Cataract Surgery: What to Expect Before, During and After

Cataract surgery is one of the most frequently performed operations in the world, and one of the most successful. It replaces the eye's natural lens, which has become cloudy, with a clear artificial lens implant. For most people, it restores sharp vision, brighter colours and better night vision within days. Yet for many patients, the idea of surgery on the eye is daunting, and questions abound: Will it hurt? Will I be awake? Which lens should I choose? How soon can I drive?

This article walks you through the whole journey, from the first assessment to full recovery, so you know what to expect at each stage. It also explains the lens choices available and the warning signs that mean you should contact your surgeon quickly after the operation.

When is surgery recommended?

A cataract is a clouding of the lens inside the eye, most commonly due to ageing. It develops gradually, causing blurred or dim vision, glare from lights, faded colours, frequent changes in glasses prescription and difficulty seeing at night. Our cataract guide explains the causes and symptoms in detail.

There are no eye drops, exercises or diets that reverse a cataract. Early on, updated glasses and better lighting may be enough. Surgery is generally offered when the cataract affects your quality of life or your ability to do important tasks, such as driving to legal standards, working or reading. In some cases it is recommended for medical reasons, for example when a dense cataract prevents the doctor from examining the retina, or when it contributes to a type of glaucoma. Waiting does not usually make the operation riskier in the short term, so the decision is largely yours, guided by your eye doctor.

Before surgery: the assessment

Before the operation you will have a detailed assessment, often at a separate appointment. It typically includes:

• Medical history: general health, medications (especially blood thinners and medicines for prostate problems such as tamsulosin, which can affect the iris during surgery), allergies and previous eye surgery such as laser vision correction.
• Eye examination: vision testing, eye pressure, slit-lamp examination and a dilated look at the retina to check for other conditions such as macular degeneration, diabetic retinopathy or glaucoma, which may limit the result.
• Biometry: measurements of the length of your eye and the curvature of your cornea, usually with an optical scanner. These are used to calculate the power of the lens implant.
• Discussion of goals: how you use your eyes, whether you want to see clearly at distance, near or both without glasses, and how you feel about wearing glasses afterwards.

This is the time to ask questions and discuss risks. Bring a list of your medications and, if you wear contact lenses, follow instructions about leaving them out for a period before measurements, because lenses can temporarily change the shape of the cornea.

Choosing your lens implant

The artificial lens (intraocular lens, IOL) stays in your eye permanently. Choosing it is one of the most important decisions in the process. Availability and cost vary between healthcare systems; in many public systems, standard monofocal lenses are provided, while premium lenses may involve additional costs.

Monovision

Another approach uses monofocal lenses set for different distances: one eye focused for distance and the other for near. Many people adapt well, particularly if they have tried monovision with contact lenses before, but it reduces depth perception slightly and does not suit everyone.

Making the decision

Multifocal and EDOF lenses are less suitable if you have other eye conditions such as macular degeneration, advanced glaucoma or significant dry eye, or if you do a lot of night driving and are bothered by glare. A frank discussion with your surgeon about your lifestyle and expectations is the best way to choose. For background on focusing and lens designs, see our guides on presbyopia and astigmatism.

On the day: the phaco procedure

Most cataract operations are done as day-case procedures, meaning you go home the same day. The most common technique is phacoemulsification, often shortened to phaco.

1. Preparation: drops are used to dilate the pupil. The eye is numbed with anaesthetic drops or an injection around the eye. Most people stay awake; a mild sedative may be offered in some settings. General anaesthesia is reserved for special situations.
2. Cleaning and draping: the skin around the eye is cleaned with antiseptic and a sterile drape covers your face, leaving the eye exposed. A small device keeps the eyelids open. Air or oxygen is supplied under the drape so you can breathe comfortably.
3. Small incisions: the surgeon makes tiny incisions, usually around 2 to 3 millimetres, at the edge of the cornea.
4. Opening the capsule: a round opening is created in the front of the thin membrane (capsule) that surrounds the lens. In femtosecond laser-assisted surgery, a laser performs this and some other steps, although studies have not shown clearly better outcomes than standard phaco for most patients.
5. Removing the cataract: an ultrasound probe breaks the cloudy lens into small pieces and suctions them out.
6. Inserting the implant: the folded artificial lens is injected through the small incision and unfolds inside the capsule.
7. Finishing: the incisions usually seal themselves without stitches. Antibiotic may be placed in the eye, and a protective shield is applied.

The operation itself usually takes 15 to 30 minutes, though you may be at the hospital for a few hours in total. Most people feel only light pressure and see bright lights or colours during surgery. Our page on eye surgery options describes other operations for comparison.

Recovery: the first days and weeks

Vision is often blurry immediately after surgery and improves over the following days. Many people notice that colours look brighter and whiter than before, because the old cataract had a yellow-brown tint. It is common to feel mild grittiness, watering or itchiness, and to see a crescent-shaped shadow or some light sensitivity initially.

Eye drops

You will usually be given antibiotic and anti-inflammatory drops to use for several weeks. Follow the schedule exactly, wash your hands before using them and keep the bottle tip clean. If you need help, a family member can assist, or ask the clinic for tips.

Practical do's and don'ts

• Wear the protective shield at night for the period advised, usually about a week, to avoid rubbing the eye while asleep.
• Avoid rubbing or pressing on the eye.
• Avoid swimming and getting soap or tap water in the eye for about two weeks.
• Avoid eye make-up for about a week or as advised.
• Light activities such as walking, reading and watching television are usually fine from the first day.
• Avoid heavy lifting and strenuous exercise for the period your surgeon recommends.
• Do not drive until you meet the legal vision standard and your surgeon confirms it is safe.
• Wear sunglasses outdoors if light feels uncomfortable.

Typical timeline

If both eyes need surgery, the second eye is often done a few weeks after the first, although some centres offer both eyes on the same day in suitable patients. Between operations, the difference between your eyes may feel unbalanced; your optometrist can advise on temporary solutions.

Results and possible complications

The large majority of people achieve improved vision after cataract surgery. Results may be limited by other eye conditions, such as macular degeneration or glaucoma. Even with a monofocal lens, many people find they need glasses only for reading.

Serious complications are uncommon but can include:

• Infection inside the eye (endophthalmitis): rare, but it requires emergency treatment.
• Inflammation: usually mild and controlled with drops; occasionally more persistent.
• Raised eye pressure: often temporary.
• Swelling of the macula (cystoid macular oedema): may cause blurry vision weeks after surgery; treatable with drops.
• Retinal detachment: rare, with higher risk in very short-sighted eyes.
• Posterior capsule rupture: a complication during surgery that may require additional procedures.
• Lens power surprises: the final focus may differ from the plan, sometimes requiring glasses or further procedures.

Posterior capsule opacification

The most common long-term issue is posterior capsule opacification (PCO), sometimes called a secondary cataract. The membrane behind the implant, left in place to support it, can become cloudy months or years later, causing vision to become hazy again in a way that feels similar to the original cataract. It is not the cataract coming back. PCO is treated with a quick, painless outpatient laser procedure called YAG laser capsulotomy, which creates a clear opening in the membrane. Vision usually improves within a day.

Signs to watch for after surgery

Mild grittiness and blurriness are normal in the early days. Your clinic will give you a phone number to call if something seems wrong. Keep follow-up appointments, and have your glasses checked by an optometrist once healing is complete. Regular eye examinations remain important afterward to monitor for other age-related conditions; see our article on how eyes change after 40.

When to see a doctor about cataracts

Book an eye examination if you notice cloudy, dim or blurred vision, increasing glare from headlights, faded colours or frequent changes in your glasses prescription. An optometrist can confirm whether a cataract is present and refer you to an ophthalmologist when surgery might help. You do not need to wait until a cataract is ripe; the old advice to wait until vision is very poor no longer applies to modern surgery.