Cataract Post-Surgery: 56 Things that you wish you knew before your cataract surgery
Can a cataract come back?
Because the natural lens is removed during cataract surgery, a cataract cannot come back. However, in approximately 15% of cases, a “secondary cataract” can develop. This clouding of the bag (capsule) holding the implant gives the same symptoms as the original cataract. Secondary cataract can develop anytime post-surgery but most commonly within the first few years.
Secondary cataract (posterior subcapsular opacification) is quick and easy to treat with laser. The treatment does not require and operating suite so it is done with little wait time. Secondary cataract does not return once treated.
Post cataract surgery drops schedule?
There are typically three (3) different drops used post cataract surgery (sometimes four (4)).
These drops have different schedules, so it is a good idea to make yourself a chart. Some surgeon’s offices will provide you with a chart that you can check off your drops as you use them.
The drops will taper down with the last one usually being used for one-month post-surgery ... but this can be sometimes extended.
Drops control inflammation, pain and infection risk. The fourth drop that is sometimes added post-surgery is to control eye pressure.
It can become especially confusing if you have the second eye done prior to the first eye’s drops being complete.
The golden rule is to stick to you prescribed eye drop schedule! It will steer you clear of trouble!
** I have included for download my practice's CATARACT DROP SCHEDULE - feel free to use!
Why do I have scratchy dry eyes after cataract surgery?
As your eye heals post-surgery you will likely experience some scratchy, dry feelings.
It is my opinion that this is from a combination of new corneal nerve regeneration through the wounds and also some true dry eye issues (likely induced/worsened by the wounds).
The key is lots and lots of proactive rewetting drops... Even before surgery!
If you already have dry eye issues, make sure that you follow your dry eye protocol precisely in the weeks leading up to both your eye measurements and surgery.
Why cannot wear my old glasses after cataract surgery?
The new implant’s focus power is different that your old natural lens’ power. Your glasses need to change to match the new focus power.
Often your lenses in your glasses can be swapped out.
Sometime immediately after surgery (too soon for an Rx)... it is better to pop out one spectacle lens and wear the glasses mono!
Post cataract surgery cobwebs - real and inside the eye!
I have many folks that joke post-surgery that they did not realize how dirty their homes were! Those fine cobwebs are hard to see with significant cataract!
Having cataract surgery will also make you more aware of increased ‘vitreous floaters’ – the spots that you may see floating about through your field of vision. These are generally not worrisome but speak to your eye care professional. Urgently if you have flashes of light!
Also “I did not realize how many wrinkles that I had!” is a common new insight!
Reasons why you may not see 20/20 post surgery?
Some folks are disappointed by their cataract surgery results. They usually present to me that “the cataract surgery did not take” or “the vision never came back after I had the cataract out”.
It is worthwhile here to make the distinction between (acuity refers to distance vision):
 BEST corrected 20/20
 UNcorrected 20/20
 BEST corrected under 20/20
 If you are “Best corrected 20/20” post-surgery – This means that with glasses, you see 20/20 but without glasses you are below perfect 20/20 distance vision. Common reasons for this can be: uncorrected residual astigmatism, poor pre-surgery measurements (e.g. disrupted by dry eye), predictive algorithm for lens selection was not accurate, incorrect lens was selected, healing caused unexpected astigmatism, lens implant centration/rotation not exact. This is not a bad thing! Being best-corrected 20/20 was the goal of cataract surgery only a few years ago.
2] If you are “Uncorrected 20/20” post-surgery – This means that without glasses, you see perfect (20/20) in the distance. This is the best result but vision could still fluctuate due to such things as dry eye or floaters. You could also be “uncorrected 20/20” and still have trouble with other things e.g. night glare or transient blur secondary to floaters.
3] If your BEST corrected is under 20/20 – This means that no matter what we do with glasses, your vision does not come back to 20/20. Typically – but not always - this is not a problem with the cataract surgery itself but rather a pre-existing or concurrent problem that limited the outcome of the cataract surgery. Cataract surgery can 100% fix your vision only if your vision limitations are 100% related to cataract. If you have vision loss 25% related to macular degeneration and 25% related to diabetes and 50% related to cataract… the most that cataract surgery can improve your sight is 50%. The two most common reasons that I see for disappointment after cataract surgery are: retinal complications of diabetes and age-related macular degeneration. Best vision under 20/20 is sometimes temporary. Talk to your eye care professional to understand exactly why you are not 20/20 post surgery and the prognosis.
Why am I am feeling dizzy after cataract surgery?
There a couple of reasons why patients report feeling dizzy after cataract surgery
#1 – If only one eye is done, there can be significant imbalance in prescription and image quality
#2 – You may have prism or correction that is not fixed with cataract surgery. You may be frustrated until you get your new glasses!
#3 – You are used to the distortion that your old glasses induce. Post cataract surgery, you suddenly do not need distance glasses (no distortion). It can take a while for your brain to adapt.
#4 – You may need to adjust from seeing well up close to now seeing well in the distance
“Before my cataract surgery, I used to be able to read without glasses?!”
If you are someone who can/could read without glasses before cataract surgery. Your vision will be flipped up-side-down. Instead of having good uncorrected close vision… your distance vision will be good uncorrected after cataract surgery.
This is a common point of anxiety of folks that think something is wrong.
Although this reversal is always well discussed by eye care provider teams, folks are still always shocked how poor that their close vision is after cataract surgery. This is due both to the power change but also can be due to larger pupils post-surgery which change the optics of your eye.
Can I drive without my glasses?
Often distance vision is improved enough to pass province/state driving requirements. However, be careful that you actually remove any previous restrictions from your driver’s license!
This can usually be done directly at a drivers’ centre or through your Optometrists office.
“Can’t I just wear cheap dollar-store readers after my cataract surgery?”
Over-the-counter reading glasses will not hurt your eyes. This is not a health question.
It is a pet peeve of mine that surgeons will sometimes say… “You will only need drug-store readers after surgery”. I feel that this is an unfortunate communication for two reasons.
#1 - There is always a better optical correction than drug-store readers! Whether it be the optics of the lens, a minor astigmatism correction, right/left Rx differences, prism or multifocal functionality of the lens… pre-fab readers are the most unevolved correction available. There are plenty of superior options.
#2 – When a patient hears that they only need reading glasses… that can get translated to … “I do not need an annual eye exam”. This is dangerous because glaucoma and macular degeneration and other eye problems are independent of cataract. They should be checked too!
Why do I have to wait so long to get my new glasses after surgery?
I understand the frustration this limbo/waiting period creates however we are ultimately trying to save you money and aggravation!
Once you have cataract surgery and the natural lens has been replaced… you will have a new prescription. This prescription could be minimal in the distance but there is always a low prescription ‘left-over’. I advise to wait thirty (30) days after your surgery to proceed with a prescription for new glasses. Prescriptions written before one month may not be accurate.
There are a couple of challenges worth mentioning here.
#1 – if you have only had one eye done… you will be faced with a decision to update a single lens in your glasses (if possible) or to continue to deal with the imbalance until the other eye is done and then get new glasses. Sometimes with high prescriptions, replacing a single lens does not work because the right vs. left Rx’s are so very different.
#2 – Many folks are ecstatic that they no longer need glasses for distance vision post cataract surgery. However.. they hate the fact that they never know where their reading glasses are! If you wore a progressive lens or bifocal prior to your surgery, I advise to continue with the same form of correction for convenience. It does not mean that you need to wear it all of the time… but you could. E.g. At the grocery store you will be able to see down an isle and read a label with bifocals but be on-and-off with readers.
#3 – Folks miss their glasses! In many people who have worn glasses their entire life, a curious thing often happens post cataract surgery and they feel naked without their glasses. Folks report feeling wind or dryness on their eyes or they simply do not like the way that they look without glasses.