Cataract surgery

Expert reviewer, Professor Simon Taylor, Consultant Ophthalmic Surgeon
Next review due July 2020

If you have a cataract, the lens inside your eye becomes cloudy. Cataract surgery is an operation to remove the cloudy lens and replace it with an artificial one. This will help you see more clearly.

Why would I need cataract surgery?

Cataracts make the lens of your eye cloudy. They usually develop slowly over many years. You may not notice any problems with your vision at first. In fact, many cataracts are diagnosed at a routine eye check. But your vision will become affected as your cataract gets worse. If your vision is severely affected, this can interfere with your daily activities, including reading, watching television and driving. Cataract surgery will help you see more clearly again.

You can have your cataracts removed at any stage. You don’t necessarily need to wait until your eyesight is badly affected. The timing of the surgery will depend on your personal circumstances, such as your age and how much your cataract affects your daily life. If you drive, you may wish to have surgery sooner than someone who doesn’t drive at all. If your optometrist thinks you may need cataract surgery, you’ll be referred to an ophthalmologist (a doctor who specialises in eye health, including eye surgery).

If you have cataracts in both eyes, you’ll usually be advised to have them removed one at a time. You’ll probably have the first operation on your eye that's most severely affected by a cataract. You’ll then have the second operation once your surgeon is sure that the first operation was successful.

Preparing for cataract surgery

The ophthalmologist will discuss the pros and cons of having cataract surgery with you. They’ll measure your eye and check your vision with several tests so they can decide which artificial lens will be best for you. They may ask about your general health and if you have any other problems with your eyes or vision. This will help them assess your risk of complications after surgery (see our section: Risks of cataract surgery).

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

You’ll usually have cataract surgery under local anaesthesia. This means you’ll be awake during the procedure but won’t feel any pain. Your surgeon will use anaesthetic eye drops or an injection to completely block pain from your eye and the area around it.

You can have cataract surgery under general anaesthesia, but this is less common. If you have a general anaesthetic, you’ll be asleep during the operation.

Your surgeon will discuss with you what will happen before, during and after your surgery. If you’re unsure about anything, don’t be afraid to ask. No question is too small. It’s important that you feel fully informed so you feel happy to give your consent for the operation to go ahead. You may be asked to do this by signing a consent form.

What are the alternatives to cataract surgery?

If you have a cataract, replacing your cloudy lens with a new one is the only way to restore your vision. But you may not need to have surgery straight away.

If your vision is only slightly affected, or not affected at all, your surgeon may suggest you have an eye examination once a year. This will monitor both how your cataract develops and any changes in your vision. Wearing glasses may help you see better for a short while, but they can’t stop the clouding of your lens from getting worse. Eventually, you’ll need to have surgery to help you see clearly again.

What happens during cataract surgery?

Your surgeon will remove your cloudy lens and then replace it with a new one. You’ll need to be able to lie reasonably flat and still.

Your surgeon will put some drops in your eye to widen your pupil and relax your eye muscles. This will make it easier for them to examine your eye and remove the lens. They’ll also put local anaesthetic eye drops into your eye or inject your eye with a local anaesthetic. Your eye may burn or sting for a few seconds after the anaesthetic, but many people don’t feel anything at all. Your surgeon will place a clean drape (sterile sheet of fabric) 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 eyelid open so you don't need to worry about blinking at the wrong moment.

Once the anaesthetic is working, your surgeon will make tiny cuts on the surface of your eye. You’ll be awake and see some movement, but you won’t be able to see any details. You won’t feel any pain either, but may feel some touch and pressure.

Most surgeons remove a cataract with an operation called phacoemulsification. They’ll use a special instrument that uses ultrasound (sound waves) to break up your cloudy lens. They’ll remove the broken lens from your eye leaving behind the capsule it sat in. Then they’ll put the new artificial lens into the empty capsule, where it will stay permanently.

Your surgeon will usually leave your eye to heal naturally without stitches.

What to expect afterwards

Your surgeon will check on your eye shortly after your surgery. You’ll usually be able to go home within a few hours, as soon as you feel ready. After you’ve had a local anaesthetic, it may take several hours before the feeling comes back into your eye. Make you have someone who can take you home.

If you have a dressing, keep it in place for 24 hours to protect your eye. You may be able to remove any dressing yourself the following day, but check with your surgeon. Your eye will probably also be protected with a plastic shield, which you’ll need to wear at night.

Your eye may feel a bit sore at first as the anaesthetic wears off, but you'll be offered pain relief as you need it. You may be given a course of antibiotic eye drops to use at home to help prevent an infection. It’s important to complete the whole antibiotic course. 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 use the drops. You may need to use them four times a day for up to four weeks.

Recovering from cataract surgery

Your eye may look red and bruised at first. This should disappear after a few days. Your vision should start to get better within a day or two, but your eye may take a few weeks to heal completely.

If you need pain relief, you should be able to take over-the-counter painkillers, such as paracetamol or ibuprofen. But always check this with your surgeon. If over-the-counter painkillers aren’t working, your surgeon may be able to prescribe something stronger. Read the patient information leaflet that comes with your medicine and if you have any questions, ask your pharmacist for advice.

Looking after your eye

To help your recovery, follow these simple tips after your surgery.

  • Don’t touch or rub your eye for a few weeks. If you’re a restless sleeper, you can wear an eye shield at night to protect your eye.
  • Keep soap, shampoo and dirty water out of your eyes.
  • Don’t do any heavy lifting, bending or strenuous exercise for the first few weeks after your surgery.
  • Don’t wear eye make-up, use hair spray, 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.

Signs of infection

You’re very unlikely to develop an infection after cataract surgery. But it’s important to be aware of the symptoms of an infection, just in case you do. These include:

  • severe pain
  • loss of vision
  • blurred vision
  • redness in your eye that keeps getting worse

If you have any of these symptoms, you’ll need immediate antibiotics. 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’ve recently had cataract surgery.

Returning to normal

Most people recover quickly from cataract surgery, but you may feel more tired than usual for a few days. It usually takes about two to six weeks to make a full recovery. This varies from person to person though, so it’s important to follow your surgeon’s advice. You’ll be able to go back to work once you feel ready, depending on what your job involves.

There aren't any restrictions on flying after cataract surgery. But remember to take your eye drops with you when you go away. You can’t go swimming in the first few weeks after your operation. Once your eye has healed, usually four weeks after your surgery, you’ll need to have an eye test. You’ll probably need to wear reading glasses. You may also need to wear glasses for distance vision, even if you didn’t need them before the surgery.

After cataract surgery, most people’s vision will meet the driving requirements of the UK. But follow your surgeon's advice on when you can drive again. You’ll need to have recovered from surgery and be free from pain and sedating medicines. You’ll 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 may need to wear glasses to be able to do this. You must also meet the other minimum eyesight standards for driving. Ask your surgeon or contact the Driver and Vehicle Licensing Agency (DVLA) if you're unsure.

Side-effects of cataract surgery

Side-effects are the unwanted, but often mild and temporary problems you may expect to happen as a result of surgery. Side-effects of cataract surgery include:

  • redness and bruising around your eye or eyelid for a couple of days afterwards
  • raised eye pressure for a few days
  • an itchy or gritty eye and blurred vision
  • mild bruising or a black eye for around a week if you’ve had a local anaesthetic by injection
  • sensitivity to bright light – lights and colours may seem much brighter than usual

Complications of cataract surgery

Complications are unexpected problems that may happen during or after your treatment. Complications of cataract surgery are rare but can include:

  • a tear in your lens capsule
  • problems with the new lens, such as 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’ll have it another day
  • fluid gathering in small spaces on your retina (cystoid macular oedema)

If you do get any of these complications, they may affect your vision and you may need to have another operation. Ask your surgeon about the risks of cataract surgery and how these apply to you.

Around one in 10 people who have cataract surgery develop posterior capsule opacification (PCO) some time later. This is when cells from the removed lens are left behind after surgery and begin to grow back. This causes blurring of your vision, similar to having a cataract again. You can have laser treatment to correct this.

Accessing cataract surgery

You’ll usually be offered cataract surgery on the NHS if your cataracts are beginning to affect your daily life. But there are no national guidelines about when people should and shouldn’t have cataract surgery. Your eligibility will depend on your personal circumstances. It may also depend on where you live or if you have another eye condition such as glaucoma.

Most people with cataracts will need surgery eventually, as cataracts get worse over time. You’ll usually be referred to an NHS eye clinic by your local optometrist, unless you already see a hospital consultant for another eye problem. You’ll need to have your eyes assessed by an ophthalmologist. They’ll discuss with you the pros and cons of having cataract surgery.

If you’re not eligible for NHS surgery, or you don’t want to wait for it, your optometrist can refer you to a private ophthalmologist. If you have private treatment, you may have access to a wider range of lenses than are available on the NHS.

Frequently asked questions

  • Most people have cataract surgery under local anaesthesia. Your surgeon will use anaesthetic eye drops or an injection. You won’t feel any pain but you may feel touch and pressure. You’ll still be able to see bright lights and movement. You won’t be able to make out any of the details though.

    Your surgeon won’t start the operation until they know the anaesthetic has worked. They’ll check your eye to make sure it’s numb. To do this, they may ask you to look in different directions.

  • Your artificial lens is designed to be permanent and shouldn’t need to be replaced. It’s made of silicone or plastic. These materials last for many years.

    Sometimes, after cataract surgery, you can develop posterior capsular opacification. This is when some cells from your natural lens are left behind after surgery and begin to grow back. This causes blurring of your vision, which can seem like your cataract is coming back. You can have laser treatment to correct the problem so the artificial lens won’t need to be replaced.

  • The nursing staff at the hospital will show you how to use your eye drops either after your surgery or beforehand during your pre-operative assessment. Ask your surgeon or nursing staff how often you need to put the drops in and for how long.

    If you think you might have trouble putting in drops, mention it at your pre-operative assessment. It may be that a friend or relative can help you. But if not, your hospital or GP may be able to arrange for a district nurse to visit you at home. If your eye drops are in a plastic bottle, you may also be able to get an eye drop dispenser device through your local pharmacy. Your doctor may be able to prescribe this on the NHS.

  • Artificial lenses come in different strengths, just like the lenses in glasses. They also vary in their ability to focus on objects at different distances. Some lenses can help you to see things both in the distance and close up. Your surgeon can discuss with you the pros and cons of each type to help decide which one’s best for you.

    Monofocal lenses are used most often in cataract surgery, especially on the NHS. These are set at one level of vision, usually distance vision. This means you’ll probably need to wear reading glasses to focus on things that are close up.

    Multifocal lenses allow you to see both near and distant objects without glasses.

    Toric lenses can correct an astigmatism. They may help you see distant objects more clearly. If you have an astigmatism, the curve of your cornea or natural lens isn’t perfectly round. This means light doesn’t bend evenly and objects appear blurry or wavy.

    Accommodating lenses change shape within your eye, in a similar way to the natural lens. This allows you to focus on both near and distant objects without glasses. If you have multifocal lenses, you may notice rings around lights (halos) and problems seeing in bright light (glare). You’ll need to discuss this with your ophthalmologist before your surgery, as these lenses may not be right for you.

    Some types of lens are only available if you’re being treated privately, rather than through the NHS. Ask your surgeon for more information.

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  • Reviewed by Pippa Coulter, Specialist Health Editor, Bupa Health Content Team, July 2017
    Expert reviewer, Professor Simon Taylor, Consultant Ophthalmic Surgeon
    Next review due July 2020

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