Guide to Cataract Surgery - Prevent Blindness
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Guide to Cataract Surgery
According to the Prevent Blindness report, Future of
Vision, more than 29 million Americans age 40 and older
have cataract. By age 80, more than half of all Americans
will have cataract. In 2017, 3.8 million cataract surgeries
were performed in the United States. Cataract surgeries
are performed without complication in 98% of cases.
What is a cataract?
A cataract is when your eye’s
natural lens becomes cloudy
leading to blurry vision. At first, Macula
225 West Wacker Drive you may not notice that you have a Cornea
Suite 400
Chicago, Illinois 60606 cataract. But over time, cataracts Lens
800.331.2020 can make your vision blurry, hazy,
PreventBlindness.org Optic Nerve
or colors may appear to be faded.
You may have trouble reading or Retina
doing other everyday activities.
Cataracts can occur in one eye
or both eyes.
Who will get a cataract? • Various diseases, such
Most people experience cataracts as diabetes, arthritis,
as a part of aging. There are other or metabolic disorders
risk factors to develop a cataract: • Smoking
• Eye infections • Family history of cataract
• Some medicines (such • Nearsightedness (also
as long-term steroid use, called myopia)
cancer medication) • Infection or inflammation
• Eye injuries during pregnancy (such as
• Exposure to intense heat measles or rubella)
or radiation
• Too much exposure to What are the types of cataract?
non-visible sunlight (called Age-related – 95% of cataract are
UV or ultraviolet light) age-related, usually after age 40.
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Guide to Cataract Surgery
(continued)
Congenital – These are present at as bright as they used to be. Or you
birth, usually caused by infection may have to change your eyeglass
or inflammation during pregnancy; prescription often.
possibly inherited. To find out if you have cataract,
Traumatic – Lens damage from a your eye doctor will want to:
hard blow, cut, puncture, intense • ask about your general
heat or chemical burn may cause medical history
Normal Vision cataract.
• ask about your specific eye
Secondary – Some medicines, history, including problems
eye disease, eye infection, or and symptoms
diseases such as diabetes cause
this cataract. • test your vision (visual acuity)
Cataracts are also named by the • test your side vision
location in the lens: (peripheral vision)
• Nuclear cataract: This cataract • test your eye movement
is located in the center of the • test you for glaucoma (by
Cataract Simulation lens. It can darken with age, measuring the eye’s
changing from clear to yellow internal pressure)
and sometimes brown. • do a microscopic exam of the
• Cortical cataract: This front of the eye (using a device
cataract affects the layer of called a slit lamp) to assess
the lens around the nucleus. It the thickness of the cataract
looks like a wedge or a spoke. and how it interferes with light
• Posterior capsular cataract: passing through the lens
This cataract is found in the • widen (dilate) the pupils of your
back of the lens. This type often eyes to examine the retina,
develops more rapidly. the optic nerve (which carries
visual messages from the retina
to the brain) and the macula
How can the eye doctor tell if (responsible for the best part
I have cataract? of central vision)
Everyone who gets cataract • test you to see how glare
experiences it differently. But a affects your vision
person with cataract commonly
experiences cloudy or blurry vision.
Lights may cause a glare, seem too Should I have cataract surgery?
dim or seem too bright. It may be You must decide whether to have
hard to read or drive, especially at cataract surgery. Cataracts will
night. If you have cataract, you may not cause large vision changes
see halos around lights, such as for some people. A cataract at
car headlights, that make it hard to the outer edge of your lens, for
focus clearly. Colors may not seem example, may hardly affect your
Prevent Blindness 2
Guide to Cataract Surgery
(continued)
vision. A cataract at the center of What kind of lens will replace my
your lens, however, may greatly cataract lens?
affect your sight. Only you can When the eye surgeon removes
decide if a change in your vision the lens with the cataract, you will
keeps you from doing all the things need something to replace it, so
you want or need to do. A cataract that you can focus and see clearly.
may also impede your eye doctor Intraocular lenses (IOLs) replace
from treating you for other vision your cataract, or cloudy lens. IOLs
diseases. If a cataract keeps have become the most popular
your eye doctor from viewing choice for replacing lenses with
the inside of your eye, he or cataract. The eye surgeon implants
she may suggest surgery. the IOL in about the same place as
your natural lens, so that it results
When should I wait to have in the most natural vision. The eye
cataract surgery? surgeon can decide to correct your
vision with an IOL to be able to
An eye care professional may not
see at a distance for driving a car
recommend cataract surgery if:
or playing golf. However, you may
• cataract has not affected your need glasses for near vision.
lifestyle or kept you from doing
all the things you want and
need to do Types of IOLs
• your vision will not improve • Monofocal IOL: This IOL is
with surgery because of other most commonly used. It is
eye problems usually used to correct for
distance vision. Using this IOL
• your glasses or contact lenses
option means that you will likely
can provide satisfactory vision
still use glasses for close vision.
• you are not well enough/fit
• Multifocal IOL: These IOLs
enough for the surgery
provide both distance and near
• you do not want surgery correction at the same time.
• Accommodative IOL: These
What if I have cataracts in lenses move or change shape
both eyes? inside your eye, allowing
correct vision at different
If you have cataracts in both eyes,
distances.
your eye surgeon will suggest
having your cataract removed in • Toric IOL: This lens is used if
one eye first and the second eye you have astigmatism.
at a later date. IOLs are the best option to replace
your own lenses. However, if
you have certain eye diseases or
problems, you may not be able to
Prevent Blindness 3
Guide to Cataract Surgery
(continued)
have lens implants. You and your Here are some points you
eye doctor will need to discuss may want to bring up with
whether any restrictions apply. your doctor.
Check the questions you’d like your
Choosing an eye surgeon eye doctor to answer during your
next appointment or conversation.
Once you decide to have cataract
surgery, you’ll need to choose ❏ Do I really need surgery?
an eye surgeon to perform What will I gain by having it?
the operation. Some things to ❏ What are the risks?
keep in mind are the surgeon’s ❏ What is surgery like? Will it
experience and skill, how easy it hurt? What will I see?
is to talk to him or her and have
your questions answered, and ❏ Will any other health issues I
your previous experience with may have-such as glaucoma or
this eye doctor, if any. If you have diabetes- affect my cataract or
insurance coverage, you will want my surgery?
to find out if the surgeon accepts ❏ How long will I need to recover
it. Referrals including from your from the surgery?
optometrist may help you choose ❏ Will I need glasses after
an eye surgeon. Ask friends who surgery? If I wear contacts,
have had cataract surgery or can I wear them again after
contact a university with a medical surgery?
school or a hospital for names and
references. ❏ Are there some things I won’t
be able to do after surgery? If
If an eye doctor has recommended so, for how long?
surgery, you may want to get
a second opinion. Make an ❏ Will someone have to take
appointment to see an eye doctor care of me after surgery? If so,
who does not work with, and was for how long?
not referred by, your regular doctor. ❏ Will the medicines I take for
You do not have to tell this doctor other illnesses interfere with
that someone else has already surgery or my recovery?
recommended surgery—let this ❏ How experienced is the
doctor come to his or her own doctor? Is he or she board
conclusions about whether you certified?
need cataract surgery.
❏ Does the doctor’s office
accept my insurance
coverage? Will I have a co-pay
amount?
❏ Is a payment plan available?
Prevent Blindness 4
Guide to Cataract Surgery
(continued)
Cost of surgery surgery. If you take medicines or
Basic charges you can expect for have diabetes, ask your doctor
cataract surgery include fees for whether different guidelines apply.
the hospital/surgical center, the Removing the cataract and inserting
doctor, the anesthesiologist, basic an intraocular lens usually takes the
tests before surgery, medicine surgeon ten to fifteen minutes. The
after surgery and follow-up visits entire process, from arriving at the
with your doctor. Ask your doctor’s hospital or surgical center to going
office and your insurance company home, takes about half a day. Less
to estimate each of the costs. You than 1% of surgeries require an
will likely need new glasses (or less overnight hospital stay.
likely contact lenses) after surgery. On the day of your surgery, you will
If you have private health insurance be given some eye drops to widen
or Medicare, it will usually pay for a (dilate) your pupils. You may also
part of or most of the surgery cost. be given a mild sedative to help
Try to find out what your health you relax. A healthcare worker will
insurance will cover before the take you into the operating room
surgery. Ask your doctor about his where an anesthesiologist or nurse
or her billing and payment methods. anesthetist will give you a local or
Newer “trifocal,” “multifocal,” or an intravenous anesthetic. He or
“astigmatism-correcting (toric)” she will monitor your condition.
IOLs are not usually covered by You will not feel the surgery
insurance, requiring you to pay out- because the topical or local
of-pocket if you wish to choose one anesthetic numbs your eye during
of these options. the operation. You may see some
Some hospitals and surgical lights or vague shapes, but that is
centers may be able to help all. Your surgeon will use a special
you with financial planning. This microscope, which magnifies
may include putting together a and illuminates the area of the
payment plan or filing claims to procedure as he or she removes
your insurance company. Filling out your cataract.
insurance forms can be hard and You may not remember much about
take a lot of time—so be sure to ask the operation after it is over. You
questions ahead of time. may feel a little drowsy afterward,
but as the sedative wears off, you
Getting ready for surgery will be encouraged to walk around
a bit. Your doctor will monitor your
Because you will be given some condition for a while, explain how
form of anesthesia during the to care for your eye at home and
surgery, your doctor will probably schedule a follow-up appointment.
ask you not to eat or drink anything Have a family member, friend,
after midnight the day before your or caregiver help you on the day
Prevent Blindness 5Guide to Cataract Surgery
(continued)
of the surgery and to assist in surgeon uses sound waves (an or she may then implant the IOL
remembering the after-surgery ultrasonic device) to break the lens in front of the iris where its loops
instructions. into small pieces, and then suctions hold it in place. Another option is
Once you’re fully recovered, you the tiny pieces out through the to suture the IOL to the wall of the
will be allowed to go home. It is a same incision. Next, the doctor will eye. This latter option enables the
good idea to have a friend, relative, insert the lens into the capsular IOL to be placed behind the iris.
or caregiver drive you, and some bag, which is the original location
surgery centers will require that of the lens. Most IOLs are foldable,
so they can be inserted through the Possible complications
you have a ride and someone from surgery
accompany you. You may feel tired same small incision.
after surgery, so try to relax the rest The lens usually unfolds slowly Less than 2% of patients
of the day. once it is placed into the capsular experience complications from
bag. The incision can be closed cataract surgery, but you should
At home, you should not discuss possible problems with
experience much discomfort. with either one stitch, or usually
none at all. your doctor. Here are three areas
Some people describe the feeling of complications:
as having an eyelash in their eye— Phacoemulsification, with
slightly uncomfortable and itchy its smaller incision, offers the Problems during surgery, called
but not painful. You will apply eye fastest healing and recovery time, operative complications, such as
drops or ointment as your doctor produces little discomfort, and severe bleeding, happen to less
prescribes, and you will learn to reduces the chance of uneven than 1% of patients. Up to 2% of
rely on your untreated eye during focus (astigmatism) or distorted patients lose the gel-like substance
this time. vision. that fills the inside of the eye
(vitreous humor) during surgery.
Extracapsular and Intracapsular Complication rates may be higher
Three kinds of cataract removal Much less common in the U.S. are if you have certain medical or
the extracapsular and intracapsular ocular diseases.
During the cataract operation, procedures. An extracapsular
your surgeon will first remove the cataract extraction may be needed Problems soon after surgery,
clouded lens. (If you are able to if your lens is too hard to break called early post-operative
have a lens implant, your doctor will apart. The extracapsular procedure complications, can include leaking
perform this procedure right after removes only the inside of the lens from the wound, bleeding or
removing your cataract lens.) There but leaves the capsular bag that infections.
are three methods for removing the holds the lens in place. Leaving the Problems after healing, called
clouded lens: capsular bag adds to the structural late post-operative complications,
• Phacoemulsification strength of the eye and promotes include retinal detachment (this
(fei·kuh·uh·muhl·suh·fuh·kei·shn) easier healing. requires surgery to correct),
• Extracapsular (ex·tra·cap·su·lar) During the intracapsular procedure, swelling of the cornea, or swelling
your eye surgeon removes the lens of the retina (called cystoid
• Intracapsular (in·tra·cap·su·lar) macular edema). Infection is a rare
and the entire capsular bag that
Phacoemulsification By far complication, but it may cause
holds it. Your doctor will make an
the most common procedure, severe vision loss. Remember,
incision in the sclera, use a special
phacoemulsification requires a the risk of severe problems or
tool to freeze the lens, and then
smaller incision in the cornea or, blindness from cataract surgery
remove it through the incision. He
less commonly, the sclera. The is very low. Still, it may ease your
Prevent Blindness 6Guide to Cataract Surgery
(continued)
iris
mind to talk about your concerns
with your doctor before surgery.
sclera
Sometimes after the extracapsular
or phacoemulsification procedure,
the capsular bag that remains
in your eye can become cloudy.
This is called an after cataract or
posterior capsular opacification.
If this happens, your doctor may
suggest laser surgery to make lens
capsular bag
a small hole through the cloudy
capsule. This hole will let you see
clearly again. • Do have someone else drive holds the drops or ointment. Put in
while your eye is healing. the prescribed amount of medicine
• Do wear sunglasses in and close your eye to distribute it
Your recovery evenly. If you have trouble doing
bright light.
After surgery, most of the healing this, ask a friend or relative for
• Do keep follow-up help. Start with a fresh bottle of
takes place in the first few days.
appointments with your doctor. medicine after surgery so germs
But it may take up to 1 month for
your eye to fully heal. For the first • Do keep moderately active. don’t get transferred. Do not touch
week or two, or as your doctor • Don’t rub or press your eye. the tip of the medicine bottle to
recommends, you should minimize your eye.
• Don’t bend over to pick things
vigorous physical activity. You Eye shields
up; kneel instead.
should avoid any lifting or deep
• Don’t get cosmetics, soap, Your doctor may want you to use
bending, which causes increased
shampoo, or other irritants an eye shield at night to protect
eye pressure. If you experience
in your eye. your eye while you sleep.
severe pain, loss of vision, or a
sudden increase in redness or Follow-up care
swelling of your operated eye, Your doctor will suggest a
Take care of your eye
call your eye doctor right away. schedule for follow-up visits. The
Here are some pointers that can first one will be the day after your
help you recover more quickly: surgery. It is important to keep
Other DO’s and DON’Ts
Applying eye medications these appointments to find out
• Do use your medication as whether your eye is healing well.
Use the eye drops or ointment
directed. These visits will also let you ask
exactly as prescribed by your
• Do sit down and lift your feet to doctor to help your eye heal. This your doctor any questions you
put on your shoes. medicine protects against infection have about medicine or your
• Do try to sleep on your back or and helps decrease swelling. activities (such as heavy lifting
on the unoperated side. or exercising).
How to apply eye drops
• Do wear a shield to protect the or ointment
eye while sleeping for the first Tilt your head back. Pull your lower
week after surgery. eyelid down to create a “cup” that
Prevent Blindness 7Guide to Cataract Surgery
(continued)
Resources for cataract surgery
Vision Care Financial Assistance Information: This resource provides
a list of organizations and services that provide financial assistance for
vision care.
https://preventblindness.org/vision-care-financial-assistance-information/
Medicare: Learn about cataract surgery benefits.
https://preventblindness.org/medicare-benefits-your-
eyes/#1587953897065-8df2ee06-1e30
Medicaid: Consult your state-specific Medicaid agency to confirm which
vision services are covered.
https://www.medicaid.gov/about-us/contact-us/index.html
Mission Cataract USA: This organization offers free cataract surgery to
people of all ages who have no means to pay.
http://missioncataractusa.org/
Transportation Services Directory: Search for transportation assistance
by city and state.
https://lowvision.preventblindness.org/transportation-services-directory/
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