A cataract (cloudy eye lens) blocks light from reaching the retina, which helps the brain process sight. Cataracts develop over time, gradually leading to blurry, hazy vision and affecting daily activities. 

If left untreated, cataracts can eventually lead to blindness. Surgery is the only effective way to remove cataracts and correct vision problems. Cataract surgery is one of the most common surgical eye procedures.

An ophthalmologist (a doctor who diagnoses and treats eye disorders) will perform cataract surgery to correct your vision if they find it medically necessary.

Your ophthalmologist will often recommend cataract surgery if you’re experiencing decreased or blurry vision due to cataracts. However, having cataracts doesn’t mean you need surgery right away. If you and your ophthalmologist monitor your vision, waiting won’t affect your eyes too much or make the surgery more difficult.

You may need cataract surgery if you’re experiencing:

• Colored halos around lights
• Sensitivity to strong lights (photophobia) such as sunlight or headlights of cars
• Double vision
• Difficulty reading fine print
• Frequent changes to your eye prescription

Cataract surgery is usually beneficial, improving your vision and overall quality of life. It may also reduce your need to wear glasses or contact lenses for reading, driving, and working and reduce potential injuries from falls, especially for older adults.

There are four different types of cataract surgery: phacoemulsification, intracapsular cataract extraction (ICCE), extracapsular cataract extraction (ECCE), and laser-assisted surgery. Phacoemulsification is the most common in the United States.

Phacoemulsification

During phacoemulsification, the opthalmologist makes a small cut in your cornea (the clear part covering your iris and pupil). They use a phaco probe (a small instrument) to break up the cloudy lens and suction the broken pieces out before placing an artificial intraocular lens (IOL).

The cut made during the surgery is usually self-healing and doesn’t require stitches.

Intracapsular Cataract Extraction (ICCE)

This procedure involves removing the eye’s entire natural lens and the lens capsule, the outer layer covering the lens that gives it its shape.

Following ICCE, you may need to wear special glasses called aphakic eyeglasses. These help correct your vision after your natural lenses have been removed. Aphakic eyeglasses are becoming less common because their lenses are thick and heavy, and special contact lenses are an available alternative.

ICCE usually has a higher chance of complications and is performed only in special cases, such as partly dislocated lenses.

Extracapsular Cataract Extraction (ECCE)

This procedure involves creating a large opening in your cornea to remove the entire cloudy lens. The capsule is left intact, providing a base for an IOL. The opening is then stitched closed. Complications from ECCE are higher compared to phacoemulsification.

Laser-Assisted Surgery

This surgery uses a camera or ultrasound to determine the exact location and size of the cloudy lens. The information is sent to a computer, which programs the laser. The laser cuts into your cornea, opening the lens capsule. Like phacoemulsification, a probe breaks the lens and suctions the pieces out, followed by placement of the IOL.

Lasers improve accuracy and sometimes provide more correction than traditional surgery.

There are many types of IOLs available. Your ophthalmologist will recommend the best one for you based on your visual needs, your budget, and any other eye problems you have.

The different types of IOL include:

• Monofocal lenses: These lenses give you clear vision, specifically at a distance. These lenses require bifocals or reading glasses for near activities. You can also choose surgery that doesn’t affect your near vision but requires you to wear glasses for distance.
• Multifocal IOL: These lenses have various focus points for your vision, like bifocal or trifocal eyeglasses. They help with both near and far vision and may also improve intermediate vision (the ability to see objects 20-40 inches away).
• Accommodative lenses: These help correct vision at all distances. They generally use the eye’s natural movement to change focus.
• Toric lenses: These lenses can also help correct astigmatism (a condition that affects the curve of the cornea or lens). They can reduce or eliminate preexisting corneal astigmatism and the need to use glasses or contact lenses following surgery for distance vision.
• Light-adjustable lens (LAL): This new monofocal IOL is customizable after surgery. Your ophthalmologist can adjust this lens for any remaining vision errors after your eyes heal so that you don’t need glasses for distance vision. You can also have it set to monovision, which means it can correct near and far vision without glasses.

Your insurance may not cover all types of IOLs. Insurance companies usually cover the cost of the most common IOL, monofocal lenses. Other types are often considered premium and are more expensive. You’ll likely need to pay out of pocket for lenses other than the monofocals.

Before cataract surgery, your ophthalmologist will check your eyes thoroughly to rule out other conditions that may cause vision problems. They’ll then perform tests to measure the size and shape of your eye, which will help determine the right type of IOL.

Before your cataract surgery, you should take the following steps:

• Use eyedrops prescribed by your ophthalmologist to prevent eye infections
• Inform your ophthalmologist about any medications you’re currently taking
• Talk to your ophthalmologist to confirm if you should stop eating or drinking before surgery
• Clean your eyelashes and eyelids the night before and the morning of the surgery to prevent infections

Consider bringing a family member or friend with you on the day of the surgery; you won’t be able to see clearly after the procedure and will need help driving afterward.

During cataract surgery, your ophthalmologist removes the cloudy lens on your eye(s) and replaces it with an artificial IOL. They may use numbing drops beforehand or give you medications to keep you calm during the surgery.

During the surgery, your ophthalmologist will:

• Make an opening in your cornea
• Break up the cloudy lens and suction it out
• Place an IOL to restore vision

The opening is usually self-healing and doesn’t require stitches. The surgery lasts for about 30 minutes and is normally painless.

Depending on your IOL, glasses may or may not be necessary post-surgery. Surgery typically occurs in one eye at a time (if you have cataracts in both), with the other scheduled a few weeks later.

After surgery, you may need to rest in a recovery area for some time. You will have a follow-up with your ophthalmologist the next day; you may need to wear a patch over your eye until then.

Your ophthalmologist may:

• Prescribe eye drops to prevent infection and promote healing
• Recommend wearing special eyeshield glasses or sunglasses
• Suggest washing hands before putting in the eyedrops and touching your eyes
• Advise avoiding intense activity for a few weeks 

After surgery, your eyes may be slightly itchy and light-sensitive, but this usually gets better within 1-2 days. Recovery usually takes 2-4 weeks, with your ophthalmologist scheduling follow-ups to ensure your eyes are healing correctly. Once you completely heal, you may need new glasses or contact lenses to correct your vision unrelated to cataracts.

Reach out to your ophthalmologist immediately if you experience severely impaired vision, pain that doesn’t go away with medications, redness, or flashes of light, small dots, or lines in your vision after surgery.

Cataract surgery is generally safe, but it may sometimes lead to a few complications. These include:

• Swelling
• Bleeding
• Vision loss
• Abnormal changes in eye pressure
• Infection

Two out of 5 people who have cataract surgery are at risk of developing secondary cataracts. This condition causes cloudy patches on the capsule behind your IOL lens, leading to blurry vision.

Secondary cataract treatment is quick and painless. Your ophthalmologist will use a yttrium aluminum garnet (YAG) laser to make an opening in the cloudy capsule, allowing light to pass and making your vision clear again. After this procedure, your vision should return to normal within a few days.

Cataract surgery removes cataracts and replaces them with artificial lenses. There are several different types, with phacoemulsification being the most common.

Talk to your ophthalmologist before cataract surgery to determine which type suits you best. They can help you prepare and discuss what to expect during and after surgery.