FAQ

Will my cataract come back, and if it does, will I need more surgery?

This is probably the most commonly asked question with regard to cataract surgery. Fortunately, once your cataract is removed, it will not return. Furthermore, except in rare instances, the new prosthetic lens that is placed in your eye (your IOL) will be good forever.

Despite this, approximately a third of patients who undergo cataract surgery will need to have a subsequent procedure called a yag laser capsulotomy (YLC). This is due to the fact that the posterior capsule has a tendency to become cloudy over time after a cataract is removed. This is called posterior capsular opacification (PCO). It is commonly referred to as an “after cataract,” which generates a bit of confusion regarding the issue of cataract recurrence. As in the case with cataracts, PCO may lead to a decrease in best-corrected visual acuity over time, because it obscures the visual axis. A clear visual axis is necessary in order to have clear vision, just as clean windows or windshields are needed to see clearly.

If this happens to you, your ophthalmologist can use a specialized laser to create a very precise opening in the posterior capsule that will clear the visual axis and improve your vision. This procedure is quick and generally painless.

If the PCO is significant, it may limit the view to the retina and optic nerve, similar to how a cataract limits the view to the back of the eye. If this is the case, complete assessment of visual function may not be possible until after the laser capsulotomy is performed. In other words, your doctor may not be able to estimate your expected vision prior to the procedure if he or she is unable to adequately assess the retina and optic nerve, which lie behind the capsule.

Will I need glasses after my cataract surgery?

This is a very important question, and one which your operating surgeon should discuss with you prior to your surgery. In summary, it is expected that most patients will rely on glasses to varying degrees after undergoing cataract surgery. If you have chosen a traditional monofocal intraocular lens, you will need to choose whether you would like to have your vision corrected for distance (driving), or near (reading). The vast majority of patients elect to correct their distance vision. This means you will need glasses to correct your intermediate (computer distance) and near (reading) vision. If you elect to have your distance vision corrected, you may still need glasses to “fine-tune” your distance vision.

If you elect to have monovision where one eye is corrected for distance, and the other for near, you may be relatively “glasses-independent.” However, in this situation, it is strongly recommended that you have a pair of glasses specifically for driving. This achieves two goals: you will have better vision for driving, especially at night and you will maintain the ability to have depth perception. Over time, uninterrupted monovision can lead to the permanent loss of depth perception in adults.

If you elect to have a premium intraocular lens, which allows for improved focus at multiple distances, you may achieve relative glasses independence compared to those individuals who have monofocal lenses. That being said, you may still find a need for glasses in certain situations. For example, you may see adequately to drive and read, but may need glasses to work on the computer; or you may see to drive and work on the computer just fine, but need glasses to read fine print. When surveyed, most patients who elect to have these lenses are extremely satisfied, and would choose to have them again. A very small percentage of patients will elect to have these premium lenses replaced with a monofocal lens due to the side effects of some premium lenses.

How do I know if my cataracts are severe enough to require surgery?

This is an excellent question, and the answer is different for every individual. It can be answered only by you and your doctor. Eventually, everyone will develop a cataract. However, not everyone will need to undergo cataract surgery. Cataract surgery is reserved for patients who have a symptomatic decrease in best-corrected vision. This is a decrease in the ability to correct vision with glasses or contact lenses. As a result, one’s ability to perform activities of daily living (ADLs) is reduced. ADLs may include driving, cooking, sewing, golfing, exercising, reading, or job performance, among other things. In other words, if you have difficulty performing the tasks that you either need or want to do as a result of your cataracts, you may be a candidate for surgery.

Some patients have decreased vision due to a cataract, but find this does not bother them. In this setting, cataract surgery is not generally necessary. Occasionally, there are reasons to have a cataract removed that are not related to visual function. Some of these are discussed in the section on “Cataract Surgery and Other Diseases.” In these cases, your surgeon may recommend surgery for you prior to the point at which you would independently choose to undergo it. This is either because it is not safe to postpone surgery, or because the view to the retina and optic nerve is diminished due to the cataract. This prevents adequate visualization of the retina and optic nerve, which prevents doctors from providing adequate evaluation and treatment for diseases that affect this part of the eye. In this case, the cataract should be removed in order to provide adequate treatment to prevent vision loss from those diseases.

How long is the surgery?

This depends on several factors. Generally speaking, more advanced cataracts take longer to remove, whereas less advanced cataracts are softer and can be removed more quickly. In addition, if you are undergoing more than a simple cataract procedure (e.g. a glaucoma procedure or astigmatism correction procedure in addition to cataract removal), surgical time will be increased. On average, a simple cataract removal will take between 10 and 20 minutes. This time is affected by a variety of factors, such as the efficiency of the operating room staff, adequacy of anesthesia, and a patient’s ability to remain still during surgery, among other things. If the surgery is complex, it will take longer, and it is important for you be comfortable during your surgery. If at any point you are uncomfortable, you should let your operating surgeon know so the team can take steps to improve your comfort. Unexpected movement during eye surgery makes the surgery more difficult for your surgeon, and potentially longer. The more comfortable you are, the more relaxed and still you can be. This contributes to the overall efficiency of your procedure.

How long is the recovery?

Your recovery period is dependent on your eye, how quickly it heals, and whether or not you have co-existing eye or medical problems. In most cases, recovery is quick. Your vision may be a bit blurry at first, but will typically improve during the first week after surgery. If you do not have a co-existing disease, you can usually be measured for your new glasses approximately three to four weeks after surgery. This is the point at which one can reasonably expect the eye to have healed, and for the prescription to have stabilized. If you need to have cataracts removed from both eyes, your recovery will be longer because you must wait three to four weeks between cataract surgery in your first and second eye. Most patients generally feel “back to normal” after a day or two, and have restrictions lifted by the seventh day after surgery.

If your cataract is dense, or you have other eye diseases, or your surgery is complex, your recovery time may be longer; this is to be expected. It is important not to compare your recovery to that of someone else you may know. Every eye and surgery is different. If you have questions or concerns regarding your recovery, ask your doctor. It is important that you follow your postoperative treatment regimen provided by your surgeon to maximize your visual recovery and the speed at which you achieve that recovery.

Does the surgery hurt?

In most cases, cataract surgery is tolerated very well. Most patients will say it is either painless, or note mild discomfort. Many patients feel pressure on the eye from the lid speculum that is used to keep the eye open during surgery and/or note some bright lights during their procedure. You may also feel some cold liquid on your eye and some manipulation during your surgery, but you do not want to feel “pain.” If you experience pain, you should let your operating surgeon know so your comfort level can be improved.

The surface of the eye may be a bit irritated after cataract surgery. This can lead to scratching and burning sensations. These symptoms tend to resolve within a few days and are not cause for concern. Most doctors give artificial tears after surgery to help with these symptoms.

Will I need to have anesthesia?

Yes, some form of anesthesia will be administered for your cataract surgery. There are several different options, which include topical (drops on the eye), local (a small injection around or in the eye), monitored anesthesia care (MAC, medications given through an IV), and general anesthesia. Often topical and local are combined with MAC, and most patients qualify for this type of anesthesia. Today, it is rare that a patient undergoes general anesthesia for cataract surgery but in certain instances it may still be required. Reasons for undergoing general anesthesia might include claustrophobia, mental retardation and Alzheimer’s disease.

How do I know if my doctor is qualified to perform my surgery?

Many ophthalmologists in the United States are qualified to perform cataract surgery, but some may be more experienced in certain types of cataract treatment than others. Your cataract surgery should be performed by an ophthalmologist, who is a medical doctor (MD) or doctor of osteopathy (DO) trained specifically for eye surgery. Ophthalmologists are graduates of four-year medical colleges. Following this, they undergo residency and sometimes fellowship training for an additional four to six years, all dedicated to learning medical diseases of the body and eye and most importantly, eye surgery.

Secondly, you will want to find a doctor with whom you are comfortable and communicate well. This is important in understanding the steps in the process and treatment before, during and after surgery. Talking with your friends and relatives who have also undergone cataract surgery can be very helpful in locating an eye doctor. Chances are if they were happy with their cataract surgeon, you probably will be as well. If you feel rushed or that your questions are not getting answered adequately, it is perfectly acceptable to get a second opinion.

Will my vision change after my surgery?

You may notice small changes in vision after your eye has healed due to small shifts in the position of your IOL, or changes in the cornea, over time, that lead to small changes in your glasses prescription. If this occurs, you can update your glasses as needed. These changes are usually small and are not cause for concern.  If you do notice changes in your vision, you should see your eye care provider for an examination.  This is to be sure you do not have other eye disease that needs treatment causing your change in vision.

How much does the surgery cost?

This will depend on your insurance company and the procedure you choose. If you have a visually significant cataract that needs removal, your insurance company will usually cover this procedure, but you will be responsible for your co-pay and/or deductible. These are set by your insurance company and will depend on your contract. If you elect to have a premium IOL and/or surgical treatment of your astigmatism, you will be directly responsible for that additional cost, as these are generally not covered by commercial insurance or Medicare. The additional costs for premium IOLs and astigmatism treatment will vary depending on what you choose and where you live. Your ophthalmologist’s office will help you determine exactly what these costs will be to help you plan and determine treatment choices. Therefore, you should be able to determine the estimated total cost to you before you undergo surgery.

When I read, my eyes get tired much faster than they used to. Is this because of my cataracts?

This is a common symptom in the setting of cataracts. Our eyes tend to fatigue faster if they are working overtime to focus. This can be due to a variety of problems, including cataracts. If you have this problem, the first thing you should do is to have a complete eye examination. You may just need an updated glasses prescription. However, it is important to determine that there are no other disease processes occurring that may require additional treatment, one of which may be a cataract.

When I’m golfing, I can’t see the ball in the distance. Is this because of cataracts?

This is a very common complaint in patients with cataracts, and it could very well be due to your cataracts. Once again, the first thing to do is have a complete eye examination. This will determine whether or not your glasses prescription can be updated. If you have not worn glasses in the past for distance vision, but you are developing cataracts, you may need to start wearing them. If your vision can be corrected with glasses, there is no need to have cataract surgery. You should understand, however, that if you have a cataract, your vision is likely to undergo periodic changes from this point on, until it is removed.

If I have a cataract, why can’t I just have LASIK to correct my vision?

As a cataract develops it will cause a change in your glasses prescription. LASIK, or laser vision correction, is not a good treatment option in this situation. Laser vision correction will not halt the progression of a cataract, and is not a long-term solution to prescription changes that are caused by cataracts. It is impossible to predict how quickly one’s cataract will progress. Some are slow and some can progress rapidly. If you have laser vision correction performed, and you have a cataract, your prescription could change in one month, or one year, or it may remain stable for several years. Whatever the case is with your cataract, once it progresses, your LASIK surgery would no longer be helpful, and you would again need to update your glasses or proceed with cataract surgery, due to the resultant change in vision.

Is there an advantage to postponing my cataract surgery?

If your ability to function is decreased because of your cataract, it makes sense to proceed with cataract removal in most cases.

There are several reasons why one might opt to postpone cataract surgery. These include uncontrolled, co-existing medical or eye disease, insurance reasons, travel reasons, and inability to find help after surgery. Your doctor can help you sort through these questions to see what is best for you.

There are also some disadvantages to delaying surgery, so it is important to balance these issues to best meet your needs. Disadvantages to delaying surgery might include loss of independence, decreased mobility and increased risk of falls, inability to perform activities of daily living, rapid progression of your cataract, and lack of adequate vision for travel and other special events.

One reason patients consider postponing many types of surgery is the possibility of technological advances in the future. The good news is that technological advancements in cataract surgery have occurred at a great rate in recent years. The technology for cataract treatment is now excellent, and the vast majority of patients who undergo cataract surgery have very good results. There are several new technologies on the horizon, but it is unclear when they will be approved, or if they will offer real advantages over what is in use today. So, if you are truly in need of cataract surgery, delaying because of the prospect of new technology is not necessary.

Will my IOL need to be changed in the future?

IOLs that are used today are usually left in your eye forever once they are placed. On occasion, there are reasons why an IOL might be removed or exchanged, but this is uncommon. Some of these reasons might include trauma to the operated eye, an unexpected refractive outcome, effects from an older style lens no longer in use today, or dissatisfaction with a premium IOL.

What are Premium IOLs and How Are They Different From Traditional IOLs?

Premium IOLs are also referred to as presbyopia-correcting, astigmatism-correcting, new-technology, or advanced-technology IOLs. These lenses are all designed to reduce your dependence on glasses or contact lenses after your cataract surgery. Conventional IOLs are what are called monofocal lenses, meaning they allow your eye to focus at one distance only. This means you must wear glasses to be in focus at other distances. Most premium IOLs are designed to allow your eyes to focus at multiple distances to reduce your dependence on glasses, by correcting for presbyopia.  There are several types of these lenses available. One class of premium IOLs, astigmatism-correcting IOLs (also called toric IOLs) correct for corneal astigmatism, and are also designed to decrease dependence on glasses. There is one premium IOL available that corrects for both presbyopia and astigmatism.

Can I have laser surgery to remove my cataract?

There is one type of laser that is now being used to assist with some of the steps in cataract surgery. This is called femtosecond laser-assisted cataract surgery. The femtosecond laser is utilized to create corneal and limbal relaxing incisions and the capsulorrhexis, and to soften the cataract or break it into smaller pieces prior to removal. However, the cataract is still removed with ultrasound and aspiration in this procedure.

How soon can I drive after cataract surgery?

This will depend on the vision in both your eyes, as well as several other factors. You should wait a minimum of 24 hours before driving after anesthesia. In addition, you will need to have legal driving vision in order to drive. Your doctor can help you determine when and if it will be appropriate for you to drive. If the legal driving requirements are satisfied, many patients are comfortable driving the day after surgery. However, you should not drive until you have seen your doctor the day after surgery. At this visit, you can talk to your doctor about resuming the operation of a motor vehicle if you are a licensed driver.

When can I return to work after surgery?

This will depend on the type of work you perform. If you do not work in a dirty and/or dusty environment, and do not perform heavy lifting, you can usually go back to work in a day or two. You will need to discuss your specific occupation and job requirements with your surgeon to determine exactly when it is safe for you to resume work.