Cataract surgery - How it's performed 

How cataract surgery is performed 

Cataract surgery

Having a cataract removed is one of the most common operations in the UK. Consultant ophthalmologist Mark Wilkins explains what's involved.

Media last reviewed: 28/03/2014

Next review due: 28/03/2016

Meet the ophthalmic team

If you have cataracts, a number of different health professionals may be involved in your care. Some of the professionals you may see are described below:

  • optometrist – examines eyes, tests sight and prescribes and dispenses spectacles and contact lenses; they are trained to recognise eye conditions and sight defects
  • ophthalmic medical practitioner – a medical doctor who specialises in eye care; they examine eyes, test sight, diagnose abnormalities and prescribe corrective lenses
  • ophthalmologist – a medical doctor who specialises in eye conditions and their treatment; they mainly work in hospitals and hospital eye departments
  • dispensing optician – fits prescriptions for spectacles provided by optometrists, ophthalmic medical practitioners, or ophthalmologists; they may also fit contact lenses, but do not carry out eye examinations 
  • orthoptist – specialises in problems relating to eye movement and the eyes working together, including squintlazy eye and double vision
  • ophthalmic nurse – a nurse who has developed skills in eye care; they work in hospital eye departments

Before having cataract surgery, you will be referred to a specialist eye doctor (an ophthalmologist or ophthalmic surgeon) for an assessment.

The specialist will assess your eyes and general health, and particularly check for any other eye conditions that may be affecting your vision.

A member of the eye care team will take measurements of your eyes to assess the strength of the artificial lens that will replace your natural lens.

This is also a good time to discuss the procedure in detail and ask any questions.

If you have cataracts affecting vision in both eyes, surgery will normally be carried out on two separate occasions, usually 6 to 12 weeks apart.

This gives the first eye time to heal and your vision time to return. It also allows the surgeon to know your new glasses prescription in the first eye.

The procedure

Cataract surgery is a common and relatively straightforward procedure that normally takes up to 30 to 45 minutes. It is usually carried out as day surgery under local anaesthetic, which means you are awake during the procedure and you can go home on the same day.

The most common surgical technique used is known as phacoemulsification.

Before the operation, a nurse will put drops in your eye to dilate (widen) your pupil. A local anaesthetic will also be given, which can be applied as eye drops or given as an injection into the tissue around the eye.

The surgeon then makes a tiny cut in your cornea (the transparent layer at the front of your eye). A small probe that emits ultrasound waves (high-frequency sound waves) is inserted through your cornea into the eye to break the affected lens into pieces. These pieces are then liquified and sucked out. A second probe sucks out the remaining soft pieces of outer lens.

When the affected lens has been removed, the surgeon inserts a small plastic lens in its place. The replacement lens is usually curled up in an injector and injected through the cut in the cornea. When it is in place, it unfolds itself and adopts the natural position of the old lens.

In a few cases, it may be necessary to make a slightly larger incision in the eye to replace the affected lens, which may need to be closed with tiny stitches that are removed a few weeks later. 

Replacement lenses

When the cloudy lens is removed, it is replaced with an artificial clear plastic lens. This replacement lens is called an intraocular implant, or intraocular lens (IOL).

There are three types of IOL available:

  • fixed strength (monofocal) lenses, which are set for one level of vision, usually distance vision – these are used in the vast majority of cataract operations
  • multifocal lenses, which can be set at two or more different strengths, such as near and distance vision
  • accommodating lenses, which allow the eye to focus on both near and distant objects, in a similar way to a natural lens

Using multifocal or accommodating lenses can potentially reduce the chances of needing reading glasses after surgery, although most people will need to wear glasses in some situations after surgery regardless of the type of lenses they had fitted.

Multifocal and accommodating lenses are also not usually available on the NHS. Ask your ophthalmologist about the type of lenses available in your area before having surgery. If NHS funding is not available for the type of lens you want, you may be able to have it by paying for the cataract surgery privately.

After surgery

Most people are able to go home a few hours after having cataract surgery, although you will need to arrange for someone to collect you and take you home. You will usually go home with a pad over your eye.

It is also a good idea to arrange for someone to help look after you when you get home, as you may feel out of sorts for 24 hours.

If the vision in your other eye is poor, you may struggle with your vision for the first few days as it settles down. It's likely you will experience some discomfort in and around your eye after the procedure, but this should improve within a few days.

Complications in the days and weeks after surgery are rare, but you should contact the hospital as soon as possible if you experience increasing pain or vision loss at any point.

Read more about recovering from cataract surgery and the risks of cataract surgery.

Page last reviewed: 12/03/2014

Next review due: 12/03/2016

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Comments

The 4 comments posted are personal views. Any information they give has not been checked and may not be accurate.

paigntondi said on 02 May 2014

I had my second cataract operation yesterday with the same excellent results as the first. It was carried out on the NHS at my local hospital and I now have wonderful vision in each eye after 60 years of wearing very strong glasses to counteract my short sight. Even my diabetes and glaucoma have not been a problem, so many thanks to the team at Torbay.

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Shirrmontana said on 21 July 2013

Having had cataracts for a few years, discussed the option of having them removed, I'm relatively young, so was told the op weould be straight forward and within a couple of days would have perfect distance vision.

It's now 2 weeks since the op and I still can't see properly/clearly out of the eye I had operated on. I went back to the Eye Hospital, they assured me everything was fine, am now on an intensive course of Steroids 1 week of every 2 hours day and night, next week 6 times daily, then another week 4 times days, another week of 3 times daily, then twice a day for a week, then once a day for a week, plus strong anti-biotic drops 4 times a day for 6 weeks. I have no infection, some inflammation at the back of the eye, but still can't see. it's like everything has a ghost, night time street light has flares coming out of them, definitely not what I expected. I can't see anything clearly either close up or distant and with the vision in my other eye poor because of cataracts I am now struggling to cope day to day. I'm praying this is only temporary, but please be aware, it's not the quick fix (if at all) it's made out to be.

Am now waiting to see if the operated eye clears, if not then I don't know what to do about the other, at this rate I'm going to be totally blind :(

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Uttambhai D Mistry said on 29 December 2012

I am in my mid-60s. I underwent cataract surgery in my left eye 10 days ago at the Royal Bolton Hospital. My post-operative follow-up was carried out yesterday by an ophthalmologist.

My right eye was eviscerated at young age following serious injury received from a car accident. I depended on my left eye which served me very well until a few months ago when I started to develop a cataract and my vision had become dim and cloudy.

Not having the security of any vision in my right eye, I was at first quite apprehensive when I had to decide whether to go ahead with a cataract surgery which had been offered to me. I need not have feared as the specialist surgeon who performed the operation was highly experienced. My pre-operative assessment was comprehensive. The operation took less than 30 minutes. At my follow-up appointment, the ophthalmologist told me encouragingly that the operation had gone very well indeed. He was able to put me at ease by answering all questions that had troubled me.

The staff at the Eye Unit were very helpful and caring at all stages. I would have no hesitation in recommending NHS cataract surgery.



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Mary Fisher said on 16 February 2012

I had cataract surgery this morning at St James', Leeds. My eye feels gritty and smarts a little and my vision isn't very good right now - I can't even wear my specs because of the eye 'patch'.
This video was very helpful in the weeks before the surgery and after watching it again I realise that my experience was exactly as shown in the film.
My expectation is that the results will be as good as expected and I look forward to having the second eye done.I can't praise the team -= from assessment to now - highly enough, they even coped with all my questions more than adequately. They are skilled at all levels of the profession.
Cataract surgery is recommended by this patient!

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