Getting surgery can be a huge relief to people who have seen the condition eat away at their independence and enjoyment of life for months or years. A cataract is a lens that has become clouded over as cells have grown and accumulated for decades. A person may develop cataracts in one or both eyes, and when they appear in both eyes, they often develop at different rates. Surgery usually results in greatly improved vision, so people who have cataracts in both eyes are usually eager to get them both taken care of.
However, most U.S. doctors will only perform the surgery on one eye at a time, spacing out the surgeries over a period of weeks or months so that the first eye has recovered before the second gets worked on. Unless there’s some unusual reason to do it otherwise, doctors typically recommend tackling the eye with the worse cataract first. Not only will this result in the greater improvement in vision, but it’s also a matter of tackling the more difficult surgery first, since removing the lens usually involves breaking it apart with sound waves or a laser, and more mature cataracts are harder to destroy.
When people hear about this “worse-first” strategy, they often come back immediately with the question, “How long is cataract surgery recovery and how soon can I have the second eye done?”
Most U.S. doctors refrain from operating on both eyes at once out of an abundance of caution. Vision is a precious thing, and doctors want to make sure everything goes OK in one eye before proceeding to the other. Before surgery, doctors carefully evaluate your vision and take pains to implant an artificial lens that’s exactly right for you. But sometimes they can get this slightly wrong. Doing one eye at a time allows them to see how accurate their calculations were once your vision has stabilized. They’ll then know whether or not to use the same lens for the second surgery and be able to insert a lens in the second eye based on the current situation with the first.
There’s also a small risk of infection with cataract surgery, and operating on one eye at a time is thought to reduce the risk of an infection spreading from one eye to the other.
And doing the two surgeries separately allows for continuity of functional vision. In other words, the recipient will be able to have some vision after both surgeries rather than having both eyes “shut down” briefly at once. Although spreading out the surgeries over a period of weeks or months may seem disruptive of your lifestyle, it’s a matter of creating a prolonged period of minor disruption as opposed to a short period of more thorough disruption. The conservative approach of repairing one eye, letting it heal while vision stabilizes, and then moving on to the other eye is favored by a considerable majority of physicians. As soon as it’s clear that the eye that’s been worked on has healed and its vision has improved, the next eye can be taken care of.
Even though most American doctors are reluctant to do cataract surgery in both eyes at once, some are open to the idea of what’s known as simultaneous bilateral cataract surgery (SBCS). From the patient’s perspective, doing both eyes at once allows them to compress the total surgery and recovery time considerably. It also might mean achieving stable vision more quickly.
Remember, a one-at-a-time strategy means improving the vision in a single eye…adjusting to life with one good eye and one bad eye (possibly while wearing your old glasses with one lens popped out, which makes some people woozy)…surgery to improve the vision in the second eye…and then adjusting to life with improved vision in both eyes (achieving “binocular” vision). With SBCS, you come out of surgery with both eyes fixed and they heal and adjust together.
Some doctors who implant light-adjustable lenses might lean toward SBCS. With light-adjustable lenses, the ophthalmologist can fine-tune the focus of the lenses after they’ve been implanted. Doing them both in the same surgery can theoretically allow for a quicker and more accurate “dialing-in” process. If the lenses were put in one at a time, the recipient would come in for multiple post-surgical sessions to make adjustments to the lens based on vision impacted by having one good eye and one bad eye. Once the second new lens was in place, both of them would potentially need to be adjusted (or in the case of the first lens, readjusted) to achieve good binocular vision. SBCS shortens that process.
However, for most doctors, these potential advantages associated with SBCS aren’t enough to outweigh the potential drawbacks. Although infections, complications, and poor tolerance of cataract surgery are rare, they do occur. Simply put, most doctors would prefer an approach that ensures that you always have at least one good eye.
If you think you want to get SBCS, don’t try to pressure your doctor into it if they’re not amenable to it. You can try another doctor if you like, but be aware that even doctors who sometimes offer SBCS might feel that you’re not a good candidate for it.
Recovery from cataract surgery usually takes about four weeks, although some experts state that full recovery is not complete until eight weeks. People briefly wear an eye shield, complete a course of antibiotics and other medications, and resume most of their daily activities as their vision improves. Blurry vision after cataract surgery is normal but usually temporary.
How soon you can get the other eye worked on will depend on a few factors, the most important of which is how quickly you heal and how quickly your vision stabilizes. Another important factor is your doctor’s preference. As long as your first eye has healed well, some physicians will feel ready for the second operation within a week of the first. Others will want to wait two weeks, and still others will routinely schedule second surgeries for four, six, or even eight weeks out at a minimum. It’s generally considered a good idea to schedule your two surgeries as closely together as is safe. That’s because a shorter interval between surgeries is simply more likely to make you happy. A study in BMC Ophthalmology found that, the longer people took between surgeries, the more visits they scheduled with mental-health therapists.
