Cataract surgery in the second eye – when, how and what happens between the operations

Cataract tends to appear in both eyes, although in each eye at a different pace and severity. That is why many patients who have had cataract surgery in one eye ask what comes next: when the second eye is operated on, what happens in the period between the two operations, and how the lens for the second eye is chosen. On this page we have gathered the general information that is important to know. The decisions themselves are always made individually, together with your treating ophthalmologist.

Why is each eye operated on separately?

When there is cataract in both eyes, two separate operations are usually performed: cataract surgery is done on each eye separately, to allow the first eye to heal and to make sure there are no complications before moving on to the second eye.

There are several reasons for this approach. The first is safety: operating on both eyes on the same day is not routine, among other things because of concern about an infection that would affect both eyes at once. The second is planning: the result in the first eye, that is, the glasses prescription (the refraction) actually obtained after surgery, provides information that helps plan the operation on the second eye. The third is flexibility: if any difficulty arose in the first eye, the treatment of the second eye can be adjusted accordingly.

In addition, separating the operations allows the patient to keep functioning in daily life using the eye that has not been operated on, while the first eye heals.

When is the second eye operated on?

There is no single fixed time that suits all patients. The two operations are usually performed a few weeks apart, to allow the first eye to heal. The exact timing is decided by the surgeon, according to how the first eye is healing and the result obtained in it.

After the first operation, follow-up check-ups are scheduled. At these check-ups the doctor reviews the healing process, makes sure there are no signs of inflammation or infection and checks the improvement in visual acuity. Based on these findings, and according to the state of the cataract in the second eye, it is decided when it is right to proceed.

It is also important to know that the second eye does not always need to be operated on right away. The decision to operate is usually made at the stage when the cataract significantly affects vision and quality of life. In some patients the cataract in the second eye is still mild, and then the doctor may recommend monitoring at this stage.

The period between the operations: imbalance between the eyes

The period between the first and second operations is sometimes the less comfortable part of the process. The operated eye now sees through a new, clear lens, while the other eye still sees through a cloudy lens. This difference between the two eyes may be noticeable.

What patients may experience during this period:

• A difference in brightness and colors: the operated eye may see colors as brighter and sharper than the other eye.
• A feeling of imbalance: if the glasses prescription of the operated eye has changed, the eyes may work together less well, and in some cases a feeling of discomfort or a headache may appear.
• A change in depth perception: many patients experience temporary changes in depth perception and in the field of vision when only one eye has been operated on.

When planning the first operation, the doctor also takes the second eye into account. The intraocular lens makes it possible to restore one eye so that it matches the vision in the second eye that has not yet been operated on. In rare cases the patient cannot tolerate full correction of the refraction, because the result is not balanced relative to the other eye. In most cases the feeling of imbalance passes once the second eye has also been operated on. If it greatly interferes with daily functioning, it is worth telling the doctor, because this may affect the planned timing of the second operation.

Glasses in the period between the two eyes

One of the common questions is what to do about glasses. When the glasses prescription of the operated eye has changed, the old glasses no longer suit it, and in some cases a situation arises in which no pair of glasses feels quite right.

Usually there is no rush to fit new glasses immediately after surgery. Patients who wear glasses will need to wait several weeks before new lenses are fitted, since the prescription may change slightly during recovery. It is therefore common practice to fit permanent glasses only after vision has stabilized, and often only after both eyes have been operated on.

Until then, the doctor or optometrist may suggest a temporary solution suited to your specific situation. It is worth asking about this already at the check-up after the first operation. More information about fitting glasses after surgery is available on the page Glasses after cataract surgery.

Choosing the lens for the second eye

Usually the type of lens and the vision plan for both eyes are decided together, even before the first operation, according to the patient's lifestyle and personal needs. In this way the lens in the second eye complements the result in the first eye and is not chosen as a separate decision.

A few general principles:

• The result in the first eye helps plan the second. The data obtained from the first eye after surgery allow the doctor to refine the lens calculation for the second eye and, if necessary, to update the plan.
• Consistency between the eyes. When an advanced lens is chosen, for example a multifocal lens, it is usually considered for both eyes, so that the eyes work together in a balanced way. The final decision is made together with the surgeon.
• Astigmatism correction is considered for each eye separately. A toric lens is matched to the astigmatism of the eye in which it is implanted, so it may be suitable for one eye only.
• Monovision is an approach in which one eye is corrected for distance vision and the other eye for near. Not all patients adapt to it, and some patients feel uncomfortable with the difference between the eyes. If this approach is being considered, it is important to discuss it with the doctor before the first operation.

For a detailed comparison of lens types, see the page Types of lenses in cataract surgery.

Can both eyes be operated on the same day?

Cataract surgery on both eyes on the same day is not the routine approach. The reasons mentioned above, chief among them the concern about infection in both eyes, the ability to refine the result in the second eye based on the first, and the ability to change the treatment if a difficulty arose in the first eye, are what lead most surgeons to perform the operations separately.

On the other hand, surgery on both eyes on the same day has possible advantages, such as convenience for the patient and fewer visits for treatment. The decision on such an approach, if at all, is an individual medical decision made with the surgeon after assessing the condition of the eyes. If this matters to you, it is worth raising it already at the first consultation.

Recovery in the second eye

Recovery in the second eye is usually similar to recovery in the first eye. In most cases the initial improvement in vision occurs within a few days, and full recovery usually takes four to eight weeks. After surgery, eye drops are used, usually for several weeks, to protect the eye from infection and inflammation.

The post-operative instructions are also the same: avoid pressing on the eye, rubbing it or touching the operated area, avoid lifting heavy objects and strenuous physical activity, and avoid swimming in the first weeks. The experience in the second eye may be slightly different from the first, so it is recommended not to compare them but to follow the doctor's instructions for each eye. Anyone having surgery on both eyes should take into account that the overall recovery period is longer, and plan work and travel accordingly. If unusual signs appear, such as severe pain, a sudden drop in vision or severe redness, contact your treating doctor immediately. Full details are available on the page Cataract surgery recovery.

How much does surgery on the second eye cost?

In private surgery, the price is usually quoted per eye, so surgery on both eyes includes two operations and two lenses. If you chose an advanced lens or a laser add-on, these extras are also usually charged per eye. It is a good idea to ask for a price quote that details the cost of each eye and what is included, including the follow-up check-ups. Information about price ranges is available on the page Cataract surgery price.

Summary

Cataract surgery on the second eye is usually a planned continuation of the treatment of the first eye. The timing is decided by the surgeon according to the healing and the result in the first eye, the lens is planned to complement the first eye, and in the period between the operations it is worth being prepared for a temporary imbalance between the eyes. Ask the doctor already at the first consultation what the plan is for both eyes, so that you know what to expect all along the way.