Preparing for cataract surgery – what happens before the operation and on the day of surgery

Cataract surgery is one of the most common operations, but people having it for the first time usually ask the same questions: which tests are needed, what to do with medications, whether fasting is needed, and what exactly will happen on the day of surgery. On this page we have gathered the main steps, from the tests before the surgery to going back home. The exact instructions are always given by the medical team, and they may differ from center to center and from person to person.

Tests before the surgery

Preparing for cataract surgery starts with an examination by an ophthalmologist. During the exam the doctor checks visual acuity and the condition of the lens, as well as the other parts of the eye, such as the cornea and the retina. It is important for an ophthalmologist to examine all parts of the eye, not just the lens, to make sure that the cataract is indeed the main cause of the reduced vision.

An important part of the preparation is measurements of the eye. These measurements are used to calculate the power of the artificial lens that will be implanted in the eye, so they have a direct effect on vision after the surgery.

People who wear contact lenses may be asked to stop wearing them for a certain period before the measurements. Contact lenses can temporarily change the shape of the cornea and so affect the accuracy of the calculation. The doctor or the team will tell you whether and when to stop.

At the same stage there is also a discussion about the type of lens and the vision plan: whether the goal is good distance vision, whether there is astigmatism that is worth correcting, and whether an advanced lens is suitable. More information about the different options is on the page Types of lenses in cataract surgery.

In the pre-operative assessment the doctor will also ask about your background illnesses, your regular medications, sensitivities and allergies, and the condition of the eye. If you have a chronic disease such as diabetes, you need to make sure it is well controlled before the surgery. More on this on the page Cataract surgery and diabetes.

Medications and drops before the surgery

It is a good idea to bring an up-to-date list of all your medications to the pre-operative tests, including over-the-counter medications, dietary supplements and eye drops. Do not change or stop medications on your own. If a change is needed, for example in blood thinners, the instructions will be given by the medical team in coordination with your treating doctor.

It is important to tell the ophthalmologist if you take, or have taken in the past, medications for prostate problems. Some of these medications can affect how the iris behaves during the surgery, and the surgeon prepares for this in advance when he knows about them.

Sometimes the doctor asks you to start eye drops already before the surgery. If you received such instructions, follow them exactly, including the date on which you should start.

Do I need to fast before cataract surgery?

The instructions about eating and drinking depend on the type of anesthesia and on the center where the surgery is done. Cataract surgery is usually done under local anesthesia, and sometimes a mild sedative is also given. Some centers ask you to stop eating and drinking a few hours before the procedure, and some allow a light meal. Follow the instructions you receive, and if you have diabetes, ask in advance what to do with your medications on the morning of surgery.

What to prepare and what to bring on the day of surgery

• An escort and a ride: you must not drive after the surgery, so plan in advance who will take you home.
• Your list of medications, medical documents and an ID.
• Comfortable clothes. Do not put makeup or creams around the eyes on the day of surgery.
• It is a good idea to wash your hair and shower before the surgery, because in the days after it you need to be careful about water and soap in the eye. See also What not to do after cataract surgery.
• Sunglasses for the way home, because the eye may be sensitive to light.

What happens on the day of surgery – step by step

Check-in and preparation: you arrive at check-in, and the team confirms your details and the eye that will be operated on. After that, drops to dilate the pupil and numbing drops are put in the eye. This stage takes time, so the wait until the surgery itself is sometimes longer than the surgery.

In the operating room: you lie on your back. The area around the eye is cleaned and covered with a sterile drape, and a gentle device keeps the eyelids open so there is no need to blink. The patient stays awake during the procedure but does not feel pain. Many people describe a feeling of slight pressure, and they see light and movement, but not details. It is important to lie still and listen to the surgeon's instructions.

The surgery itself: the surgeon makes a small incision at the edge of the cornea, breaks the cloudy lens into small pieces and removes them from the eye, and implants an artificial lens in its place. In most cases the incision is small enough that no stitches are needed. The surgery usually takes between 15 and 30 minutes. More information is on the page What is cataract surgery.

After the surgery: you rest for a short time on site, receive an explanation about the drops and the instructions for the coming days, and sometimes an eye shield. In most cases you go home the same day.

After you get home

In the first days your vision may be blurred, and there may be a feeling of mild irritation or increased tearing. These are known effects that improve gradually. More information on the page Blurred vision after cataract surgery.

Use the eye drops exactly as instructed, avoid rubbing the eye, and wear an eye shield while sleeping, especially in the first nights. The doctor will schedule follow-up visits to make sure the eye is healing properly. In most cases, full recovery usually takes four to eight weeks.

In any case of worsening vision, increasing eye pain, redness or swelling that does not go down, or discharge from the eye, inform your treating doctor immediately.