Cataract surgery: what to know before you decide

Who it is for

• People whose cataract is limiting daily life: reading, driving at night, recognising faces, or managing steps and kerbs.
• People whose glasses no longer correct their vision well enough because of the cataract.
• If the cataract is not yet limiting your daily life, waiting with a periodic review is usually reasonable, and you are told so.

What happens, step by step

1. Consultation.Vision test, eye pressure check, examination of the front of the eye, and a dilated examination of the retina.
2. Measurements.Optical biometry and corneal measurements, used to calculate the power of the lens implant.
3. Lens discussion.Monofocal, toric and multifocal or extended-depth lenses are explained with their trade-offs. See lens options.
4. Before the day.Blood pressure and blood sugar are checked as advised, and your regular medicines are reviewed.
5. Surgery.Dilating and numbing drops. The cloudy lens is removed through a small incision by phacoemulsification and a folded artificial lens is placed. Usually one eye is operated at a time.
6. Going home.You go home the same day with an eye shield and a written schedule of drops.
7. Reviews.Review visits are scheduled after surgery, and the dates are written down for you.

Which tests are done, and why

• Optical biometry.Measures the length of the eye and the curve of the cornea. The lens power is calculated from these numbers.
• Corneal topography.Maps the shape of the cornea and shows astigmatism, which decides whether a toric lens is worth discussing.
• OCT of the macula.A scan of the centre of the retina. Its health affects how much vision can improve after surgery and which lenses are suitable.
• Eye pressure and dilated retina examination.Checks for glaucoma and retinal conditions that need to be known before surgery.
• Image-guided planning.A reference image of your eye is used to plan the incision and the lens alignment.

What you feel

• The measurements and scans are painless. You rest your chin, look at a light, and each takes a few seconds to a few minutes.
• Dilating drops sting briefly and blur near vision for a few hours.
• During surgery you are awake and the eye is numbed. You see light and movement, and you may feel touch or pressure. Tell the surgeon if you feel pain.
• For the first few days the eye can feel scratchy, watery and sensitive to light.

Recovery, in days and weeks

• Day of surgery.Rest at home. Vision is often blurred on the first day. Wear the eye shield at night as instructed.
• First week.Use the drops on schedule. Do not rub the eye. Keep water, soap and dust out of it. Avoid heavy lifting and swimming. Walking, television and reading are usually fine.
• Weeks two to four.The drops are reduced as written in your schedule. Most everyday activities return in this period, on the surgeon's advice.
• About one month.Once the eye has settled, your glasses power is checked and new glasses are prescribed if needed.
• The second eye.If the other eye also needs surgery, its timing is decided at your review.

What you are told before you consent

• What the examination and measurements show, in plain language.
• The options for your eye, including waiting or not having the procedure.
• What the procedure is expected to do, and what it cannot do.
• The risks that apply to your eye in particular.
• A written estimate, and whether your insurance policy is likely to apply.
• You do not need to decide on the day of the consultation. Nothing is scheduled without your signed consent.

How much time to keep

• First consultation: around an hour. Dilating drops take 20 to 30 minutes to work, and measurements or scans add to this.
• Day of surgery: the procedure usually takes well under an hour. Keep about half a day for preparation and rest afterwards.
• Review visits are short. Bring your drops and your written schedule each time.

What affects the cost

• The lens selected. This is usually the largest single factor.
• Whether astigmatism is corrected with a toric lens.
• The complexity of your eye, if it needs additional planning or steps.
• Whether the surgery runs through cashless insurance or is self-funded, and what your policy covers.

A written estimate is given after the consultation, once your eyes have been examined.

What to bring

• Your current glasses and any earlier prescriptions.
• Earlier eye reports, scans and discharge summaries.
• A list of all medicines you take, including blood thinners, diabetes and blood pressure medicines.
• Your insurance or TPA card and a photo ID, if you plan to use cashless.
• Someone to accompany you. If your eyes are dilated you should not drive yourself home.