Cataract Surgery: Risks, Recovery, Costs

The purpose of your lens is to bend (refract) light rays that come into the eye to help you see. Your own lens should be clear, but with a cataract it is cloudy. Having a cataract can be like looking through a foggy or dusty car windshield. Things may look blurry, hazy or less colorful.

The only way to remove a cataract is with surgery. Your ophthalmologist will recommend removing a cataract when it keeps you from doing things you want or need to do.

During cataract surgery, your cloudy natural lens is removed and replaced with a clear artificial lens. That lens is called an intraocular lens (IOL). Your ophthalmologist will talk with you about IOLs and how they work.

What to Expect with Cataract Surgery

Before surgery:

Your surgeon will measure your eye to determine the proper focusing power for your IOL. Also, you will be asked about any medicines you take. You might be asked not to take some of these medicines before surgery.

You may be prescribed eye-drop medicines to start before surgery. These medicines help prevent infection and reduce swelling during and after surgery.

The day of surgery:

Your ophthalmologist may ask you not to eat any solid food at least 6 hours before your surgery.

Cataract removal surgery may be done in an outpatient surgery center or in a hospital. Here is what will happen:

With phacoemulsification

cataract surgery, an ultrasound

instrument breaks up the center

of the cloudy lens and suctions

it out.

• Your eye will be numbed with eye drops or with an injection around the eye. You may also be given a medicine to help you relax.
• You will be awake during surgery. You may see light and movement during the procedure, but you will not see what the doctor is doing to your eye.
• Your surgeon looks through a special microscope. She creates tiny incisions (cuts, created by blade or a laser ) near the edge of your cornea. The surgeon uses these incisions to reach the lens in your eye. Using very small instruments, he or she will break up the lens with the cataract and remove it. Then she puts your new lens into place.
• Usually your surgeon will not need to stitch the incisions closed. These “self sealing” incisions will close by themselves over time. A shield will be placed over your eye to protect it while you heal from surgery.
• You will rest in a recovery area for about 15–30 minutes. Then you will be ready to go home.

How Long Does It Take To Recover From Cataract Surgery?

Days or weeks after surgery:

• You may have to use eye drops after surgery. Be sure to follow your doctor’s directions for using these drops.
• Avoid getting soap or water directly in the eye.
• Do not rub or press on your eye. Your ophthalmologist may ask you to wear eyeglasses or a shield to protect your eye.
• You will need to wear a protective eye shield when you sleep.
• Your ophthalmologist will talk with you about how active you can be soon after surgery. He or she will tell you when you can safely exercise, drive or do other activities again.

What Are the Risks of Cataract Surgery?

Like any surgery, cataract surgery carries risks of problems or complications. Here are some of those risks:

• Eye infection.
• Bleeding in the eye.
• Ongoing swelling of the front of the eye or inside of the eye.
• Swelling of the retina (the nerve layer at the back of your eye).
• Detached retina (when the retina lifts up from the back of the eye).
• Damage to other parts of your eye.
• Pain that does not get better with over-the-counter medicine.
• Blurred vision.
• Seeing halos, glare, and dark shadows.
• Vision loss.
• The IOL implant may become dislocated, moving out of position.

Cataract surgery will not restore vision lost from other eye conditions, such as macular degeneration, glaucoma, or diabetic retinopathy.

Your ophthalmologist will talk with you about the risks and benefits of cataract surgery.

Posterior Capsular Opacification

Your vision could become cloudy or blurry weeks, months or years after cataract surgery. This is not unusual. Your doctor might call this a “posterior capsular opacification (or PCO).” It's also called "secondary cataract" or "scar tissue." It's not like a scar you get on your skin. But because it happens after the eye has healed from cataract surgery, some people think of it as a scar. It happens when a membrane called the posterior capsule becomes cloudy. It might help to think of the posterior capsule as a transparent pocket. It holds your IOL in place. It also once held your eye’s natural lens (what became the cataract) in place. If you notice cloudy vision again, you might need to have a laser procedure. The laser creates an opening in the cloudy capsule and is called a posterior capsulotomy (or a YAG laser capsulotomy). This procedure helps restore clear vision.

Cataract Surgery Costs

Cataract surgery costs are generally covered by Medicare if you are Medicare eligible. Private insurance usually covers cataract surgery as well.

Medicare will cover your costs if your vision tests at a certain level of acuity or clarity. Private insurance plans may have similar vision requirements. If your surgery is covered you may still have some costs. Special types of IOLs will cost more. Choosing to have cataract surgery before your vision has deteriorated enough will cost more.

In certain cases, it might be possible to get coverage before you meet the age or vision requirements. Talk with your ophthalmologist if you are considering having early cataract surgery.

What do you do if you don't have Medicare or private insurance coverage? You may still be able to reduce and manage the cost of cataract surgery. Ask about payment plans through your doctor's office. See if your employer offers flexible spending accounts that can help. Your ophthalmologist can help you learn more about costs of cataract surgery. Discuss your options for affording the procedure.