What to Expect at Cataract Surgery

It’s normal to have anxiety about cataract surgery—and even postpone scheduling the procedure out of fear. But it shouldn’t be that way.

Dr. Jeff Dello Russo, an ophthalmologist at Dello Russo Laser Vision and New Jersey Eye Center, recalls working with one patient who was “hesitant and nervous for months” before scheduling her surgery. For years, the 78-year-old had been struggling to drive at night, read books, and enjoy activities with her grandchildren. “Within 24 hours after her cataract procedure, she was thrilled to be able to read her morning paper without glasses and see her grandchildren’s faces more clearly than she had in years,” says Dello Russo. “Cataract surgery is life-changing.”

“Many of my patients feel that their world is brighter, richer, and clearer after surgery,” echoes Dr. Danielle Trief, an associate professor of ophthalmology at Columbia University Irving Medical Center. A large portion even say that they see better than their children. “Sometimes they realize that their clothing or paint in their house is a different color than they thought,” she says. Those aren’t the only benefits: some studies have found lower risks of dementia and falling after cataract surgery. “I believe this is because patients are better able to navigate their world,” says Trief.

Here’s what you should know about the outpatient procedure.

What are cataracts?

Your eyes act like a camera, taking pictures and sending them to your brain so that you can see. In the front of the eye, a lens brings images into focus onto the retina. “The lens typically is clear when we are born, but gets cloudy with time/age,” says Trief. As the lens fogs up, vision blurs, and this clouding of the lens is called a cataract. With cataracts, “often we have more glare in certain conditions,” Trief says, like driving at night or reading.

The formation of cataracts is a natural part of aging. “Nearly everyone develops cataracts over time,” Trief says. Roughly 25 million Americans have cataracts, and more than half of people age 80 and above either currently have them or have had cataract surgery, per the U.S. National Institutes of Health. “Often they start to affect our vision in our 60s, 70s, or 80s, but sometimes earlier,” Trief says. “We can sometimes initially adjust our glasses to improve vision, but ultimately the cataract becomes too cloudy, and the lens needs to be replaced.”

What is cataract surgery?

Cataract surgery is designed to restore clear vision by removing the cloudy lens and replacing it with a transparent artificial lens. 

“This lens can correct the vision as well as provide more clarity, better contrast and less glare,” says Trief. And, adds Dello Russo, “if left untreated, cataracts can lead to significant vision impairment.”

After the surgery, Trief says patients’ vision improves, and they are less reliant on glasses, though most people will still need glasses for some tasks, such as reading. 

Modern cataract surgery is one of the safest and most effective surgical procedures, says Dello Russo, with a 98% success rate. “Many people report that they wish they hadn’t waited so long to have the surgery,” he says. Complications include infection, retinal detachment, and loss of vision; it is estimated they occur in less than 2% of patients.

How to prepare for cataract surgery

Here are some of the key things you will be asked to do before undergoing the procedure, according to Dello Russo and Trief:

What happens during cataract surgery

Cataract surgery is an outpatient procedure that’s typically done in an ambulatory surgical center, though it may be done in a hospital setting. “The surgery should be very easy for the patient,” says Trief.  

Before your surgeon starts, your eyes will be dilated and examined, and an IV will be placed. Then, you’ll receive numbing eye drops or a local anesthetic to prevent discomfort. You may also be given a mild sedative to help you relax, says Dello Russo. You won’t be asleep during the procedure, but fear not: you won’t see the surgeon at work since they’ll be working under an operating microscope that prevents you from seeing the surgery take place.

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“During the procedure, the surgeon uses a tiny incision to remove the cloudy lens and replaces it with an artificial intraocular lens,” Dello Russo says. He calls the surgery “painless”—though you might feel slight pressure or see bright lights during it.  

The procedure only takes about 10 to 30 minutes, and you’ll lie on your back with head support. (“Patients sometimes worry about moving,” says Trief.) Doctors only correct one eye per surgery in order to allow the surgeon to assess the outcome and fine-tune the approach for the second eye, which could potentially improve overall results. If you need the procedure in both eyes, there’s typically a wait-time between surgeries of a week to a month.

A note about the different kinds of cataract surgery 

Cataract surgery can be done with or without laser assistance. Unlike traditional cataract surgery, which relies on manual incisions and ultrasonic tools, laser cataract surgery uses high-tech laser systems to perform many steps of the procedure, says Dello Russo. “The laser creates precise incisions in the eye and softens the cataract for removal, reducing the need for manual tools.” Dello Russo prefers laser surgery, saying that it minimizes stress on the eye, leading to faster recovery times and less discomfort.

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However, Trief cautions that the laser is usually not covered by insurance and has an out-of-pocket cost to the patient (even though cataract surgery itself is typically covered). This is because laser-assisted cataract surgery is considered an advanced technology that is not mandatory to complete the procedure, says Dello Russo. “Insurance may cover the standard procedure portion, but the patient may be responsible for the extra cost of the laser.” As always, check with your insurance provider to learn about your plan’s coverage.

There are also many different lens implants available. Some correct for distance vision, some correct both near and distance vision (a multifocal lens), and others (toric lenses) correct astigmatism. “Cataract surgery used to be one-size-fits-all, but now with the lasers and our specialty lenses, we have many different options to customize for the patient’s preference,” says Trief. She encourages people to read about their options and consult with their doctor about what makes the most sense for them.

What to expect after cataract surgery

“Many patients notice significantly clearer vision within 24–48 hours, although full recovery can take a few weeks,” says Dello Russo. Some may have blurry vision for the first few days or weeks after surgery, but it typically clears quickly.

After surgery, doctors will send you home with an eye cover, and you’ll return for a follow-up appointment the next day. Because of the eye patch and sedation, patients will need to arrange for a ride home. “Most of my patients take a few days off from work, but some go back to work the next day,” says Dello Russo. 

As for post-op pain, you shouldn’t feel much, if any. Sometimes patients feel itchiness, scratchiness, or like something is stuck in their eye. “It often feels better the next day,” Trief says.

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According to Trief, most people resume their normal lives in the days following surgery: you can read, meet up with friends, and even work, as long as it does not involve physical exertion. (Typically, the eye patch will be removed the day after surgery, but you’ll continue sleeping with it for a week.) You may also have some light sensitivity after the procedure, but if it does not hurt your eyes to use the computer or read, you can do so, says Trief. She asks patients not to do any exercise or bend their head below their waist for one week after surgery. In general, Dello Russo says light activity is fine within a day or two, but you should avoid strenuous activities for at least a week.

Your doctor will direct you to use eye drops after surgery. How often you’ll need them varies by the person and the type of drops prescribed, whether they’re lubricating, antibiotic, steroidal, or nonsteroidal anti-inflammatory. “Typically, patients will need to use several different types of eye drops multiple times a day for a few weeks after surgery,” says Dello Russo. The amount of time you’ll use eye drops varies, too, but expect to use them for about a month after surgery. 

In terms of follow-up visits, patients are seen the day after the procedure and again within one to two weeks. You may also return to your ophthalmologist’s office for a final check-up in a month. “I typically do the two eyes two weeks apart, and a few weeks after their second eye has surgery, they will get their final visual prescription,” says Trief. Patients can also wear an updated contact lens prescription after cataract surgery once you’re done with your post-op eye drops protocol.

If you’re still anxious

For nervous patients, Dello Russo and Trief have some more reassurance to share. For one thing, it’s a resoundingly safe procedure that truly improves people’s quality of life and fosters independence as people age. Trief stresses that it’s one of the few surgeries where people notice a big benefit almost right away, and that it’s a quick procedure without much downtime.

Along with the many technological and safety advances in this surgery, there have also been innovations in its ability to not only restore vision but also to reduce dependency on glasses following the procedure.  

And if the idea of being awake during surgery is the part that scares you, Trief gets it—but says you’ll be provided enough anesthesia to feel comfortable. As a bonus? “Some people remark that they enjoyed the experience and see pretty colors,” she says.