammation before surgery, or using them in the form of eye drops during surgery, if necessary. It must be taken 3 hours before the surgery.

Before the surgery: your doctor performs a painless ultrasound test to measure the shape and size of your eye. Using the results of the ultrasound test, your doctor selects an Intraocular lens (IOL) that is precisely matched to your eye. An IOL is like a tiny telescope that is implanted during cataract surgery and restores your vision so you can see clearly again. Talk to your surgeon about what kind of IOL will be right for you. The doctor might use a monofocal lens implant if you want to maintain flexibility in your focusing abilities. If you're more concerned with stable vision throughout your everyday life, your doctor might recommend a multifocal implant instead. Monofocal lenses provide better distance and near vision but not intermediate vision.  Multifocal lenses give you distance, intermediate, and near vision and are better for night driving.

You should include toric contact lenses in your treatment plan when you have astigmatism. These lenses are designed to correct the visual distortion that results from an irregularly shaped cornea.

Related article: Presbyopia - What Is It and When Did You Get It

What happens during the surgery?

Most people are awake during cataract surgery because they are given a sedative to relax. You may be given a stronger sedative called a general anesthetic if you need surgery on both eyes or the first eye is more complicated.

The surgery may take one hour or less, depending on the type of procedure. Your doctor will give you a prescription eye drop medication to numb your eye or maybe sedative to help you relax. The drops are safe and effective. They make it easier for your doctor to do the procedure without causing any discomfort. Soft contact lenses may also be placed in the eye to ensure that eye pressure and oxygen levels remain normal.

You have two surgical options to restore your vision, each with its own benefits and risks.

  • Phacoemulsification procedure: Your surgeon creates a small incision in your cornea by hand with a scalpel to get into the space behind your natural lens (capsular bag). After the area behind the lens has been cleaned, a precision tool is inserted through the opening behind the pupil, where the lens of the eye sits. Another tool creates a circular opening in the lens, and then, a probe uses ultrasound waves to break up the nucleus of the natural lens into small pieces which is then suctioned out. The center part of the natural lens capsule remains intact to provide a secure place for the clear vision lens to rest. The new synthetic lens is then gently placed in front of the iris so that patient's vision can return to normal.

* Stitches may be placed to close the tiny incision in the center of your cornea.  The stitches will dissolve over time.*

  • Extracapsular cataract extraction: The extracapsular lens extraction procedure involves making an incision larger than that made during a phacoemulsification cataract surgery. Surgical tools are used to remove the front capsule of the lens, where most of the cloudiness originates. During this procedure, they will use surgical tools to remove the front portion of the cloudy lens, while keeping more than 90 percent of your existing lens capsule intact. The very back portion of your original lens is left behind to serve as a place for your new intraocular lens implant to rest. With the larger incisions, stitches are required.

These are the main surgical procedures to correct cataract issues, however Laser-assisted Cataract Surgery; the newest surgical procedure, uses newer technology to improve certain parts of cataract surgery, although its very expensive and may not be covered by insurance. It's very effective in patients with astigmatism and as it corrects refractive errors by reshaping the cornea with the lasers.

Laser-assisted and Phacoemulsification surgery have all most equal and similar healing times so the Laser-assisted is not primarily used as there is no other special benefit it provides other than that of astigmatism patients.

After The Surgery

The first 24 hours after cataract surgery will probably be the most difficult for you. You may require intensive eye care so that you do not put your eyes at risk of infection, injury or swelling. Immediately after surgery, an ophthalmologist or optometrist will prescribe eye drops or other medication to prevent infection and control eye moisture and pressure, test your vision and dilate your pupils to keep them open for several minutes.

The first few days after cataract surgery, you may notice that colors look brighter and more vivid than before your surgery. Colors can also look different because you are no longer looking through a yellow or brown-tinted lens but through a new one. Your eye is also healing and adjusting to the new lens in your eye. Seeing colors in a new way can be disconcerting at first, but it is part of the normal recovery process. Minor pain is normal but contact the clinic if any sharp pains are felt.

You may experience sensitivity to light and swelling, red and bloodshot eyes, bruising due to the anesthesia injection you might have received, all these should fade and dissipate within a few days. Other side effects include burning, small amounts of discharge, itching, feeling like something is in your eye and blurry vision, all these should decrease as days go by, if not so, talk to your doctor.

Avoid rubbing or any contact with your eye. That's why your doctor may recommend an eye patch or protective shield for some days after surgery to help protect your eyes against dust, external contact, etc that could affect the eyes during this sensitive time.

Exercises, working, driving, and every other activity that could strain your eye should be avoided immediately after the surgery and going.

If you have cataracts in both eyes, your doctor will most likely recommend the second surgery for the other eye after about two weeks. Majority of people who undergo these surgeries live wonderful lives successfully.

Contact your doctor immediately if any of these symptoms persist after speculated weeks of cessation:

* Increased eye redness.

* Swelling of the eyelid.

* Light flashes or floaters(multiple new spots) in front of your eye.

* Vision loss.

* Nausea or excessive coughing.

* Pain that still persists despite the use of over- the -counter painkillers.

Tips for Post-cataract surgery (recovery)

These are certain precautions that should be taken seriously for a safe and fast recovery after 24 hours of your surgery, these are:

  1. Don't drive on the first day of the surgery. Someone should drive you home immediately after the surgery.
  2. Try not to sneeze or vomit right after surgery.
  3. As stated above, avoid rubbing your eyes.
  4. Take your doctor's medications, instructions seriously. Avoid walking around or bending over.
  5. Try to get plenty of rest.
  6. Drink plenty of water during your weeks of recovery.
  7. Don't drive for at least 10 days after your cataract surgery.
  8. Don't do strenuous or heavy activities for a few weeks.
  9. Don't swim to avoid risk of infection.
  10. Avoid dusty areas as well as areas that accommodate dirt, wind etc.
  11. Wearing of make-ups should be avoided during this period.
  12. If you stay on top of pain medications, take large doses of Vitamin C every day.
  13. Don't hold back blunt force trauma to your eye.

What if I my vision get cloudy again?

Developing cataracts after surgery isn't an uncommon occurrence. In fact, as many as 5 percent of patients who've undergone cataract surgery have posterior capsule opacification (PCO). This is accurately treated with laser surgery.

PCO can occur at any age, but most often occurs among those who are new to intraocular contact lenses, those with poor hygiene or foreign body retention in their eyes, and those who have an abnormally high number of microorganisms or inflammatory cells in their eyes (cyclitis). As the name implies, posterior capsular opacification occurs when the back of the lens capsule — a modified layer of iris muscle cells that remains after cataract surgery — becomes cloudy and impairs vision.

PCO is treated with a painless out-patient procedure called yttrium-aluminum-garnet (YAG) laser capsulotomy. YAG laser capsulotomy uses a less invasive procedure to open the clouded lens capsule. This procedure involves the use of a laser beam to create a small opening into the lens capsule so light can enter more easily. That will clear up your vision.


In summary, a vast majority of cases of cataract or post-cataract surgery have positive outcomes when performed by an experienced and qualified surgeon. In today’s world of advanced surgical techniques, there is now rarely any need to be hesitant about choosing cataract or post-cataract surgery. Your eye care professional will be able to discuss the entire procedure thoroughly with you and make you feel much more at ease with this essential decision regarding your eyesight.

Everything Eyewear to Eyecare. 

We've Got your back! 
Spinoza Team.


Related article: Presbyopia - What Is It and When Did You Get It