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

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

What Happens Before the Surgery?

When can I eat before cataract surgery?

Generally, you can eat up until midnight the night prior to your surgery. In other words, no breakfast allowed including fluids such as milk or coffee. If your surgery is to take place later in the day, your surgeon may specify a different time. Please remember to not eat breakfast the morning of your procedure. It can be very frustrating to go through all the preparation and then have your procedure canceled or do the surgery with no sedation because you ate.

Since I am fasting, should I take my regular medications as usual the morning of my procedure?

Yes, you should take your medications as usual unless directed to do otherwise by your surgeon. Many times, patients will arrive at the surgery center without having taken their medications and their blood pressure or blood sugar is elevated. In most cases, we are able to normalize these levels and perform the surgery as scheduled, but occasionally surgery is cancelled due to high blood pressure or blood sugar. If you need to take medications in the morning, drink only a sip of water with the medications.

If you are taking eye drops for glaucoma, it is very important to use them as usual unless your surgeon instructs you to do otherwise.

Do I need to start eye drops before the surgery?

Most eye surgeons recommend that their patients start their medicated eye drops a few days before cataract surgery. There are several reasons that this may be beneficial. The antibiotic eye drop may decrease the number of bacteria living in your eye and reduce the risk of infection. The anti-inflammatory and steroid drops may help your eye to be more comfortable and heal quickly if started before the procedure. Finally, by starting the medications before your surgery, you will have a few days to work on any medication problems such as formulary restrictions or a pharmacy that needs to order the medication for you. If you are unable to start the medications prior to the surgery, do not be concerned. You are likely to have great results from the surgery even if the drops are started that day. Occasionally we get phone calls with panicked patients thinking that their surgery needs to get canceled because they forgot to take the eye drops.

What Should I Expect on the Day of Surgery?

Cataract Surgery Day: Why do I need someone to drive me home after surgery?

You will require a driver on cataract surgery day. You will be receiving medications for sedation during the procedure and will not be able to operate a motor vehicle safely until the effects of these medications wear off in a few hours. You may feel normal and safe to drive, but for your safety and the safety of those around you, it is best to have the assistance of another driver on the day of surgery. If you arrive at the surgery center without a driver, your surgery may be canceled. If you run into difficulties finding a friend, neighbor, or family member who can drive you on your surgery day, please call our surgery scheduler. There are often community resources available that could help you get the required transportation.

How early should I arrive at the surgery center and what should I bring and wear?

On cataract surgery day, plan to arrive at the surgery center at the time indicated by your surgery scheduler. This is usually one hour prior to your scheduled surgery time. This will provide the staff enough time for checking you in and getting you prepared for the surgery. Please bathe or shower in the evening or the morning of your surgery. Avoid wearing makeup. Do not bring jewelry or valuables if possible. Wear comfortable loose-fitting clothes. Bring your eye medications so the nurses can confirm that you have the correct bottles.

What happens before my cataract surgery?

When you arrive at the surgery center you will have some paperwork to fill out. Any co-pays or deductibles related to the surgery will also be collected. Please remember to bring a credit card or check book to the surgery center. Several things happen in the pre-operative area. This is where you will be prepared to have your surgery done. Your vital signs (blood pressure, blood sugar, heart rate, temperature) will be checked by a nurse. An IV line may be inserted to allow sedating medications to be administered before and during the procedure. You will also be given eye drops to help dilate your pupil to allow the surgeon a good view of the cataract. Other eye drops anesthetize the eye so you do not feel pain during the procedure. The nurses will have you lay on a bed where you can relax while you are waiting for your surgery appointment.

What can I expect during my cataract surgery?

In the operating room, you will first be positioned properly for surgery. This is lying comfortably on your back with a small cushion under your head and neck. The anesthesiologist or nurse anesthetist will begin administering the relaxing medicines through your IV to help you feel comfortable. The perfect amount of sedation will make you comfortable but not asleep. Patients who get too much sedation can become confused and wake up suddenly with dangerous movements that could cause problems with the procedure. Therefore, we want you relaxed but not completely asleep. If you have a high level of anxiety, please share this with the anesthesiologist. In this case extra medications can be given. A nurse will then cleanse the skin around the eye with an antiseptic (Povidone iodine). After this is done, you will be covered with a sterile drape which covers your face and upper body. This can be a little claustrophobic but the drape is very light and there is plenty of air underneath. If you need to cough or clear your throat after the surgery has started, let your surgeon know before doing so.

A small wire (speculum) is used to keep your eye open during the surgery. You don’t have to worry about blinking because the speculum will hold your eye open. It is best for you to keep both eyes open during the procedure. Once the speculum is placed, your primary responsibility is to look straight ahead at the bright microscope lights at all times. This places your eye in the perfect position for the surgeon. The best way to avoid pain is to keep both of your eyes open and relaxed.

During the surgery, you will see bright lights. Some patients describe a kaleidoscope with lots of vibrant and beautiful colors. You may feel a pressure sensation as the cataract is removed and the new lens implant is inserted into your eye. You should not feel any sharp pain. If you experience pain, let your surgeon know and more medication can be given to help relieve the pain. This medication may burn slightly when it is given, but your eye will be numb in a few seconds. You will hear the buzz of the instrument used to break up the cataract and you may feel cool water on your face. These are all normal aspects of the surgery. A typical cataract surgery takes between 10 and 20 minutes. It usually done before you know it.

What happens in recovery?

In the recovery area, the nursing staff will make sure you are stable before releasing you to your designated responsible party. You can have a drink and a little snack. They will also go over important information, including how to use your eye drops and what to do in the event of an emergency. Because you may still be sleepy, it is helpful to have another adult available to listen to the instructions. We will do all we can to make your cataract surgery day a smooth and gentle experience.

What Happens After the Surgery?

After Cataract Surgery – What I can I expect?

You will most likely have three follow-up appointments after your cataract surgery. Your first follow-up appointment is the day after your surgery. We also recommend that you have a driver for this visit. This is not an absolute requirement but is probably safer for you because of possible blurred vision. At this appointment, your vision and eye pressure will be checked, and detailed instructions will be given for the eye drops you will use. We generally expect that the vision will be a little blurry, but this should improve in the first few days following surgery. It is not unusual to have an elevated eye pressure for the first few days after the surgery. If the eye pressure is elevated, you may need to use an additional eye drop to help lower the pressure.

The second follow-up appointment usually takes place about 1-2 weeks after the surgery. Usually, the schedule for your eye drops will be changed at this appointment and reviewed with you. Your eye may be dilated again at this appointment to allow a thorough examination of the retina.

The final follow-up appointment happens about 1 month after the cataract surgery. At this appointment, you will be checked for a prescription for eyeglasses. Most patients at this appointment will be instructed to stop using all of the surgery-related eye drops.

In general, your eye should feel better and have better vision each day after the surgery. If a day or two passes and you notice worsening symptoms of pain, redness, or blurred vision, contact your doctor immediately.

Which Dr. will I see for my post-operative care?

Your surgeon bears primary responsibility for making sure that your surgery has the best outcome. You will almost always see your surgeon on the day after the surgery. If you have a family optometrist, they can also see you for some of your post-operative care. You might choose to have follow-up visits with your optometrist if their office is more conveniently located, or you have a relationship with that doctor that would make your follow-up care more comfortable in their office. Shared post-operative care is known as co-management. If you choose to have your follow-up care with your optometrist, it is important that you know that you can return to your surgeon at any time or with any problems.

Are there any activity restrictions after surgery?

Modern cataract surgery has a very quick recovery and there are minimal activity restrictions.

  • Do not rub your eye for at least the first week after surgery. If you rubbed your eye you could push open the incision and cause an infection.
  • Avoid strenuous activities for one week after the surgery such as lifting heavy rocks in the garden, or high impact exercise. Normal household activities are generally safe.
  • There are no restrictions with bending or lifting most household objects.
  • You may bathe or shower the day after your surgery. Keep your eye closed while you shower and avoid getting water to directly into the eye.
  • You should not swim or bathe with your face under the water for one week after the procedure. You can be in a pool if you keep your head above water.

What vision changes should I expect?

After cataract surgery, most patients with healthy eyes end up having vision that would allow them to pass the DMV vision test without eyeglasses. Many patients are amazed by the brightness of colors and the clarity of their vision. Most people find that after cataract surgery they are able to perform their normal distance visual tasks without a significant need for glasses. Things we hear…

  • Doctor, I didn’t notice how dirty my house was! Now I can see the dirt on the floor and have to do a deep house cleaning.
  • Doctor, I looked in my closet and found out that my black dress is really navy blue. Colors are so bright now.
  • I can see the rocks and trees on the mountains miles away.

What about my glasses after the surgery?

Within a few days after your surgery, your vision will likely have improved to a point where you see better without glasses. If this is your first cataract surgery and you are nearsighted or farsighted, you probably will still need your glasses to sharpen the vision in your other eye. This can feel awkward because one eye needs glasses and the other one does not. A good way to cope with the change in your vision is to remove the lens from your glasses in front of the surgical eye. If you have difficulty doing this at home, most glasses stores such as LensCrafters can help you. Another option is to just keep your glasses on in which case the surgical eye will not see clearly, or remove the glasses completely in which case the nonsurgical eye cannot see clearly. If you have a cataract in the other eye, doing that surgery within a few weeks can start the recovery process faster and help give you equal vision.