Cataract surgery
Your health expert: Professor Simon Taylor, Consultant Ophthalmic Surgeon
Content editor review by Pippa Coulter, Freelance Health Editor, March 2022
Next review due March 2025
Cataract surgery is an operation to remove a cloudy lens (cataract) in your eye and replace it with an artificial one. This will help you to see more clearly. For most people, it’s a very successful procedure that can significantly improve your quality of life.
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About cataract surgery
If you have a cataract, the lens inside your eye becomes cloudy. This can start to affect your vision and interfere with activities such as reading, watching television and driving. Most people eventually need surgery for cataracts. It’s the only way to restore your vision if you have cataracts.
When to have cataract surgery
You can have your cataracts removed at any stage – you don’t necessarily need to wait until your eyesight is bad. If you drive, for example, you may wish to have surgery sooner than someone who doesn’t drive. If you have cataracts that are starting to affect your vision, your optometrist may suggest surgery. They’ll talk to you about what’s involved, and the risks and benefits of surgery. If you decide you’d like to go ahead, they can refer you to an ophthalmologist. An ophthalmologist is a doctor who specialises in eye health, including eye surgery.
If you have cataracts in both eyes, it’s usually best to remove them one at a time, starting with the eye that’s worse. You can have the second operation once you’ve recovered.
Preparing for cataract surgery
You’ll need to go for a pre-operative assessment at an eye clinic before you have cataract surgery. Your healthcare team at the clinic will carry out some tests to examine and measure your eye and check your vision. They’ll use this information to plan which type of artificial lens will be best for you. They’ll also ask about your general health and if you have any other problems with your eyes or vision. This will help to assess your risk of complications after surgery.
Your healthcare team will discuss with you exactly what to expect before, during and after surgery. This will include the potential risks and benefits involved. If you’re unsure about anything, don’t be afraid to ask. If you go ahead with the operation, you’ll need to sign a consent form, so it’s important to make sure you feel fully informed.
Types of lens
Cataract surgery involves replacing the lens in your eye with an artificial one. There are different types of artificial lens you may have. They come in different strengths, just like the lenses in glasses. They also vary in how well they focus on objects at different distances. The main types of lens include the following.
- Monofocal lenses. Most people have these. They’re set at one level of vision – usually on things that are further away. This means you’ll probably need to wear reading glasses to focus on things that are closer up.
- Multifocal lenses. These allow you to see things that are both near and far away without glasses. You can normally only get multifocal lenses through private treatment.
Anaesthesia
Cataract surgery is usually done as a day-case procedure, which means you’ll have the operation and go home on the same day. You won’t be able to drive straight after surgery though, so you’ll need to arrange for someone to take you home.
You’ll usually have cataract surgery using local anaesthetic eye drops. Sometimes, you may have a small injection of local anaesthetic into your eye too. The anaesthetic numbs your eye so you won’t feel any pain, and means you’ll be awake during the procedure. Sometimes, you may be offered a sedative. This will make you drowsy and relaxed during the operation, so you’re not fully aware of what’s happening. Under certain circumstances, you may have a general anaesthetic, which means you’ll be asleep during the operation. But this is less common.
What happens during cataract surgery
Almost all cataract surgery in the UK is done using a technique called phacoemulsification (pronounced fa-co-emul-se-fa-cation). This involves using ultrasound (sound waves) to gently break down the cloudy lens and replacing it with a new, artificial one. This procedure usually takes about 20 to 45 minutes.
You’ll need to lie down and stay as still as possible during your surgery. Your surgeon will put some drops in your eye to widen your pupil and relax your eye muscles. They’ll also put local anaesthetic eye drops into your eye to numb it. Your eye may sting for a few seconds after the anaesthetic.
Your surgeon will place a clean sheet over your face, just leaving it open at the eye you’re having treatment on. They may put a tube under the sheet to blow fresh air around your mouth and nose to make you feel more comfortable. They’ll use a small clip to hold your eyelid open so you don't need to worry about blinking.
Your surgeon will make a tiny cut on the surface of your eye, and a small hole in the part of your eye that holds the lens. They’ll then insert the ultrasound probe and use it to gently break down your lens. Your surgeon will remove the broken lens from your eye and insert your new artificial lens. You’ll be awake and may see some movement and lights during the procedure, but you won’t be able to see anything in detail. You won’t feel any pain but you may feel some touch and pressure.
Your surgeon will usually leave your eye to heal naturally without stitches. They’ll usually cover your eye with a pad or dressing.
How cataract surgery is carried out
Animation | Cataracts | Surgery procedure | Watch in 2:17 mins
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.
This animation shows how surgery is used to correct a cataract.
This operation is called phacoemulsification cataract surgery.
In this animation, we show the different parts of the eye.
A cataract is caused by changes in the lens protein of your eye.
It usually develops over a long period of time.
Most often a cataract is due to the aging process.
Once your ophthalmic surgeon has examined you, drops will be placed in you eye to dilate (widen) your pupil.
This makes it easier for the surgeon to see the lens of your eye.
Local anaesthetic drops will be placed in your eye.
This will completely numb your eye.
Sometimes a local anaesthetic injection is used instead of drops.
A tiny cut is made on the surface of your eye.
The cut or opening is usually so small that no stitches are needed after the operation.
An ultrasound tool is used to break up the lens.
The lens sits in a thin sac of tissue called a lens capsule.
The broken up pieces of lens are removed from the lens capsule through a small tube.
An artificial lens (intraocular lens) is inserted through the cut into the lens capsule.
The lens is folded so that it can pass easily through the tiny opening.
Once inserted, the artificial lens unfolds itself and replaces the old lens.
Your eye will be covered with a dressing to protect it.
You will need to wear the dressing over your eye for a few hours after your operation.
What to expect after cataract surgery
You can usually go home within an hour or so, as long as you’re feeling well enough. Your nurse will give you any medication you need and advice about how to take care of your eye at home. The eye drops used to widen your pupil may cause blurry vision for a few hours after your operation. Ask someone to take you home because you won’t be able to drive yourself.
If you have a dressing, keep it in place overnight to protect your eye. You may be able to remove the dressing yourself the following day but check with your surgeon. The hospital may give you a plastic shield to wear at night, which will prevent you from accidentally rubbing your eyes. They’ll tell you how long you need to wear this for.
Your eye may feel a bit sore at first as the anaesthetic wears off. You can take over-the-counter painkillers to manage this. You’ll usually have antibiotic eye drops to help prevent an infection, and steroid eye drops to help control any swelling in your eye. Follow your surgeon's advice about how often to use your drops. It’s important to complete the whole antibiotic course. You’ll probably need to use them for at least two weeks.
Recovering from cataract surgery
Most people recover quickly from cataract surgery, but you may feel more tired than usual for a few days. Your eye may look red and bruised at first and feel a bit itchy and gritty. This should start to improve after a couple of days. Lights and colours may seem unusually bright at first too. This should also settle down within a day or two. You should feel comfortable reading or watching TV the day after your surgery (although you may need reading glasses).
Within the first week after your operation, your eye should be feeling back to normal, and your vision should start to get better. But it may take a few weeks for your eye to heal completely. If you work, you can go back as soon as you feel ready, depending on what your job involves.
Looking after your eye
There are certain things you should avoid while your eye is healing, especially in the first week or so after surgery. These include:
- touching or rubbing your eye
- getting soap, shampoo or dirty water in your eyes
- heavy lifting, bending and strenuous exercise or contact sports like rugby (gentle exercise is fine)
- wearing eye make-up
- windy or dusty environments – wear an eye shield or glasses to protect your eyes if you’re going out in windy weather
- swimming (even with goggles)
Your surgeon will tell you exactly when you can restart these activities.
Your vision after cataract surgery
Once your eye has healed, you’ll need to have an eye test. This will usually be with your optometrist, around four weeks after your operation. If you’ve had more complex surgery or you’ve developed complications, you may need to have a follow-up appointment at the hospital.
Cataract surgery is usually very effective in making your vision less blurry. But you’re still likely to need glasses afterwards. The artificial lens that’s put in your eye will usually help you to see things further away more clearly. But you may need glasses to improve this even more. You’ll almost definitely need reading glasses too. Some lenses correct both your near and far vision, so that you no longer need to wear any glasses. These are usually only available if you have private treatment.
Driving after cataracts surgery
Most people’s vision will meet the minimum UK driving requirements after cataract surgery. You’ll usually be able to drive within a few days of your cataract operation. But this can depend on many things and will be different for everyone. You should feel fully recovered from your surgery and able to control your car safely before you drive. You may need to wait until you’ve been prescribed glasses at your post-surgery sight test. Contact the Driver and Vehicle Licensing Agency (DVLA) if you’re unsure.
Complications of cataract surgery
Complications are unexpected problems that may happen during or after the surgery. The chance of having serious complications after cataract surgery is low. Most people have a successful procedure and can see well afterwards.
The most common complication after cataract surgery is something called posterior capsule opacification (PCO). This is when your lens capsule, which holds the lens in place, becomes cloudy, similar to having a cataract again. It can happen weeks, months or even years after your cataract surgery. You can have laser treatment to correct this, and the artificial lens won’t need to be replaced.
Other complications of cataract surgery are rare but include:
- a tear in your lens capsule
- problems with the position of the new lens in your eye
- an eye infection
- a detached retina (the thin lining at the back of your eye pulls away from the blood vessels that supply it)
- bleeding inside your eye (suprachoroidal haemorrhage) – this can happen during surgery
- macula oedema (fluid builds up in your retina) – this usually goes away on its own, but it can make your vision blurry
- dysphotopsias – these may be glares, starbursts and haloes or dark areas and shadows – they usually get better with time but occasionally may need treatment
It’s important to be aware of any new or unexpected symptoms after your cataract surgery. For example:
- blurry vision
- other problems with your vision such as flashing lights or floaters
- increased sensitivity to light
- redness
- severe pain
If you develop any of these symptoms, contact the hospital straight away because they could be signs of complications. If you do develop a complication, the sooner you get treatment, the better.
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 or want to have surgery straight away.
If your vision is only slightly affected or not affected at all, your surgeon may recommend putting off surgery for a while. They may suggest you have an eye examination once a year instead. This will monitor both how your cataract develops and any changes in your vision. Your vision will become increasingly cloudy and eventually you may decide to have cataract surgery. Delaying surgery won’t make a difference to the results of your surgery.
You may be offered cataract surgery on the NHS if your cataracts are beginning to affect your daily life. Your optometrist will usually refer you to an NHS eye clinic to have your eyes assessed by an ophthalmologist. They can also refer you to a private ophthalmologist if you prefer.
During your pre-operative assessment, your healthcare team at the hospital will talk to you about how to use your eye drops. Someone you trust may be able to help you if you need it. But if not, your hospital may be able to arrange for a district nurse to visit you at home.
Most people recovery quickly. You’re likely to be feeling back to normal and have clearer vision within a week of your operation. It can take several weeks for your eye to completely heal though. You may need to take particular care of your eye during this time. For more information, see our Recovery section above.
The local anaesthesia drops used to numb your eye during cataract surgery, may sting a little when your surgeon puts them in. You may feel some pressure during the procedure, but you shouldn’t feel any pain. You can take painkillers to manage any pain after the procedure. To find out more, read our section, What happens during cataract surgery above.
Cataracts
Local anaesthesia
Local anaesthesia involves numbing a small part of your body with a medicine called a local anaesthetic
Over-the-counter painkillers
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- Personal communication, Professor Simon Taylor, Consultant Ophthalmic Surgeon, 7 March 2022
