Cataract Surgery

Cataract surgery is usually done in an outpatient surgery center. Plan to be there for 2-3 hours, even though the surgery itself is short.

Before surgery:

• Your eye is numbed with drops. You stay awake but get a mild sedative through an IV to help you relax.
• The eye is washed and a clear drape is placed around it. You will see lights and shapes but not the instruments.

During surgery (15-30 minutes):

• The surgeon makes a tiny cut (2-3 mm) in the front of the eye.
• Sound waves break the cloudy lens into pieces, which are gently suctioned out.
• A folded clear plastic lens is slid through the cut. It unfolds inside the lens sac and stays there for life.
• The cut usually seals itself with no stitches.

After surgery:

• You rest for 15-30 minutes. A friend or family member drives you home.
• You wear a clear shield over the eye when sleeping for the first week to keep from rubbing it.
• You start eye drops the same day or the next morning.

The new lens stays in your eye for life. There are three main types ³:

• Monofocal (standard) IOL. Set for one distance, usually far away. You will still need reading glasses for small print. This is the basic option covered by most insurance.
• Multifocal or extended-depth-of-focus IOL. Gives clear vision at more than one distance, so you may not need glasses for many tasks. Some people see glare or halos at night.
• Toric IOL. Corrects astigmatism. Can be combined with monofocal or multifocal designs. Often an extra out-of-pocket cost.

Cataract surgery is very safe, but no surgery is risk-free. The chance of a serious problem is less than 1 in 100 ¹:

• Infection (endophthalmitis). Rare (about 1 in 1,000-3,000) but serious. Eye drops after surgery help prevent it.
• Swelling of the back of the eye (cystoid macular edema). Causes blurry central vision in the first few weeks. Usually treated with drops.
• Posterior capsule tear. A break in the thin sac that holds the new lens. The surgeon usually still places a lens; some people need extra steps.
• Retinal detachment. Risk is higher for several years after surgery, especially in very nearsighted eyes.
• Lens dislocation. The new lens shifts out of place. Very rare in the first few weeks; can happen years later.
• Posterior capsule opacification. Not really a complication — the thin sac behind the new lens can cloud up months or years later. A quick laser fixes it.
• Mild floaters, halos, or glare at night. Common with premium lenses; usually settle over weeks.

What it costs in the U.S.:

• Standard cataract surgery with a monofocal IOL: about $3,500-$5,000 per eye before insurance.
• Premium lenses (multifocal, EDOF, toric): $1,500-$3,500 extra per eye on top of the standard fee.
• Laser-assisted surgery (FLACS): $500-$1,500 extra per eye.

What insurance usually covers:

• Medicare and most U.S. health insurance plans cover standard cataract surgery and a monofocal IOL when vision is bad enough to affect daily life.
• Upgrades like multifocal, toric, or laser-assisted surgery are usually an out-of-pocket cost.
• The surgery center fee and anesthesia are usually covered when the surgery is covered.