Cataract Surgery: What to Expect Before, During, and After

Cataract surgery (phacoemulsification with intraocular lens implantation) is among the safest and most effective surgeries performed today. Over 95% of patients achieve improved vision.

Preoperative

• Comprehensive eye exam: Refraction, slit-lamp, dilated fundus exam, biometry (IOL power calculation), corneal topography, OCT macula.
• Discuss IOL options: Monofocal (distance), toric (astigmatism), multifocal/EDOF (presbyopia correction), light-adjustable.
• Pre-op drops: Antibiotic + NSAID/steroid (start 1–3 days prior).
• Medication review: Anticoagulants usually continued; alpha-blockers (tamsulosin) increase intraoperative floppy iris syndrome (IFIS) risk—inform surgeon.
• Fasting: NPO after midnight (IV sedation).

Day of Surgery

• Outpatient; 2–3 hours total; surgery takes 10–20 minutes.
• Topical anesthesia (drops) ± IV sedation (awake, relaxed).
• Phacoemulsification: 2.2–2.8 mm corneal incision → ultrasonic probe emulsifies lens → aspiration → foldable IOL injected into capsular bag.
• No sutures typically (self-sealing incision).

Postoperative

• Shield worn home; remove next morning.
• Drops: Antibiotic × 1 week, steroid × 4–6 weeks (taper), NSAID × 3–4 weeks.
• Restrictions (1–2 weeks): No heavy lifting (>15 lbs), bending, eye rubbing, swimming, eye makeup, dusty environments.
• Vision: Blurry initially; improves over days–weeks. Fluctuation is normal.
• Follow-up: 1 day, 1 week, 1 month (or per surgeon).

Recovery Milestones

• Day 1: Light activity OK; vision hazy.
• Week 1: Most daily activities; driving if vision meets legal standard.
• Month 1: Stable refraction; glasses prescribed if needed (monofocal IOLs need reading glasses).
• Months 2–3: Full healing; YAG capsulotomy if posterior capsular opacification (PCO) develops (20–30% at 2–5 years).

Complications (Rare)

• Infection (endophthalmitis) <0.1%.
• Retinal detachment (higher in high myopes).
• Cystoid macular edema (CME) — treated with NSAID/steroid drops.
• IOL dislocation, iris damage, corneal edema.

Long-Term Outcomes

• Durable vision improvement; IOLs do not degrade.
• Presbyopia-correcting IOLs reduce glasses dependence (trade-offs: halos, contrast sensitivity).
• Regular eye exams still needed for glaucoma, macular health, etc.

Modern cataract surgery is a refractive procedure—customizing vision for your lifestyle. Discuss IOL options thoroughly with your surgeon.