15 things you need to know about cataract surgery

1. When should I have my cataract operated on?

Traditionally, cataract surgery has been performed when the patient starts to experience vision loss. However, we now also take into account subtle changes to vision, such as loss of contrast sensitivity and loss of colour perception. You may notice that colours are faded and dull, and also that you have trouble seeing in low-contrast situations (e.g. at night). These are early signs that the cataract is having an effect on your vision and you may want to consider surgical removal.

2. Does my cataract need to be mature to have it removed?

That was the case in the past when cataracts had to be removed in one piece. Now, we use ultrasound and laser technology to break the cataract into smaller pieces for removal – this means it is better if the lens is softer (i.e. immature) to aid the fragmentation process. In fact, the length of the patient’s surgery and recovery are both shorter if the cataract is immature when operated on.

3. Is the operation painful?

Cataract surgery is not at all painful. Most patients describe a mild sensation of pressure around the eye. In some cases, we may use local anaesthesia (administered via eye drops) or perform a small anaesthetic block around the eye.

I have previously published a scientific paper investigating the levels of pain and light sensitivity during cataract surgery, and the majority of patients did not find the operation particularly painful or distressing.¹

We also have the option to offer patients a general anaesthetic if they prefer to be asleep during the procedure or if there are other medical issues that need to be taken into account (e.g. patients with tremors who cannot lie flat for ten minutes).

4. How long after cataract surgery do I have to wait before driving?

Most patients can drive within 48 hours after the operation – the general advice is that they can start driving when they feel comfortable doing so. It is a good idea to avoid driving long distances in the first week, as the eye will feel strained after the surgery.

I also recommend wearing sunglasses to minimise the effect of sensitivity to bright lights and sunlight.

5. When can I resume my regular chores, like cooking or gardening?

Most patients can resume normal housework such as cooking and gardening within a day or so after having a cataract extraction – it is really up to the individual. However, take care to avoid irritating your eye after it has been operated on (e.g. with dirt or dust, in windy conditions).

I also recommend avoiding heavy lifting and vigorous household duties for the first week after your cataract operation.

6. When can I go swimming or resume going to the gym?

As a general rule, it is best to avoid swimming for the first month after surgery to reduce the risk of infection. The problem is that pools are often full of viruses and germs that can infect the eye in the immediate post-operative period. Heavy gym workouts are also generally not recommended for the first week. There is no issue with gentle treadmill use or walking.

7. When will I see the results of the cataract surgery?

The visual results of a cataract operation are almost immediate in most cases. However, not all patients and cataracts are the same, so some patients may take longer than others to notice a change.

Be aware that your vision will tend to fluctuate as the eye heals following the surgery but will generally stabilise within one month for most patients. If you have a co-existing medical condition such as diabetes, you may experience delayed healing following a cataract extraction.

8. My friend had her cataract removed and she does not wear glasses anymore. How is that possible?

There are a number of options available to correct presbyopia during cataract surgery. We now have multifocal intraocular lenses (IOLs) that give us the option to correct distance and near vision, while the latest lenses (trifocal IOLs) correct vision at far, intermediate and near distances. Trifocal IOLs are the lens of choice if your goal is to be as independent of glasses as possible – some patients can get rid of their glasses completely with trifocal IOLs.

Alternatively, monovision lenses can allow one eye to be set for distance vision and the other for near vision (known as blended monovision), or you can have both eyes set for distance vision and still use a pair of reading glasses. It all depends on your specific needs and the state of your eyes. It’s important that you understand the advantages and disadvantages of each option prior to the surgery taking place.

9. I have astigmatism – can this be cured?

Astigmatism is a refractive error that occurs if the cornea or lens of the eye has an irregular curve. People with astigmatism have blurry vision because the light rays do not focus at one point on the retina at the back of the eye. Astigmatism can also occur with shortsightedness or longsightedness.

We now have the ability to correct or reduce astigmatism (and other refractive errors) at the time of cataract surgery. This involves inserting a special intraocular lens called a toric lens during the cataract operation. The severity of pre-operative astigmatism will determine whether we can correct it completely after the cataract extraction.

10. I have had herpes in my eye. Can I still have my cataract removed?

Once infected, the herpes virus becomes resident in the eye and can reactivate following cataract surgery. This means that you will require post-operative antiviral medication to prevent any virus-related complications. The medication is usually taken for a period of four weeks after the operation.

11. I have glaucoma – is it safe to have my cataracts removed?

There is no issue provided the glaucoma is under control prior to the surgery. We now offer patients the option of inserting a micro-stent (iStent inject) at the time of cataract surgery to improve fluid drainage from the eye. The iStent can reduce the amount of glaucoma medication required – in many cases, patients can stop eye drops completely.

12. I have keratoconus – can I have my cataracts removed safely?

Patients with keratoconus do very well after cataract surgery. In fact, many find that they can actually get rid of their contact lenses altogether. One of the features of keratoconus is astigmatism and this can also be addressed at the time of the operation (see question 9 above).

13. Do cataracts ever come back after having them removed?

A cataract operation is a once-off procedure in the sense that cataracts themselves do not return. Cataracts do not ‘grow’, and the replacement artificial lens will not turn into a cataract.

However, sometimes a thin membrane of scar tissue develops behind the lens implant after the cataract extraction. This membrane is called a posterior capsule opacification and can be removed with a quick and painless laser procedure in the clinic (YAG laser capsulotomy).

14. I have had a corneal transplant in the past. Is it safe for me to have cataract surgery?

Patients who have had corneal transplants can have their cataracts removed quite safely. However, they do need to be aware that there is a small risk of developing a rejection to the graft following cataract surgery – this can be treated with steroid drops. There is also a small risk that the cornea may be damaged and that a second graft will be required.

15. Will I have stitches in my eye following the operation?

Modern cataract surgery does not routinely require stitches, as it is a keyhole procedure and the main incision is about 2 mm in length. The intraocular lens is inserted via a thin cartridge and is designed to unfold once it has been placed inside the eye. Some cases of complicated cataract surgery may require one or two small stitches. These are removed a few weeks post-operatively when the tissue has healed.

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