Cataract surgery

Published by Bupa’s Health Information Team, December 2010.

This factsheet is for people who are having cataract surgery, or who would like information about it.

Cataract surgery involves removing the natural lens inside the eye and replacing it with a lens made of a clear artificial material, such as plastic or silicone.

You will meet the surgeon carrying out your procedure to discuss your care. It may differ from what is described here as it will be designed to meet your individual needs.

Animation - How cataract surgery is carried out

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About cataract surgery

A cataract is a painless clouding of the lens inside your eye. Cataracts usually develop over a long period of time, causing eyesight to gradually get worse. If left untreated, the lens will eventually become so clouded that it’s impossible to see any detail at all, although you will always be able to see some light.

Removing the cloudy lens and putting a new lens inside your eye is the only way to improve or restore your vision. Cataracts are usually removed using a technique called phacoemulsification.

The most common type of artificial lens used is a monofocal lens (a lens that can only focus at one distance) but other lenses are available that can focus on both near and distant objects. Your surgeon will discuss with you which type of lens is most suitable for you.

Cataracts can occur in one or both eyes. Very rarely, both eyes are treated at the same time. If you have cataracts in both eyes, you will usually have to wait until you have made a full recovery from surgery on your first eye before treating your other eye. This is usually about two months.

What are the alternatives?

So far, no medication or diet has been found to slow down the growth of cataracts and there is no medication that can clear a clouded lens. Removing the cloudy lens and putting a new lens inside your eye is the only way to improve or restore your vision. 

Preparing for cataract surgery

Your surgeon will explain how to prepare for your operation. He or she will also discuss your options for the type of artificial lens you will have fitted.

Cataract surgery is usually done as a day case. This means you have the procedure and go home the same day.

The operation is usually under local anaesthesia. This completely blocks the pain from the eye area and you will stay awake during the procedure. The local anaesthetic is usually given in the form of eye drops but sometimes it is given as an injection. You may also be offered a sedative. This relieves anxiety and helps you to relax during the procedure.

Less commonly, cataract surgery is done under general anaesthesia. This means you will be asleep during the operation.

At the hospital, your nurse will explain how you will be cared for during your stay. Your nurse may check your heart rate and blood pressure.

Your nurse will place drops in your eye to widen (dilate) your pupil and relax the muscles in your eye. This makes it easier for your surgeon to examine your eye and remove the lens.

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, and you can help yourself by preparing questions to ask about the risks, benefits and any alternatives to the procedure. This will help you to be informed, so you can give your consent for the procedure to go ahead, which you may be asked to do by signing a consent form.

What happens during cataract surgery

The operation usually takes between 15 and 20 minutes.

Your surgeon will ask you to lie back in a reclining chair (like a dentist’s chair). He or she will 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 easily.

Once the anaesthetic has taken effect, your surgeon will make a tiny cut on the surface of your eye. You won’t be able to see out of your eye as its being treated, but you may be aware of light and movement.

Your surgeon will put some fluid into your eye and use ultrasound to break up the cloudy lens. You may hear a soft buzzing sound as the sensor releases sound waves to break up the lens. Your surgeon will remove the broken lens from your eye. You may feel the fluid that is put into your eye trickle into a bag that is part of the drape at the side of your face.

Your natural lens sits inside a sac of thin tissue called a capsule. The cloudy lens is broken up and removed but the capsule is left in place so it can hold the artificial lens.

Your surgeon will put a folded artificial lens into your eye (keeping it folded makes it easier to get through the cut). The artificial lens will unfold when it’s inside your eye. The lens is made from a clear plastic or silicone and is left permanently in your eye.

Your surgeon will usually leave the cut to heal naturally. Sometimes, a single stitch is used to close the cut.

What to expect afterwards

After a local anaesthetic, it may take several hours before the feeling comes back into the treated eye. Your eye is likely to be covered with a protective pad, which you will need to wear for a few hours.

You may need pain relief to help with any discomfort as the anaesthetic wears off. 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 prevent swelling and inflammation.

You will usually be able to go home when you feel ready.

You will need to arrange for someone to drive you home. Try to have a friend or relative stay with you for the first 24 hours.

Your nurse will give you some advice about caring for your eye before you go home. You may be given a date for a follow-up appointment.

If you remove the protective pad before you leave the hospital, it may be helpful to wear sunglasses or a hat as your eye may be sensitive to light.

Recovering from cataract surgery

If you have been prescribed antibiotics, 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 that comes with your medicine and if you have any questions, ask your pharmacist for advice.

Sensation usually returns to the eye within a few hours. Your vision should improve within a few days and you should be able to return to your usual activities.

There are some important things to remember while recovering from cataract surgery.

• Don’t touch or rub your eye.
• Keep soap and shampoo out of your eyes. It’s sensible not to wash your hair for the first few days.
• Don’t do any heavy lifting or strenuous exercise for the first few weeks after the operation, as this can increase the pressure in your eye and could put strain on your healing scar.
• Don’t wear eye make-up for at least six weeks.
• Don’t do any swimming for at least six weeks.

Contact your doctor for advice if you have any of the following symptoms:

• a fever – a temperature higher than 37.5 C
• severe pain or pain that lasts for more than 48 hours
• loss of vision
• increasing redness of your eye

It usually takes about two to six weeks to make a full recovery from cataract surgery, but this varies between individuals, so it’s important to follow your surgeon’s advice.

If a stitch is used to close the cut in your eye, depending on what type you have, it may need to be removed by your surgeon six weeks later. This can be done very easily after putting anaesthetic drops in your eye.

Once your eye has healed, you will need to have an eye test and new prescription glasses.

What are the risks?

As with every procedure, there are some risks associated with cataract surgery. We have not 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

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
• aching of the eye
• bruising of the eyelid or eye

Complications

Complications are when problems occur during or after the operation.

The most common complication of cataract surgery is called posterior capsule opacification (PCO). It is caused by lens cells left behind after surgery and is essentially a wound-healing response of the lens to surgery. Over time, the cells grow and cause the capsule to thicken. This results in reduced vision similar to a cataract and can be corrected with laser treatment.

Other complications of cataract surgery are rare but can include:

• eye infection – this is probably one of the most serious complications but is quite rare and usually happens within the first week or two after surgery
• a tear in the capsule
• a piece of broken lens moving into the back of the eye
• bleeding inside the eye
• artificial lens becoming loose
• loss of vision because of damage to the retina (the light-sensitive lining at the back of your eye) – this is usually permanent
• disturbances in your vision such as halos, flare and glare

If any of these complications occur, you may need to have a repeat operation.

For answers to frequently asked questions on this topic, see Common questions.

For sources and links to further information, see Resources.