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What to Expect with Cataract Surgery: Before, During and After the Procedure

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 If you or a loved one is scheduled for cataract surgery, it’s natural to have questions and concerns about what to expect before, during, and after the procedure. This guide will walk you through the entire process, from preparation to recovery, and address common concerns and questions you may have about getting a cataract removed and what vision will be like afterwards.

What to Expect with Cataract Surgery: The Basics

Cataract surgery is a relatively straightforward procedure that typically takes less than an hour to complete. It’s performed on an outpatient basis, meaning you’ll be able to go home the same day. While the surgery itself is quick, the recovery process can take several weeks or months. During this time, you’ll need to follow specific aftercare instructions and make some lifestyle adjustments.

This guide provides a comprehensive overview of what to expect before, during, and after cataract surgery. It covers the entire process from initial preparations to recovery, addressing common concerns and questions about the procedure and its outcomes.

Cataract surgery is a straightforward outpatient procedure typically lasting less than an hour. However, the recovery phase may span several weeks or months, during which adherence to aftercare instructions and lifestyle adjustments are crucial.

Before the surgery, comprehensive eye examinations determine the severity of cataracts and guide treatment decisions, including the selection of an intraocular lens (IOL). The procedure itself involves making a small incision to remove the clouded lens and replace it with an artificial lens, offering restored vision.

Post-surgery, patients are advised on proper care, including the use of medicated drops, protective eyewear, and restrictions on strenuous activities. Understanding these phases ensures patients are well-prepared and informed throughout their cataract surgery experience.

What to Expect Before Cataract Surgery

Before your cataract surgery, you’ll have a comprehensive eye examination to evaluate the severity of your cataracts and determine the appropriate treatment plan depending on which stage you are at. During the early stages, cataracts can usually be managed with glasses. Once they interfere with daily activities, however, surgery is needed.

Besides choosing what type of cataract surgery you want to have, you will have to decide on an intraocular lens (IOL) implant to replace the natural lens that will be removed during the procedure. Your vision outcome will vary significantly depending on the IOL you chose, so it’s highly recommended that you discuss your options with your surgeon.

How to Prepare for Cataract Surgery

Preparing for cataract surgery is a fairly straightforward process, and most facilities will provide written pre-op instructions. Common preparation steps for cataract surgery include:

  • Some facilities may require you to get cleared for surgery at least one week prior by your primary physician.
  • Arrange transportation to and from your surgery, as you cannot drive the day of your surgery because of anesthesia.
  • Use medicated eye drops on a set schedule leading up to your surgery.
  • Avoid food and drink for at least 8 hours before the procedure.
  • Avoid makeup and similar cosmetic products around the eyes the day of your procedure.

What to Expect During Cataract Surgery

During cataract surgery, a small incision is made to access the eye and the clouded lens of the eye (the cataract) is removed by ultrasound. It is then replaced with an artificial lens. This replacement lens replaces the patient’s natural lens and restores the ability to see. The lens is permanent, needs no maintenance, and can remain in the eye for the patient’s entire life.

  1. Prior to your surgery you will get medication to help with anxiety and your eye will be dilated. Numbing medication will be placed on and in the eye to ensure there is no pain.
  2. The surgeon will make a tiny incision in the cornea, the clear front part of the eye. Using ultrasound waves, the surgeon will break up and remove the clouded natural lens (this part of the procedure is known as phacoemulsification). 
  3. An artificial intraocular lens (IOL) is then inserted into the empty lens capsule to replace the natural lens.

Are you Awake During Cataract Surgery?

You will typically be awake during cataract surgery, but you won’t feel any pain or discomfort due to the local anesthesia. Your surgeon may ask you to focus on a specific light or follow instructions during the procedure.

Cataract Surgery Recovery

After your cataract surgery, you will be taken to a recovery area where you will rest for a short period. Your eye may feel itchy or uncomfortable, but this is normal and should subside within a few hours.Your doctor will provide you with specific aftercare instructions, which may include:

  • Using eye drops or ointments to prevent infection and promote healing
  • Wearing an eye shield or protective glasses to protect your eye
  • Avoiding strenuous activities or heavy lifting for a few weeks
  • Avoiding rubbing or putting pressure on your eye

After You Get Home

The incision is so small that it will heal on its own. Your vision may be blurry at first, but it should improve over the next few days. You’ll need to use medicated eye drops as directed to prevent infection and reduce inflammation.

Most people can return to normal activities within a few days, but strenuous activities may need to wait a week or two.

If you have cataracts in both eyes, the second eye is typically operated on 1-2 weeks after the first.

Common Problems after Cataract Surgery and How to Manage Them

While cataract surgery is generally safe and effective, some people may experience minor complications or side effects during the recovery process. Here are some common problems and how to manage them:

  1. Eye discomfort or pain: Your doctor may prescribe eye drops or oral medications to alleviate discomfort or pain. It’s important to follow the recommended dosage and schedule.
  2. Dry eye: Cataract surgery can sometimes cause temporary dry eye symptoms. Using preservative-free artificial tears or lubricating eye drops can help alleviate this issue.
  3. Light sensitivity: You may experience increased light sensitivity or glare after surgery. Wearing sunglasses or a hat with a brim can help reduce discomfort.
  4. Blurred vision: Blurred vision is common in the days and weeks immediately following surgery, but it should gradually improve as your eye heals.
  5. Eye redness or swelling: Some redness and swelling around the eye are normal after surgery, but if it persists or worsens, contact your doctor.

On average, full recovery from cataract surgery takes 8 weeks, although vision may take longer to stabilize. Make sure to follow the instructions of your healthcare provider during the recovery period. If you experience severe pain, sudden vision loss, or any other concerning symptoms, contact your eye doctor immediately.

Risk Factors Associated With Complications

Certain underlying health issues or other eye problems can raise the risk of serious complications after cataract surgery. Any condition that affects the eye’s structure or your overall health may potentially increase these risks. The following conditions may be considered a risk factor for cataract surgery:

Diabetes

Diabetes is a major risk factor for cataracts and can also lead to poorer visual outcomes after cataract surgery. Diabetic patients have higher rates of complications like posterior capsular opacification, cystoid macular edema, and retinopathy progression.

Hypertension

Uncontrolled high blood pressure is associated with an increased risk of intraoperative complications like suprachoroidal hemorrhage, as well as postoperative issues such as corneal edema and cystoid macular edema.

Autoimmune Disorders

Conditions like rheumatoid arthritis, lupus, and Sjögren’s syndrome can increase inflammation and the risk of complications like posterior capsular opacification and cystoid macular edema after cataract surgery.

Previous Eye Injuries or Surgeries

A history of prior ocular trauma, inflammation, or procedures like vitrectomy can lead to anatomical changes that make cataract surgery more challenging and increase complication rates.

Chronic Steroid Use

Long-term use of corticosteroid medications, whether oral, inhaled, or topical, can predispose patients to the development of posterior subcapsular cataracts. Steroid use may also worsen surgical outcomes.

Retinal Detachment History

Patients with a prior history of retinal detachment have a higher risk of recurrence after cataract surgery, especially if they have high myopia or a history of retinal tears.

Macular Degeneration

Age-related macular degeneration is a leading cause of vision loss in the elderly. Cataract surgery may not improve vision in patients with advanced macular degeneration.

Glaucoma

Glaucoma patients have higher rates of complications like posterior capsular opacification, cystoid macular edema, and corneal decompensation after cataract surgery. Careful monitoring and management is required.

Corneal Diseases

Conditions affecting the cornea, such as keratoconus, Fuchs’ dystrophy, and severe dry eye, can increase the risk of corneal edema, infection, and poor visual outcomes after cataract surgery.

It’s important to talk to your healthcare provider about any existing conditions before having cataract surgery, to determine the best course of action for your case.

Vision Changes after Cataract Surgery

One of the most significant benefits of cataract surgery is the improvement in your overall visual clarity and quality. However, it’s important to understand that your vision may not be perfect immediately after surgery, and it may take some time to adjust to your new vision.

  • In most cases, vision improves immediately after surgery, although the pupils may remain dilated for 1-2 days. 
  • Patients usually experience clear vision the day following the surgery, though for some it can take several days for vision to return to normal. 
  • Many patients report that their vision is clear only a few hours after cataract surgery. However, it may take a week or two before they see the world around them with full clarity. 
  • The best vision may not show up for a while, as the eyes need time to heal and adjust to the new intraocular lens (IOL). Full recovery and stabilization of vision typically takes 2-4 months
  • Patients with premium IOLs might experience glare and halo after the surgery, but they are usually mild and often improve over time as the brain adapts to the new IOL. Most patients find the benefits of reduced dependence on glasses outweigh the visual disturbances.

Questions and Concerns About Cataract Surgery

Am I a Candidate for Cataract Surgery?

Most cataracts develop in people over the age of 55. Cataracts are a progressive condition, usually worsening over time. In the early stages of cataracts, their effect on vision may be minimal or even nonexistent. At this point, a surgeon might determine that surgery is unnecessary.

Generally, it is best to wait for cataracts to affect your quality of life enough that other measures, like reading glasses and adjusting lighting conditions as necessary, cannot offset the symptoms caused by cataracts enough for you to live a comfortable life.

What happens if you don’t wear sunglasses after cataract surgery?

It’s essential to wear sunglasses or protective eyewear after cataract surgery to protect your eyes from bright light, wind, and debris. Not wearing sunglasses can increase your risk of eye irritation, discomfort, and potential complications during the healing process.

Do eyes look different after cataract surgery?

While the appearance of your eyes may not change significantly after cataract surgery, some people may notice a slight difference in the size or shape of their pupils. This is due to the artificial intraocular lens (IOL) that replaces your natural lens.

Can you have cataract surgery after lasik?

Yes, it’s possible to have cataract surgery after undergoing LASIK or other refractive surgery. However, your doctor will need to take into account your previous refractive surgery when planning your cataract surgery and selecting the appropriate intraocular lens (IOL).

Can you wear contacts after cataract surgery?

In most cases, you can wear contact lenses after cataract surgery, but you may need to wait several weeks or months for your eyes to fully heal and your vision to stabilize. Your doctor will provide specific guidance on when it’s safe to resume wearing contact lenses.

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