Cataract surgery

Expert reviewer, Professor Simon Taylor, Consultant Ophthalmic Surgeon
Next review due October 2022

Cataract surgery is an operation to remove a cloudy lens in your eye and replace it with an artificial one. This will help you see more clearly.

About cataract surgery

If you have a cataract, the lens inside your eye is cloudy. Cataracts usually develop slowly over many years and your vision will start to be affected as your cataract gets worse. Cataracts can eventually interfere with daily activities, such as reading, watching television and driving.

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 your optometrist thinks you may need cataract surgery, they’ll refer you to an ophthalmologist (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 your eye that's most severely affected. You can have the second operation once you’ve recovered.

Preparation for cataract surgery

Your ophthalmologist will discuss the pros and cons of having cataract surgery with you. They’ll measure your eye and check your vision so they can decide which 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 them assess your risk of complications after surgery.

Cataract surgery is usually done as a day-case procedure, which means you 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. Under certain circumstances you can have cataract surgery under general anaesthesia, and be asleep during the operation, but this is less common.

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’re 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.

Cataract surgery

In cataract surgery, your surgeon will remove your cloudy lens and replace it with a new artificial one. If it’s going to be a straightforward procedure, it usually takes about 15 to 30 minutes. Ask your surgeon how long your surgery will be. Although the actual surgery is short, plan to be at the hospital for all or most of the day – your hospital will give you details of what will happen and when.

You’ll need to be able to lie reasonably flat and still during the 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 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 and expose just the eye you’re having treatment on. They may put a tube under the drape 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.

Once the anaesthetic takes effect, 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 in an operation called phacoemulsification. They’ll use an 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. There are different types of lens that your surgeon can fit. For more information, see the FAQ below: Are different lenses used for cataract surgery?

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

Aftercare for cataract surgery

You can usually go home within an hour or so, as soon as you have been given some eye drops and advice about what to do after you leave. After you’ve had a local anaesthetic, it may take several hours before the feeling comes back into your eye. Ask your family or a friend to take you home as 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. Your hospital may give you a plastic shield, which you’ll need to wear at night for the first week.

Your eye may feel a bit sore at first as the anaesthetic wears off and you'll be offered pain relief. You may be given 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. Follow your surgeon's advice about how often to use the drops. You usually need to use them for at least two weeks.

Recovery for cataract surgery

Your eye may look red and bruised at first and feel a bit itchy and gritty, but this should disappear after a couple of days. Lights and colours may seem unusually bright too. 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 check with your surgeon. Read the patient information leaflet that comes with your medicine and if you have any questions, ask a pharmacist for advice.

Looking after your eye

To help your eye recover after your surgery:

  • try not to touch or rub your eye for a few weeks – 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
  • don’t wear eye make-up, use hair spray or drive 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 – wear an eye shield or glasses
  • don’t go swimming for a couple of weeks after your operation (even if you wear goggles) – it’s best to get the all-clear from your surgeon first at your check-up appointment

Once you get home after your surgery, your eye will be a bit sore and watery so it might not feel comfortable to read or watch TV. But you should be fine to do these the next day.

Signs of infection

You’re very unlikely to develop an infection after cataract surgery but it’s important to be aware of the symptoms in case. 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 antibiotics immediately. 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. You’ll need to go to hospital for antibiotics rather than your GP as they’ll need to inject them.

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, but this varies from person to person so follow your surgeon’s advice. You can go back to work once you feel ready, depending on what your job involves.

If you need to travel by air, you can do so 24 hours after your operation, but check with your surgeon before you make any plans. Remember to take your eye drops with you when you go away.

Once your eye has healed, you’ll need to have an eye test (usually six weeks after your operation). You’ll probably need to wear reading glasses and possibly glasses for distance vision, even if you didn’t need them before the surgery. Some lenses correct both your distance and up-close vision, so that you no longer need to wear any glasses, but these are only available if you have private treatment. For more information, see the FAQ below: Are different lenses used for cataract surgery?

After cataract surgery, most people’s vision will meet the UK driving requirements so are able to drive soon after their cataract operation. But this can depend on things like your glasses prescription so ask your surgeon's advice on when you can drive again. 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
  • an itchy or gritty eye
  • mild bruising or a black eye for around a week
  • 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
  • an 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)
  • seeing a small arc of light (positive dysphotopsia), or darkness (negative dysphotopsia), which both usually get better with time but occasionally may need treatment

If you 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 four in 10 people who have cataract surgery develop posterior capsule opacification (PCO) weeks, months or even years after. This is when your lens capsule, which holds the lens implant in place, becomes cloudy, similar to having a cataract again. You can have laser treatment to correct this and the artificial lens won’t need to be replaced. It’s a straightforward procedure that you can have and go home the same day.

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. Your local optometrist will usually refer you to an NHS eye clinic, unless you already see a hospital consultant for another eye problem. You’ll need to have your eyes assessed by an ophthalmologist.

If you wish to have private treatment, your optometrist can refer you to see a private ophthalmologist. You may then have access to a wider range of lenses than are available on the NHS.

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 straightaway.

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 cataract surgery to help you see clearly again.

Frequently asked questions

  • The nursing staff at the hospital will talk you through how to use your eye drops 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 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. If you have these, 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.
    • Toric lenses can correct an astigmatism, which 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 distorted.
    • 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.

    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 Rachael Mayfield-Blake, Freelance Health Editor, October 2019
    Expert reviewer, Professor Simon Taylor, Consultant Ophthalmic Surgeon
    Next review due October 2022