The prospect of cataract surgery can certainly raise some mixed emotions. On one hand, it holds the promise of correcting vision problems that have gotten progressively worse and have become progressively disruptive to your life. A quick surgery that will get rid of the blurriness, cloudiness, and other vision symptoms that have been nagging you, making it impossible to read, keeping you from driving seems like a pretty good deal. But on the other hand, we all have an innate loathing of the thought of anyone or anything probing or cutting at our eyes (some of us more than others, to be sure). How painful will it be? How uncomfortable? How long is cataract surgery, and how long is the recovery?
Here’s what you should know about what to expect when you go in for surgery. But be reassured in advance that cataract surgery is one of the most commonly performed and successful surgeries worldwide, and that most people who have had it done are pleasantly surprised at how easy it was. And it’s an outpatient procedure, so you don’t need to worry about a hospital stay.
Many people…even eye doctors…often talk about these surgeries in terms of “removing the cataract.” If you have only a vague idea of what a cataract is and know only that it’s a clouding of the eye’s natural lens, then you might picture “removing the cataract” as some kind of process not unlike headlight restoration on a car. “This lens has gotten blurred and cloudy with age, time to buff it clean.” But that’s not what cataract surgery entails. The lens isn’t clouded over because it’s collected grime, and the damage is not just on the outer layer of the lens. Your lens’s proteins have deteriorated and clumped throughout, and it is not salvageable. Instead, your eye’s natural lens will be removed and replaced by an artificial one. There are a few different methods for achieving this, but all cataract surgeries consist of the removal and replacement of the lens.
We can live with cataracts as an annoyance up to a certain point, after which the vision problems are not just irritating but dangerous or severe enough to interfere with the activities of daily living. That’s when surgery becomes necessary for people who wish to preserve or resume their independent lifestyles. In the past, these kinds of severe vision problems were the threshold for recommending cataract surgery. But today, many surgeons recommend intervening while the cataract is still “immature,” and the symptoms are noticeable but not overly prohibitive. That’s because a more mature cataract is stiffer and more difficult to break up for removal.
If you have cataracts in both eyes that you plan to have fixed, you will most likely do them one at a time. Usually that means first taking care of whichever eye is worse, waiting until it is completely healed, and then tackling the second eye.
Well in advance of surgery day, you’ll meet with your ophthalmologist, who will examine you closely and take measurements to gather the necessary information for the design of the replacement lens. The doctor will need to know the exact size of your eye, as well as its shape. The ophthalmologist will set the focusing power of the replacement lens based on the contour of your cornea as well as your vision history and prescriptions.
Bring your full list of prescriptions with you to this visit. Your doctor will want to ask you about what medications you’re taking so that you can discontinue any that are contraindicated with the surgery. You’ll also be written a prescription for eye drops containing steroids or antibiotics with instructions for taking them in the lead-up to the surgery. If you wear contacts, you’ll refrain from putting them in for the three days before surgery. You may be instructed not to eat or drink past midnight before the day of surgery.
After you arrive for your surgery, you’ll lie back in a surgical chair, wearing your regular clothes, not a gown. You might want to bring an extra shirt in case yours gets something on it during the surgery. Your ophthalmologist will be working with a small surgical team. They’ll use iodine to disinfect the skin surrounding your eye and put in drops to widen your pupils so that the lens is more easily accessed. You’ll also be given a numbing agent such as lidocaine so that you can no longer feel your eye, and possibly a medication to keep you “consciously sedated,” such as a benzodiazepine. Some surgeons offer general anesthesia to people who prefer to be knocked out during the procedure, and in some cases this is necessary because the person has a tremor or other condition that makes it impossible to lie still for a prolonged period. However, most people remain awake during the surgery. Even so, you won’t be able to see the surgical tools approaching your eye, or anything else traumatic. Most people find the surgery to be completely painless and not at all distressing, while some describe a sensation of mild pressure around the eye.
The team will make a small incision in your cornea and either remove the lens in one piece, break the lens apart using sound waves and then remove it, or take the lens out using a laser. The incision is typically only 2 millimeters or less in length. Then the team inserts the new lens using a tiny cartridge designed so that the lens unfolds once it’s in place. The entire process usually takes less than an hour. Unless your case is uncommonly complicated, there will be no stitches in your eye.
The team finishes off the procedure by placing a protective cover over the eye, which you’ll wear home. You’ll be monitored for at least 30 minutes to make sure there have been no complications and to make sure that any anesthesia that would make you drowsy or unsteady on your feet has worn off.
You’ll be instructed about how to use the eye drops that will help you heal, and about when to wear (and stop wearing) the protective cover. Your doctor will probably also talk to you about what food not to eat after cataract surgery, including fried foods, very sugary and salty foods, and foods that are very spicy, all of which can inhibit the healing process.
You’ll schedule a follow-up appointment to make sure everything’s healing okay and that the surgery was successful. Then you’ll be released. You won’t be able to drive home, so you’ll need to make sure somebody is with you or can pick you up on the day of surgery.
In the days following the surgery, you might have some blurriness in your vision, your eye might feel slightly irritated, and it might even seem like you’re viewing the world through a pinkish lens. But these symptoms should resolve after a few days, and you shouldn’t experience any pain that an over-the-counter pain med can’t help with. You’ll wear the protective eye cover while you’re sleeping for the first few nights but won’t need it after that (unless your doctor instructs you to wear it for longer). The eye should heal completely within two months.
