Cataract Surgery: When to Have It and What to Expect

Recognising cataract

• Gradually blurring or cloudy vision, like looking through frosted glass
• Glare and haloes around lights, particularly while driving at night
• Colours appearing faded or yellowed
• Frequent changes of spectacle prescription
• Difficulty reading in dim light
• Double vision in one eye
• A temporary improvement in near vision — 'second sight' — which then deteriorates

The maturity myth

Older surgical techniques required a hard, mature cataract for removal. Modern phacoemulsification does not — and in fact a mature, dense cataract is harder to remove, takes longer, and carries a higher rate of complications.

The correct timing is when vision interferes with what you want to do: reading, driving, cooking, working, recognising faces, or moving about safely. There is no benefit whatsoever in waiting beyond that point.

What the surgery involves

The procedure takes fifteen to thirty minutes under local anaesthesia, usually with eye drops alone. A small incision is made, the cloudy lens is broken up with ultrasound and removed, and a clear artificial intraocular lens is placed. Most cases require no stitches, and patients go home the same day.

Lens options include monofocal lenses, which give excellent distance vision with reading glasses needed for near work, and multifocal or extended-depth-of-focus lenses, which reduce spectacle dependence but cost more and can cause haloes at night. Toric lenses correct astigmatism. Discuss which suits your eyes, work and budget.

Recovery

• Vision improves within a day or two and stabilises over four to six weeks
• Use prescribed eye drops exactly as directed — this is the most important part of recovery
• Do not rub the eye; wear the protective shield at night as advised
• Avoid dusty environments, swimming and heavy lifting for the advised period
• Avoid bending forward with the head below waist level for a few weeks
• Attend all follow-up appointments, usually next day, one week and one month
• New spectacles are prescribed after four to six weeks

Report immediately after surgery if

• Sudden pain not relieved by prescribed medication
• Sudden decrease in vision
• Increasing redness or discharge
• Flashes of light or a shower of new floaters
• Nausea and vomiting with eye pain

After a few years: posterior capsular opacification

Some patients notice vision clouding again months or years after successful surgery. This is usually not a 'cataract returning' — the natural lens has been removed and cannot re-form. It is thickening of the membrane behind the implanted lens.

It is treated with a YAG laser capsulotomy: a painless outpatient procedure taking a few minutes, with vision improving almost immediately and no recovery period.