At a glance
- What the surgery does
- Removes the cloudy natural lens of the eye and replaces it with a clear artificial lens.
- Why people consider it
- Blurry or dim vision, glare at night or faded colors that get in the way of driving, reading, work or getting around safely.
- The main choices
- When to have it, and which lens. Standard lenses usually mean reading glasses afterward. Multifocal lenses reduce glasses but cause more glare and halos.[3] Laser-assisted surgery gave the same results as standard surgery in two large trials.[1][2]
- What recovery involves
- Clearer vision within days for most people, weeks of eye drops, and a final glasses check about a month later.
- What to ask your surgeon
- Which lens they recommend and what you'll still need glasses for, what you'll pay out of pocket, and whether anything else in your eyes could limit the result.
The short version
- A cataract is clouding of the eye's natural lens. Surgery removes it and puts in a clear artificial lens. There is no eye drop or pill that reverses a cataract.
- The standard lens (monofocal) gives clear vision at one distance, usually far, so most people still need reading glasses.
- Multifocal lenses cut down on glasses for reading, but cause more glare and halos around lights.[3] Toric lenses correct astigmatism and give sharper distance vision without glasses for people who have it.[4]
- Laser-assisted cataract surgery costs more but gave the same results as standard surgery in two large randomized trials.[1][2]
- Routine blood tests and ECGs before surgery did not make cataract surgery safer in a review of trials covering more than 21,000 operations.[5]
What a cataract is
Behind the colored part of your eye (the iris) sits a clear lens that focuses light. With age the proteins in that lens slowly clump and yellow, and the lens turns cloudy. That's a cataract.
Common signs are blurry or dim vision, glare and halos around headlights at night, colors that look faded, and needing brighter light to read. Glasses prescriptions often change more often than usual. Cataracts usually develop slowly over years, and most people have them in both eyes, though one is often worse.
Age is the main cause. Diabetes, smoking, long-term steroid use, eye injuries, previous eye surgery and a lot of sun exposure can bring them on earlier.[14][15]
When to have surgery
There's usually no rush. The main reason to operate is that blurry vision is getting in the way of things you need or want to do: driving, reading, work, hobbies, or getting around safely.[12] Waiting rarely makes the operation itself riskier, though a very advanced, hard cataract can make surgery more difficult.
The research in detail: What the research says about benefits beyond seeing better
In a Western Australian study of more than 27,000 older drivers, police-reported crashes fell by about 13% in the year after first-eye cataract surgery compared with the year before.[10]
In a study of more than a million Medicare patients with cataracts, those who had surgery had about 16% lower odds of breaking a hip in the following year than those who didn't.[9]
A long-running Seattle study of about 3,000 older adults found that people who had cataract surgery were less likely to develop dementia than those who didn't. That kind of study can show a link, but it can't prove the surgery caused the difference.[11]
A driving test, a vision standard at work, or frequent falls are all fair reasons to bring up timing with your eye surgeon.
Choosing a lens implant
The artificial lens (intraocular lens, or IOL) is meant to stay in your eye for life. This is the decision most worth taking time over.
| Lens type | What it does | What the evidence says |
|---|---|---|
| Monofocal (standard) | Sharp focus at one distance, usually far. Reading glasses for close work. | The standard choice and usually fully covered by insurance. Fewest visual side effects. |
| Monovision with monofocals | One eye set for distance, the other for near. | Some people adapt well, others don't like it. Many surgeons suggest trying it with contact lenses first. In two trials, multifocal lenses left people less reliant on glasses than monovision, but with more glare.[3] |
| Toric | Corrects astigmatism (an unevenly curved cornea) as well as the cataract. | Across 13 randomized trials, toric lenses gave better distance vision without glasses and roughly halved the need for distance glasses compared with standard lenses in people with astigmatism, without more complications.[4] |
| Multifocal and extended depth of focus | Split or stretch the focus so you can see at more than one distance. | In a Cochrane review of 20 trials, people with multifocal lenses saw better up close and were less dependent on glasses. Distance vision was about the same. Glare and halos were more common, with halos more than three times as likely.[3] |
Premium lenses (toric, multifocal and similar) usually mean an out-of-pocket charge on top of what insurance pays. In the US, Medicare covers cataract surgery with a standard lens. If you choose a premium lens, you generally pay the extra cost yourself.[13] Ask for the extra cost in writing before surgery.
The best lens depends on your eyes and your life. Someone who drives at night a lot may care more about avoiding halos. Someone who hates reading glasses may accept some halos. Tell your surgeon what you do every day.
Laser-assisted surgery: worth paying for?
In standard surgery, the surgeon makes small incisions and an opening in the lens capsule by hand, then breaks up the cloudy lens with ultrasound (phacoemulsification). Femtosecond laser-assisted surgery uses a laser for some of those steps first. It's often sold as an upgrade.
The research in detail
Two large randomized trials compared the two head to head. In France (FEMCAT, 870 patients analyzed), the laser was not better at three months, and it cost more.[1] In the UK (FACT, 785 patients), laser-assisted surgery was no worse than standard surgery for vision and safety at three months, and there was no meaningful difference on any outcome.[2]
Some surgeons still find the laser useful in particular eyes. If it's offered, ask what specific benefit they expect for you, and what it costs.
Before surgery
Your surgeon will measure your eye to choose the lens power. Those measurements matter, so follow any instructions about stopping contact lenses beforehand, since lenses can change the shape of the cornea.
For most healthy people, routine blood tests, ECGs and chest X-rays aren't needed. In a Cochrane review of three trials covering 21,531 cataract operations, routine testing did not reduce medical problems during or after surgery, did not reduce cancellations, and cost more.[5] Your team may still order tests if your own health calls for them.
Tell your surgeon about every medicine you take. Some prostate and urinary medicines (alpha-blockers such as tamsulosin) can make the iris floppy during surgery, even if you stopped them long ago. Surgeons can plan for this, but only if they know.[12]
What happens on surgery day
Cataract surgery is usually an outpatient procedure that takes well under an hour in the operating room. You're awake. The eye is numbed with drops or an injection, and you may get medicine to help you relax.
The surgeon makes a tiny incision at the edge of the cornea, opens the front of the lens capsule, breaks up and removes the cloudy lens, and slides the folded artificial lens into the empty capsule, where it unfolds. The incisions usually seal without stitches.
Many surgeons place an antibiotic inside the eye at the end of surgery. In a large European trial of 16,603 patients, leaving that step out was linked with about five times the risk of infection inside the eye.[7]
Both eyes on the same day?
Most people have the second eye done days to weeks after the first. Some centers do both eyes on the same day, as two separate procedures. A Cochrane review found probably no clinically important difference in results between the two approaches, with lower costs for same-day surgery, though the evidence was limited.[6] Ask whether it's offered and whether it suits you.
Recovery
Most people notice clearer vision within a day or a few days, though it can take a few weeks to settle completely.
- Day 1A check-up, often the next day. You'll start a schedule of eye drops (usually antibiotic and anti-inflammatory drops). Wear the shield at night as instructed.
- Week 1Avoid rubbing the eye, swimming, and getting soap or dirty water in it. Most people go back to reading, TV and light activity quickly. Ask when you can drive.
- Weeks 2 to 6The drops taper off. Vision keeps settling. Your final glasses prescription, if you need one, is usually checked around a month after surgery.
Call your eye team the same day for worsening pain, worsening vision, a lot of redness, or new flashes, floaters or a shadow in your vision. These can be signs of infection or retinal detachment, which need quick treatment.
Risks and complications
Serious complications are uncommon, but you should know the main ones:
- Clouding behind the lens (posterior capsule opacification). The capsule holding the new lens can turn hazy months or years later. It's fixed in a few minutes in the office with a YAG laser.
- Swelling at the back of the eye (cystoid macular edema), which can blur vision for weeks. It's more common in people with diabetes or certain eye conditions and is usually treated with drops.
- Infection inside the eye (endophthalmitis). Rare but serious. Antibiotic given inside the eye at the end of surgery lowers the risk.[7]
- Retinal detachment. In a national French study of more than 2.6 million eyes, about 1% had a retinal detachment within four years. The risk was higher in people with high myopia (very nearsighted), men, younger patients, and when there was a tear in the lens capsule during surgery.[8]
- Glare, halos and dissatisfaction with a premium lens. More common with multifocal lenses.[3] Occasionally a lens is exchanged.
- Needing glasses anyway. Lens power calculations are very good but not perfect, especially in eyes that have had laser vision correction.
Questions to ask your surgeon
- How much is the cataract causing my vision problems, and is anything else going on in my eyes?
Why we ask: Other conditions such as macular degeneration, glaucoma or diabetic eye disease can limit how much vision improves after surgery. Knowing up front sets realistic expectations. What a cataract is
- Which lens do you recommend for me, and what will I still need glasses for?
Why we ask: Standard lenses usually mean reading glasses afterward. Multifocal lenses cut down on glasses but cause more glare and halos. Your daily life should drive the choice. Choosing a lens implant
- Do I have astigmatism, and would a toric lens help?
Why we ask: Toric lenses gave better distance vision without glasses in people with astigmatism across 13 trials. If you have it, this is worth asking about. Choosing a lens implant
- What will I pay out of pocket for each lens option and for laser-assisted surgery?
Why we ask: Medicare and most insurers cover surgery with a standard lens. Premium lenses and laser steps often cost extra. Get the numbers in writing before you decide.
- How often do your patients with this lens report glare or halos?
Why we ask: Halos were more than three times as likely with multifocal lenses in a Cochrane review. Your surgeon's own experience with the specific lens is useful context. Risks and complications
- Is laser-assisted surgery likely to make a difference in my eye?
Why we ask: Two large trials found laser-assisted surgery gave the same results as standard surgery, at higher cost. Ask what specific benefit they expect for you. Laser-assisted surgery
- Will you do both eyes on the same day or separately, and why?
Why we ask: Same-day surgery on both eyes gave similar results to separate days in a Cochrane review. Some people prefer it for fewer trips, others prefer to see how the first eye does. Surgery day
- Do I take any medicines that could affect surgery, like tamsulosin or other prostate or urinary drugs?
Why we ask: Some of these can make the iris floppy during surgery, even if stopped long ago. Surgeons can plan for it if they know. Before surgery
- What signs after surgery mean I should call you right away?
Why we ask: Worsening pain, worsening vision, a lot of redness, or new flashes, floaters or a shadow can signal infection or retinal detachment, which need quick treatment. Recovery
Print this page or save it to your phone, and write down the answers during your visit.
Understanding your lens implant options
The companies that make the implants and devices used in this surgery, compared side by side with FDA records and sources, plus recent research and FDA news explained for patients.
Recovery supplies
We list recovery supplies at every budget, from gel ice wraps to cold therapy machines, with what to look for in each.
- Eye protection
- Keeping track of eye drops
- Reading and lighting
Sources
- Schweitzer C, et al. Femtosecond laser-assisted versus phacoemulsification cataract surgery (FEMCAT): a multicentre participant-masked randomised superiority and cost-effectiveness trial. Lancet. 2020;395:212-24. https://doi.org/10.1016/S0140-6736(19)32481-X
- Day AC, et al. Femtosecond laser-assisted cataract surgery versus phacoemulsification cataract surgery (FACT): a randomized noninferiority trial. Ophthalmology. 2020;127:1012-9. https://doi.org/10.1016/j.ophtha.2020.02.028
- de Silva SR, et al. Multifocal versus monofocal intraocular lenses after cataract extraction. Cochrane Database Syst Rev. 2016;12:CD003169. https://doi.org/10.1002/14651858.CD003169.pub4
- Kessel L, et al. Toric intraocular lenses in the correction of astigmatism during cataract surgery: a systematic review and meta-analysis. Ophthalmology. 2016;123:275-86. https://doi.org/10.1016/j.ophtha.2015.10.002
- Keay L, et al. Routine preoperative medical testing for cataract surgery. Cochrane Database Syst Rev. 2019;1:CD007293. https://doi.org/10.1002/14651858.CD007293.pub4
- Dickman MM, et al. Immediate sequential bilateral surgery versus delayed sequential bilateral surgery for cataracts. Cochrane Database Syst Rev. 2022;4:CD013270. https://doi.org/10.1002/14651858.CD013270.pub2
- ESCRS Endophthalmitis Study Group. Prophylaxis of postoperative endophthalmitis following cataract surgery: results of the ESCRS multicenter study and identification of risk factors. J Cataract Refract Surg. 2007;33:978-88. https://doi.org/10.1016/j.jcrs.2007.02.032
- Daien V, et al. Incidence, risk factors, and impact of age on retinal detachment after cataract surgery in France: a national population study. Ophthalmology. 2015;122:2179-85. https://doi.org/10.1016/j.ophtha.2015.07.014
- Tseng VL, et al. Risk of fractures following cataract surgery in Medicare beneficiaries. JAMA. 2012;308:493-501. https://doi.org/10.1001/jama.2012.9014
- Meuleners LB, et al. The effectiveness of cataract surgery in reducing motor vehicle crashes: a whole population study using linked data. Ophthalmic Epidemiol. 2012;19:23-8. https://doi.org/10.3109/09286586.2011.628776
- Lee CS, et al. Association between cataract extraction and development of dementia. JAMA Intern Med. 2022;182:134-41. https://doi.org/10.1001/jamainternmed.2021.6990
- Miller KM, et al. Cataract in the Adult Eye Preferred Practice Pattern. American Academy of Ophthalmology. Ophthalmology. 2022. https://pubmed.ncbi.nlm.nih.gov/34780842/
- Medicare.gov. Cataract surgery coverage. https://www.medicare.gov/coverage/cataract-surgery
- National Eye Institute. Cataracts. https://www.nei.nih.gov/learn-about-eye-health/eye-conditions-and-diseases/cataracts
- American Academy of Ophthalmology (EyeSmart). What are cataracts? https://www.aao.org/eye-health/diseases/what-are-cataracts
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