This factsheet is for people who are having cataract surgery, or who would like information about it.

Cataract surgery involves removing the natural lens inside the eye and replacing it with a lens made of a clear artificial material, such as plastic or silicone.

You will meet the surgeon carrying out your procedure to discuss your care. It may differ from what is described here as it will be designed to meet your individual needs.

About cataract surgery
What are the alternatives?
Preparing for cataract surgery
What happens during cataract surgery
What to expect afterwards
Recovering from cataract surgery
What are the risks?

About cataract surgery

A cataract is a painless clouding of the lens inside your eye. Cataracts usually develop over a long period of time, causing eyesight to gradually get worse. If left untreated, the lens will eventually become so clouded that it’s impossible to see any detail at all, although you will always be able to see some light.

Removing the cloudy lens and putting a new lens inside your eye is the only way to improve or restore your vision. Cataracts are usually removed using a technique called phacoemulsification.

The most common type of artificial lens used is a monofocal lens (a lens that can only focus at one distance) but other lenses are available that can focus on both near and distant objects. Your surgeon will discuss with you which type of lens is most suitable for you.

Cataracts can occur in one or both eyes. Very rarely, both eyes are treated at the same time. If you have cataracts in both eyes, you will usually have to wait until you have made a full recovery from surgery on your first eye before treating your other eye. This is usually about two months.

What are the alternatives?

So far, no medication or diet has been found to slow down the growth of cataracts and there is no medication that can clear a clouded lens. Removing the cloudy lens and putting a new lens inside your eye is the only way to improve or restore your vision.

Preparing for cataract surgery

Your surgeon will explain how to prepare for your operation. He or she will also discuss your options for the type of artificial lens you will have fitted.

Cataract surgery is usually done as a day case. This means you have the procedure and go home the same day.

The operation is usually under local anaesthesia. This completely blocks the pain from the eye area and you will stay awake during the procedure. The local anaesthetic is usually given in the form of eye drops but sometimes it is given as an injection. You may also be offered a sedative. This relieves anxiety and helps you to relax during the procedure.

Less commonly, cataract surgery is done under general anaesthesia. This means you will be asleep during the operation.

At the hospital, your nurse will explain how you will be cared for during your stay. Your nurse may check your heart rate and blood pressure.

Your nurse will place drops in your eye to widen (dilate) your pupil and relax the muscles in your eye. This makes it easier for your surgeon to examine your eye and remove the lens.

Your surgeon will discuss with you what will happen before, during and after your procedure, and any pain you might have. This is your opportunity to understand what will happen, and you can help yourself by preparing questions to ask about the risks, benefits and any alternatives to the procedure. This will help you to be informed, so you can give your consent for the procedure to go ahead, which you may be asked to do by signing a consent form.

What happens during cataract surgery

The operation usually takes between 15 and 20 minutes.

Your surgeon will ask you to lie back in a reclining chair (like a dentist’s chair). He or she will put local anaesthetic eye drops into your eye and place a clean drape over your face. The drape will make a small tent over your face so you can still breathe and speak easily.

Once the anaesthetic has taken effect, your surgeon will make a tiny cut on the surface of your eye. You won’t be able to see out of your eye as its being treated, but you may be aware of light and movement.

Your surgeon will put some fluid into your eye and use ultrasound to break up the cloudy lens. You may hear a soft buzzing sound as the sensor releases sound waves to break up the lens. Your surgeon will remove the broken lens from your eye. You may feel the fluid that is put into your eye trickle into a bag that is part of the drape at the side of your face.

Your natural lens sits inside a sac of thin tissue called a capsule. The cloudy lens is broken up and removed but the capsule is left in place so it can hold the artificial lens.

Your surgeon will put a folded artificial lens into your eye (keeping it folded makes it easier to get through the cut). The artificial lens will unfold when it’s inside your eye. The lens is made from a clear plastic or silicone and is left permanently in your eye.  

Your surgeon will usually leave the cut to heal naturally. Sometimes, a single stitch is used to close the cut.

What to expect afterwards

After a local anaesthetic, it may take several hours before the feeling comes back into the treated eye. Your eye is likely to be covered with a protective pad, which you will need to wear for a few hours.

You may need pain relief to help with any discomfort as the anaesthetic wears off. You may be given antibiotic eye drops to use at home to help prevent an infection. You may also be given steroid eye drops to help prevent swelling and inflammation.

You will usually be able to go home when you feel ready.

You will need to arrange for someone to drive you home. Try to have a friend or relative stay with you for the first 24 hours.

Your nurse will give you some advice about caring for your eye before you go home. You may be given a date for a follow-up appointment.

If you remove the protective pad before you leave the hospital, it may be helpful to wear sunglasses or a hat as your eye may be sensitive to light.

Recovering from cataract surgery

If you have been prescribed antibiotics, it’s important to complete the whole course.
 
If you need pain relief, you can take over-the-counter painkillers such as paracetamol or ibuprofen. Always read the patient information that comes with your medicine and if you have any questions, ask your pharmacist for advice.

Sensation usually returns to the eye within a few hours. Your vision should improve within a few days and you should be able to return to your usual activities.

There are some important things to remember while recovering from cataract surgery.

  • Don’t touch or rub your eye.
  • Keep soap and shampoo out of your eyes. It’s sensible not to wash your hair for the first few days.
  • Don’t do any heavy lifting or strenuous exercise for the first few weeks after the operation, as this can increase the pressure in your eye and could put strain on your healing scar.
  • Don’t wear eye make-up for at least six weeks.
  • Don’t do any swimming for at least six weeks.

Contact your doctor for advice if you have any of the following symptoms:
 

  • a fever – a temperature higher than 37.5 °C
  • severe pain or pain that lasts for more than 48 hours
  • loss of vision
  • increasing redness of your eye

 
It usually takes about two to six weeks to make a full recovery from cataract surgery, but this varies between individuals, so it’s important to follow your surgeon’s advice.

If a stitch is used to close the cut in your eye, depending on what type you have, it may need to be removed by your surgeon six weeks later. This can be done very easily after putting anaesthetic drops in your eye.
Once your eye has healed, you will need to have an eye test and new prescription glasses.

What are the risks?

As with every procedure, there are some risks associated with cataract surgery. We have not included the chance of these happening as they are specific to you and differ for every person. Ask your surgeon to explain how these risks apply to you.

Side-effects

Side-effects are the unwanted but mostly temporary effects you may get after having the procedure. Side-effects of cataract surgery include:

  • an itchy or sticky eye and blurred vision
  • aching of the eye
  • bruising of the eyelid or eye

Complications

Complications are when problems occur during or after the operation.

The most common complication of cataract surgery is called posterior capsule opacification (PCO). It is caused by lens cells left behind after surgery and is essentially a wound-healing response of the lens to surgery. Over time, the cells grow and cause the capsule to thicken. This results in reduced vision similar to a cataract and can be corrected with laser treatment.

Other complications of cataract surgery are rare but can include:

  • eye infection – this is probably one of the most serious complications but is quite rare and usually happens within the first week or two after surgery
  • a tear in the capsule
  • a piece of broken lens moving into the back of the eye
  • bleeding inside the eye
  • artificial lens becoming loose
  • loss of vision because of damage to the retina (the light-sensitive lining at the back of your eye) – this is usually permanent
  • disturbances in your vision such as halos, flare and glare

If any of these complications occur, you may need to have a repeat operation.

Will I be able to see or feel anything happening in the operation?
How long will the artificial lens last?
What is the difference between the types of lens used for cataract surgery?
What if I’m unable to use the eye drops after surgery?

Will I be able to see or feel anything happening in the operation?

You will see and feel very little during the operation.

Explanation

The eye drops used to widen your pupils and relax the muscles in your eye cause your vision to blur.  This means you probably won’t be able to see clearly through your affected eye. You may vaguely see movement, but won’t be able to make out any of the detail. Your eye that isn’t being operated on will be covered.

Local anaesthesia completely blocks the pain from the eye area. You may feel a light pressure from the instruments used in the operation and the surgeon’s hands.

Usually, your surgeon will explain what is happening during the operation, and often, a nurse will sit with you and hold your hand if you wish, to make sure you are comfortable and relaxed.

If at any point you do feel pain or discomfort, you will be asked to signal this by either squeezing the nurse’s hand or speaking. However, it’s important you don’t move your head. Your surgeon will top up the local anaesthetic so that you don’t feel any pain.

Sources

  • Eye. Joint Formulary Committee. British National Formulary. 60th ed. London: British Medical Association and Royal Pharmaceutical Society, 2010
  • Personal communication, Mr Scott Robbie, MBBS Bsc GMP MRCOphth, Clinical Lecturer in Ophthalmic Translational Research and SpR in Ophthalmology, NIHR Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust and  UCL Institute of Ophthalmology, London, 10 November 2010

How long will the artificial lens last?

The artificial lens used to treat a cataract is designed to last a lifetime.

Explanation

The artificial lens is made of silicone or plastic (acrylic polymers). These materials should last a lifetime.

The artificial lens very rarely needs replacing. The most common complication of cataract surgery (posterior capsular opacification) is treated with laser surgery and the lens doesn’t need to be replaced.

Further information

Royal College of Ophthalmologists
www.rcophth.ac.uk

Sources

  • Cataract surgery guidelines 2010. Royal College of Ophthalmologists. www.rcophth.ac.uk
  • Action on cataracts – good practice guidance. Department of Health, 2000. www.dh.gov.uk

What is the difference between the types of lens used for cataract surgery?

The main difference between the types of lens used in cataract surgery is the ability to focus on objects.

Explanation

There are three types of artificial lens available for use in cataract surgery.

  • Monofocal intraocular lens. This is the most commonly used lens in cataract surgery. Monofocal means it has a fixed power and can’t adjust to focus on objects that are close to you. Intraocular means it’s designed to fit inside your eye. Monofocal lenses require the use of glasses for near vision, for example for reading or driving.
  • Multifocal intraocular lens. This has areas with different focusing power, allowing you to see both near and distant objects.
  • Accommodating intraocular lens. This changes shape within your eye, in a similar manner to the natural lens in the eye, allowing you to focus on both near and distant objects.

Multifocal and accommodating lenses reduce the need for wearing glasses but you are at a greater risk of having visual disturbances such as halos, flare and glare compared to monofocal lenses.

Your surgeon will be able to advise you which types of lens are most suitable for you. Your surgeon will consider the type of work you do and the quality of vision in your other eye. It may be that your vision in your untreated eye isn’t as good as it used to be and so you may still need glasses.

Sources

  • Implantation of multifocal (non-accommodative) intraocular lenses during cataract surgery: guidance . National Institute for Health and Clinical Excellence (NICE), 2008. www.nice.org.uk
  • Implantation of accommodating intraocular lenses during cataract surgery: guidance. National Institute for Health and Clinical Excellence (NICE), 2007. www.nice.org.uk

What if I’m unable to use the eye drops after surgery?

Nursing staff at the hospital will show you how to use your eye drops. If you have trouble putting them in yourself, your hospital should be able to arrange for a district nurse to assist you after you go home.

Explanation

You may need to use eye drops for up to two months following your operation.

The nursing staff at the hospital will show you how to use these before you are discharged from hospital. You may also be shown how to put eye drops in at your pre-operative assessment, and may be given some non-medicated ones to practise using at home.

However, many people find that they still need help with putting eye drops in the eyes. If a friend or relative is unable to help, your hospital may arrange for a district nurse to visit you at home. This will be arranged before you leave the hospital.

Sources

  • Eye. Joint Formulary Committee. British National Formulary. 60th ed. London: British Medical Association and Royal Pharmaceutical Society, 2010

Related topics

 

Cataract surgery factsheet

Visit the cataract surgery health factsheet for more information.

Related topics

Further information

Royal College of Ophthalmologists
www.rcophth.ac.uk

Royal National Institute of Blind People
0303 123 9999
www.rnib.org.uk

The Eyecare Trust
0845 129 5001
www.eye-care.org.uk

Sources

  • Cataract surgery guidelines 2010. Royal College of Ophthalmologists. www.rcophth.ac.uk
  • Action on cataracts – good practice guidance. Department of Health, 2000. www.dh.gov.uk
  • Implantation of multifocal (non-accommodative) intraocular lenses during cataract surgery: guidance. National Institute for Health and Clinical Excellence (NICE), 2008. www.nice.org.uk
  • Implantation of accommodating intraocular lenses during cataract surgery: guidance. National Institute for Health and Clinical Excellence (NICE), 2007. www.nice.org.uk
  • Cataracts. The Eyecare Trust. www.eyecaretrust.org.uk, accessed 18 October 2010
  • Eye. Joint Formulary Committee. British National Formulary. 60th ed. London: British Medical Association and Royal Pharmaceutical Society, 2010
  • Personal communication, Mr Scott Robbie, MBBS Bsc GMP MRCOphth, Clinical Lecturer in Ophthalmic Translational Research and SpR in Ophthalmology, NIHR Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, 10 November 2010

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