Cataract Surgery: What to Expect on the Day of Surgery

Also known as lens replacement surgery, cataract surgery is a routine treatment for cataract, or the clouding of the eye’s lens. In the procedure, a surgeon makes a small incision in the cornea of the eye, takes out the faulty lens, and replaces it with a prosthetic called an intraocular lens (IOL). A relatively quick and painless, outpatient surgery—the operation, itself, typically takes between 15 minutes and an hour—patients are usually able to go home the same day. This treatment is very well-tolerated and highly successful in correcting this issue; however, success also depends on before and after patient care. If you’re undergoing this procedure, it’s essential to listen to the healthcare provider carefully; the more you know, the better off you’ll be on the day of your cataract surgery. 

Before the Surgery

On the day of cataract surgery, you should budget between three and six hours altogether and make sure you’ve arranged for transportation as you won’t be able to drive afterward. If you have cataracts in both eyes, you’ll need two separate treatments. The necessary testing and diagnosis will already have happened, so the primary task prior to the surgery will involve ensuring you’re ready. Cataract surgery is performed while the patient is awake, and getting ready involves several steps:

• Initial examination: Typically, the first step involves a nurse or other professional sitting with you and confirming your medical information and making a quick evaluation of health status. Be sure to let them know if there are any changes or new developments.
• Eye drops: You’ll be administered eye drops before the procedure to dilate the eye. You may also need to take prescribed eye drops in the run-up to the procedure to help prevent inflammation and infection of the region. 
• Anti-anxiety medications: Talk to your healthcare provider if you’re feeling particularly anxious about the procedure; they can prescribe special medications to help you to relax.
• Local anesthesia: As the procedure isn’t performed with the patient “asleep” (general anesthesia), a local anesthetic needs to be administered to numb the area. This is also done using eye drops, or, in some cases, an injection is made. After administration, you’ll be asked to relax in the operating room for about 30 minutes to allow the medication to set in. In some cases, an intravenous line may be placed into your hand.

Importantly, while you should sit still during the procedure, the healthcare provider will advise you on how you can communicate any concerns.

During the Surgery

You will be awake, lying supine (face up) on an operating table. The procedure itself takes between 15 and 45 minutes. During the surgery your face and shoulders will be covered with drapes to ensure the area is clean and sanitary, and the healthcare provider will be using a specialized microscope to get a closer picture of the area. The main idea here is to safely remove the clouded-over lens and replace it with an IOL; this is performed by a specialized medical healthcare provider called an ophthalmologist as well as support staff. In some cases, an anesthesiologist will also be present.

Two major types of cataract surgery are indicated, depending on the scope of the cataract. These are laid out below:

• Small incision cataract surgery: Once the eye is numbed, the ophthalmologist will make a tiny incision on the cornea and inserting a specialized, small probe. This device emits ultrasound waves that break up the damaged lens, allowing the pieces to be removed, a process called phacoemulsification. After these are taken out, the healthcare provider then implants the IOL; this permanent implant is well-tolerated and can correct other vision problems, such as astigmatism (an irregular shape of the lens that causes blurry vision). The incision does not need to be stitched closed. This approach is the most popular in the U.S.    
• Extracapsular: In cases where the cataract has progressed to a point where phacoemulsification is likely to be ineffective, this approach involves a slightly larger incision. This allows the surgeon to physically remove the lens using special tools. Typically, since incisions for this type of surgery are larger, stitches will be required after the IOL is in place.

Cataract surgery is painless aside from the pinch of an injection of medication or anesthetic. In rare cases, usually when the patient is a small child or neuro-atypical, general anesthesia—putting the patient to sleep—can be employed. Be sure to talk to your healthcare provider about your options.    

After the Surgery

Immediately following cataract surgery, the ophthalmologist will do a quick evaluation and examination, and the affected eye is usually covered over with an eye shield. You’ll be taken to a recovery room and can rest as the sedating drugs and anesthetic wear off. Here are some other tips to keep in mind:

• No driving: Until your eye has healed, you should not operate motor vehicles. Your healthcare provider will tell you when it’s safe to do so.
• Don’t touch your eye: Avoid touching or rubbing your eye as much as possible in the weeks after surgery.
• Resuming activity: You may need to take some time off of physical exertions for at least a couple days following cataract surgery. Again, your healthcare provider will give you a timeline of when you an resume such activities.

In most cases, you’ll be given special eye drops as well as pain managing medication for the period of recovery. All told, it takes about eight weeks to recover fully from cataract surgery. In this time, make sure to contact your healthcare provider if you experience any of the following:

• Severe pain: While some discomfort is expected in the aftermath of this procedure, if you’re feeling pain in and around the eye despite the medications you’re taking, be sure to contact your healthcare provider.
• Problem symptoms: If you experience redness, swelling, or blurred vision in the period after surgery, something may have gone wrong, so be sure to let your healthcare provider know.
• Worsening acuity: If your vision is getting worse and worse following surgery—especially if you experienced an initial improvement—can also be a sign that the surgery has not quite worked out.

There are no dietary restrictions following this surgery. Most people are typically advised to wait before resuming physical activity. Wait to get clearance from your healthcare provider before you start working out again or go back to a physically demanding job.

As the staff will tell you, you’ll need to schedule a follow-up appointment afterward to ensure that your eye is healing appropriately. During this time, it’s absolutely essential that you follow healthcare provider's orders and are in solid communication with medical staff. Depending on the case, this may occur as soon as a day after the procedure, though, usually, this appointment takes place a week after the operation.

Notably, in rare cases, clouding can occur on the IOL, which is a condition called a secondary cataract. In these cases, an additional procedure performed using a laser—called a Yag capsulotomy. Basically, since the issue here is that the prosthetic lens has thickened, this treatment uses a laser light is used to create a small opening to remove the clouded capsule.  

A Word From Verywell

When it comes to cataract surgery, it’s important to remember that this is a very common procedure, and it’s usually well-tolerated. A vast majority of patients are satisfied with the procedure. Complications can occur, so risks and benefits of surgery should be discussed with your healthcare provider to make an informed decision. If you’re undergoing this procedure, be sure to communicate with hospital staff as well as loved ones as well. With their support, you’ll help assure the best possible outcome.