Your surgeon will explain how to prepare for your operation and will discuss your options for the type of artificial lens you can have fitted.
You may have a pre-operative assessment. An ophthalmologist (a doctor who specialises in eye health, including eye surgery) will measure your eye and vision. These tests help to decide which artificial lens will be best for you, so your vision is as good as possible after the surgery. They will also try and establish whether you may be at increased risk of complications after the surgery (see 'Risks' section below).
Cataract surgery is usually done as a day case. This means you have can have the operation and go home the same day.
You will usually have cataract surgery under local anaesthesia so you’ll be awake during the procedure. Anaesthetic eye drops or an injection will be used to completely block pain from your eye and the area around it. You can also have cataract surgery done under general anaesthesia, although this is less common. If you have a general anaesthetic, you will be asleep during the operation.
Your surgeon will discuss with you what will happen before, during and after your procedure, and any pain you might have. This is your opportunity to understand what will happen. You might like to prepare questions to ask about the risks, benefits and any alternatives to the procedure. This will help you to have all the information you need so you can give your consent for the procedure to go ahead. You may be asked to do this by signing a consent form.
Removing the cloudy lens and putting a new lens inside your eye is the only way to restore your vision. Glasses or other visual aids may help you to see better in the short-term but they can’t stop the cloudiness of your lens. So you will eventually need to have surgery to restore your vision.
The operation usually takes around 30 minutes.
Your surgeon will put some drops in your eye to widen your pupil and relax the muscles in your eye. This will make it easier to examine your eye and remove the lens. He or she will also put local anaesthetic eye drops into your eye and place a clean drape over your face. The drape will make a small tent over your face so you can still breathe and speak. Your surgeon will use a small clip to hold your eyelids open so you don't need to worry about blinking at the wrong moment.
Once the anaesthetic has taken effect, your surgeon will make tiny cuts on the surface of your eye. Although your eye is open and you’ll be awake, you won’t be able to see the instruments being used. However, you may see light and some movement. You won’t feel any pain.
The most common way to remove a cataract is with a type of operation called phacoemulsification. Your surgeon will use a special instrument that uses ultrasound (sound waves) to break up the cloudy lens. You may hear a soft buzzing sound when it’s being used. Your surgeon will remove the broken lens from your eye leaving behind the capsule it sits in. They will then put the new artificial lens in, where it will stay permanently.
Your surgeon will usually leave your eye to heal naturally without stitches.
After a local anaesthetic, it may take several hours before the feeling comes back into your eye. Your eye will probably be covered with a protective shield, which you will need to wear overnight.
You might have some discomfort as the anaesthetic wears off but you'll be offered pain relief as you need it. You may be given antibiotic eye drops to use at home to help prevent an infection. You may also be given steroid eye drops to help control any swelling in your eye. It's important to follow your surgeon's advice about how often to put the drops in.
You will usually be able to go home a few hours after your operation, when you feel ready. Make sure someone can take you home. And ask someone to stay with you for a day or so while the anaesthetic wears off.
If you have been prescribed antibiotic eye drops, it’s important to complete the whole course. If you need pain relief, you can take over-the-counter painkillers, such as paracetamol or ibuprofen. Always read the patient information leaflet that comes with your medicine and if you have any questions, ask your pharmacist for advice.
You should start to get some feeling back in your eye after a few hours. Your vision should start to improve within a day or two but it may take a few weeks to heal completely.
There are some important instructions to follow for the first 10 days after cataract surgery, which are listed below.
- Don’t touch or rub your eye. If you’re a restless sleeper, you can wear an eye shield at night to protect your eye.
- Keep soap and shampoo out of your eyes.
- Don’t do any heavy lifting or strenuous exercise for the first few weeks after the operation. This can increase the pressure in your eye and could put strain on your healing scar.
- Don’t wear eye make-up, drive or go swimming until your surgeon tells you it’s safe to do so.
- If you go out when it’s windy, protect your eye from grit and dust.
Seek urgent medical attention if you have symptoms that include:
- severe pain
- loss of vision
- redness in your eye that continues to get worse
These are symptoms of a severe infection and you will need immediate treatment. Your surgeon may have given you information on who to contact in an emergency. If you can’t get in touch with them, go to your local accident and emergency department and tell them you have recently had cataract surgery.
It usually takes about two to six weeks to make a full recovery from cataract surgery. However, this varies from person to person, so it’s important to follow your surgeon’s advice.
Once your eye has healed, you may need to have an eye test and new prescription glasses.
Follow your surgeon's advice on when you can drive again. You will need to be able to read a number plate 20 metres away with both eyes open to be within the legal limits for driving. You might need to wear glasses to be able to do this. You must also meet the minimum eyesight standard for driving. Ask your surgeon or contact the Driver and Vehicle Licensing Agency (DVLA) if you're unsure.
There aren't any restrictions on flying after having cataract surgery so you can go on holiday. Remember to take your eye drops away with you.
As with every procedure, there are some risks associated with cataract surgery. We haven't included the chance of these happening as they are specific to you and differ for every person. Ask your surgeon to explain how these risks apply to you.
Side-effects are the unwanted but mostly temporary effects you may get after having the procedure. Side-effects of cataract surgery include:
- an itchy or sticky eye and blurred vision
- mild pain, discomfort and bruising of your eyelid or eye
- sensitivity to bright light
Complications are when problems occur during or after the operation. Complications of cataract surgery are rare but can include:
- a tear in your lens capsule
- problems with the new lens, such as the wrong type of lens used or problems with its position in your eye
- a severe eye infection
- a detached retina (when the thin lining at the back of your eye pulls away from the blood vessels that supply it)
- bleeding inside your eye (suprachoroidal haemorrhage) – your surgeon may need to stop your operation and you will have it another day
- fluid gathering in small spaces on the retina (cystoid macular oedema)
If any of these complications occur, they may affect your vision and you may need to have another operation. Ask your surgeon to explain the risks to you in detail.
The most common problem you can get after cataract surgery is called posterior capsule opacification (PCO). This is when cells from the removed lens are left behind after surgery and begin to grow back. This causes problems with your vision similar to having a cataract. You can have laser treatment to correct this.
Will I be able to see or feel anything happening during cataract surgery?
The local anaesthesia and eye drops you’re given to relax your eye mean that you will see and feel very little during the operation.
Your surgeon will use eye drops to widen your pupils and relax the muscles in your eye and these cause your vision to blur. This means you probably won’t be able to see clearly through your affected eye. You may vaguely see movement, but won’t be able to make out any of the detail. Your eye that isn’t being operated on will be covered.
Local anaesthesia completely blocks the pain from your eye so you shouldn't feel any pain.
Your surgeon may explain what is happening during the operation, and a nurse may sit with you to make sure you’re comfortable and relaxed.
After cataract surgery, how long will my artificial lens last?
The artificial lens used to treat a cataract is designed to be permanent and shouldn’t need to be replaced.
The artificial lens will be made of silicone or plastic (acrylic polymers). These materials should last for many years. An artificial lens very rarely needs replacing.
One problem that can happen after cataract surgery is posterior capsular opacification. This is when cells from the removed lens are left behind after surgery and begin to grow back. This causes problems with your vision similar to having a cataract. You can have laser treatment to correct the problem so the lens won’t need to be replaced.
What is the difference between the types of lenses used for cataract surgery?
The main difference between the types of artificial lens used in cataract surgery is their ability to focus on objects. Some lenses can help you to see things in the distance, as well as close up.
The artificial lenses used in cataract surgery come in different strengths, in the same way that the lenses in glasses do. The three types of artificial lens used in cataract surgery are explained below.
- Monofocal lens. This is used most often in cataract surgery. These lenses are set at one level of vision, usually only distance vision. This means you will probably need to use reading glasses as well for focusing on things that are close up.
- Multifocal lens. This type of lens allows you to see both near and distant objects.
- Accommodating lens. This changes shape within your eye, in a similar way to the natural lens in your eye. This allows you to focus on both near and distant objects.
- Toric lens. This type of lens can correct an astigmatism.
Some types of lens are only available if you’re being treated privately, rather than through the NHS. Ask your surgeon for more information.
If you have multifocal or accommodating lenses, you’re less likely to need to wear glasses. However, you're more likely to have drawbacks with your vision if you have multifocal lenses. These might include seeing rings around lights (halos) and problems seeing in bright light (glare).
Ask your surgeon about the type of lens that's most suitable for you.
What if I can't use the eye drops after cataract surgery?
Nursing staff at the hospital will show you how to use your eye drops. If you have trouble putting them in yourself, your hospital or GP can arrange for a district nurse to help you at home.
The nursing staff will show you how to use your eye drops before you leave the hospital. You may also be shown how to put eye drops in at your pre-operative assessment. If you would like to practise using drops at home, ask your doctor for some non-medicated ones to have a go with.
Ask your surgeon or nursing staff how often you need to put your eye drops in and for how long.
If you find that you need help to put the eye drops in, ask a friend or relative. If they can’t help, your hospital may arrange for a district nurse to visit you at home. This will be arranged before you leave the hospital, or you can ask your GP.
- Cataracts. BMJ Best Practice. www.bestpractice.bmj.com, published 1 August 2014
- Understanding cataracts. The Royal College of Ophthalmologists. www.rcophth.ac.uk, published January 2013
- Cataracts and cataract surgery. PatientPlus. www.patient.co.uk/patientplus.asp, published 5 November 2012
- Cataract surgery. American Optometric Association. www.aoa.org, accessed 3 December 2014
- Implantation of multifocal (non-accommodative) intraocular lenses during cataract surgery. National Institute for Health and Care Excellence (NICE), June 2008. www.nice.org.uk
- Cataract surgery guidelines. The Royal College of Ophthalmologists. www.rcophth.ac.uk, published September 2010
- Gower EW, Lindsley K, Nanji AA, et al. Perioperative antibiotics for prevention of acute endophthalmitis after cataract surgery. Cochrane Database of Systematic Reviews 2013, Issue 7. doi:10.1002/14651858.CD006364.pub2
- Get well soon: helping you to make a speedy recovery after cataract surgery. Royal College of Surgeons of England. www.rcseng.ac.uk, accessed 3 December 2014
- Senile cataract. Medscape. www.emedicine.medscape.com, published 10 November 2014
- Map of Medicine. Cataract. International View. London: Map of Medicine; 2012 (Issue 3)
- For medical practitioners: at a glance guide to the current medical standards of fitness to drive. Driver and Vehicle Licensing Agency. www.gov.uk, published November 2014
- Cataracts. NICE Clinical Knowledge Summaries. cks.nice.org.uk, published July 2013
- Ong HS, Evans JR, Allan BDS. Accommodative intraocular lens versus standard monofocal intraocular lens implantation in cataract surgery. Cochrane Database of Systematic Reviews 2014, Issue 5. doi:10.1002/14651858.CD009667.pub2
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