Cataracts: Should I Have Surgery?

You may want to have a say in this decision, or you may simply want to follow your doctor's recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them.

Cataracts: Should I Have Surgery?

Get the facts

Your options

  • Have cataract surgery.
  • Wait until poor eyesight caused by the cataract gets bad enough to bother you.

Key points to remember

  • Not all cataracts need to be removed. It depends on how much they bother you. Many people get along very well without surgery by wearing contact lenses or glasses.
  • Poor eyesight caused by cataracts happens slowly over time, so you probably don't need to rush into having surgery.
  • Most people who have cataract surgery see better after it. Serious problems from surgery aren't common.
  • Surgery removes the lens from your eye. The lens has to be replaced.
  • You may still need to wear glasses or contacts after surgery to see well.
FAQs

What is cataract surgery?

Cataracts are cloudy areas in the lens of your eye. Your lens is behind the colored part of your eye (iris). Its job is to focus light onto the back of your eye. In some people, cataracts prevent light from reaching the back of the eye. This can cause vision problems.

Cataract surgery helps you see better. It replaces your natural lens, which has become cloudy, with a clear artificial one.

There are several types of cataract surgery. They include:

  • Phacoemulsification. This is the most common type. The doctor makes a small cut (incision) in your eye. A special ultrasound tool is used to break your cloudy lens apart. Then the small pieces of the lens are removed and replaced with an artificial lens. Most people do not need stitches because the incision is so small.
  • Extracapsular extraction. This uses a larger incision to remove the lens in one piece. It is replaced with an artificial lens. And the cut is stitched.
  • Femtosecond laser-assisted cataract surgery (FLACS). This uses laser technology and replaces the natural lens with an artificial lens.

How well does cataract surgery work?

Cataract surgery is successful for most adults. Surgery may also improve vision in infants who have cataracts.

Both phacoemulsification cataract surgery and femtosecond laser-assisted cataract surgery (FLACS) work about equally well for treating cataracts in adults. FLACS is more expensive, but it may be a better option in some cases. For example, people who are going to have multifocal lenses placed may choose FLACS.

People who have surgery for cataracts usually have:

  • Improved vision.
  • Increased mobility and independence.
  • Relief from the fear of going blind.

What are the risks of cataract surgery?

Although the risk is low, surgery for cataracts does involve the risk of partial to total vision loss if the surgery is not successful or if there are complications. Some complications can be treated and vision loss reversed, but others cannot. Complications that may occur with cataract surgery include:

  • A torn lens covering (posterior capsule rupture).
  • Infection in the eye (endophthalmitis).
  • Swelling and fluid in the center of the nerve layer (cystoid macular edema).
  • Swelling of the clear covering of the eye (corneal edema).
  • Bleeding in the front of the eye (hyphema).
  • Detachment of the nerve layer at the back of the eye (retinal detachment).

Complications that may occur some time after surgery include:

  • Problems with glare.
  • Clouding of the back portion of the lens covering (capsule) that remains after surgery. (Your doctor can easily treat this using a laser.)
  • Glaucoma.
  • Retinal detachment.
  • Astigmatismorstrabismus.
  • Sagging of the upper eyelid (ptosis).

What are the risks of not having cataract surgery?

Usually, a cataract that isn't removed will slowly get worse and make your eyesight worse:

  • You may no longer be able to do your usual daily activities.
  • You may not be able to drive safely, especially at night.
  • You may be more likely to fall or hurt yourself.

The cataract may make it hard for your doctor to check for other eye problems, such as damage from diabetes.

When a cataract isn't treated until after it has become severe, the surgery may be harder to do. Also, you may be more likely to have problems after surgery or have a slower recovery than someone who had surgery for a less severe cataract.

Why might your doctor recommend cataract surgery?

Your doctor might recommend surgery if:

  • Poor eyesight is affecting your ability to do your job or take part in some leisure or social activities.
  • Surgery would help your doctor keep track of another eye problem, such as a problem with your retina.
  • You do not have glaucoma, diabetic retinopathy, or macular degeneration. Surgery may not improve eyesight in people who also have these eye problems.

When children have cataracts that cause vision problems, surgery is usually needed.

Compare your options

Compare

What is usually involved?









What are the benefits?









What are the risks and side effects?









Have cataract surgery Have cataract surgery
  • You will probably be awake during the surgery. You may feel pressure, but you shouldn't feel pain.
  • You will go home the same day.
  • Surgery works well to restore poor eyesight caused by cataracts.
  • Cataract surgery also improves eyesight for people who are nearsighted, are farsighted, or have astigmatism.
  • Your vision may be cloudy right after surgery. This will go away as your eye heals.
  • You may need laser surgery a few months or years later if your vision clouds up again.
  • Serious problems are not common but include:
    • A torn lens covering (posterior capsule rupture).
    • Infection in the eye (endophthalmitis).
    • Swelling and fluid in the center of the nerve layer (cystoid macular edema).
    • Swelling of the clear covering of the eye (corneal edema).
    • Bleeding in the front of the eye (hyphema).
    • Detachment of the nerve layer at the back of the eye (retinal detachment).
  • You may still need glasses or contact lenses after surgery.
Wait and see Wait and see
  • You will decide when the cataract is affecting your vision and your life enough to have surgery.
  • You avoid the risks of surgery.
  • Your eyesight will continue to slowly get worse.
  • You may have a slightly higher risk of problems from surgery if you wait to have surgery until your cataract is severe.

Personal stories about cataract surgery

These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.

My left eye is so clouded that I feel like I'm looking through tinted plastic wrap. I'm a little nervous about the surgery, but I need to have good eyesight to read, play cards, and do other things like that. I will talk to my doctor and get more information about what to expect, then maybe I won't be so nervous.

Betty, age 72

I didn't even know that I had a cataract until my eye doctor told me about it during my last eye exam. I suppose my eyesight has changed a little bit, but it has happened so slowly that I haven't noticed it much. So long as I am still able to pass my driver's test and see well enough to do what I need to do, I don't plan to have surgery.

Bob, age 69

I have known about my cataract for a long time. Only recently has it started to bother me. It is very hard for me to drive at night, and I attend a lot of meetings in the evenings. Most people I know have had a good experience with cataract surgery. So I feel confident that the surgery is right for me and will help me see better at night.

Harold, age 67

I am very nervous about any surgery on my eyes. I know that cataract surgery is very safe, but it is still surgery on my eye, and the thought of blindness scares me. So far I am able to manage fine, and my eyesight is only affected a little bit. I am going to put off having surgery for as long as I can.

Marie, age 55

What matters most to you?

Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.

Reasons to have cataract surgery

Reasons to wait and see

My poor eyesight is affecting my ability to do my job.

My work isn't affected by my poor eyesight.

More important
Equally important
More important

The glare from the sun or headlights bothers me when I drive.

I don't notice glare from the sun or headlights when I drive.

More important
Equally important
More important

Because of my eyesight, I can't take part in activities the way I'd like to.

I am able to take part in activities well enough.

More important
Equally important
More important

I'm afraid I might fall and hurt myself because I don't see well.

I'm not worried about falling or hurting myself.

More important
Equally important
More important

The thought of having surgery on my eye doesn't bother me.

I don't want surgery if I can possibly avoid it.

More important
Equally important
More important

My other important reasons:

My other important reasons:

More important
Equally important
More important

Where are you leaning now?

Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.

Having cataract surgery

Waiting

Leaning toward
Undecided
Leaning toward

What else do you need to make your decision?

Check the facts

1, Do you need to have your cataract removed even if it doesn't really bother you?
2, Do you have to decide right away about surgery?

Decide what's next

1,Do you understand the options available to you?
2,Are you clear about which benefits and side effects matter most to you?
3,Do you have enough support and advice from others to make a choice?

Certainty

1. How sure do you feel right now about your decision?

Not sure at all
Somewhat sure
Very sure

Your Summary

Here's a record of your answers. You can use it to talk with your doctor or loved ones about your decision.

Your decision

Next steps

Which way you're leaning

How sure you are

Your comments

Your knowledge of the facts

Key concepts that you understood

Key concepts that may need review

Getting ready to act

Patient choices

Credits

Credits
Author Healthwise Staff
Primary Medical Reviewer Kathleen Romito MD - Family Medicine
Primary Medical Reviewer Adam Husney MD - Family Medicine
Primary Medical Reviewer Heather Quinn MD - Family Medicine
You may want to have a say in this decision, or you may simply want to follow your doctor's recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them.

Cataracts: Should I Have Surgery?

Here's a record of your answers. You can use it to talk with your doctor or loved ones about your decision.
  1. Get the facts
  2. Compare your options
  3. What matters most to you?
  4. Where are you leaning now?
  5. What else do you need to make your decision?

1. Get the Facts

Your options

  • Have cataract surgery.
  • Wait until poor eyesight caused by the cataract gets bad enough to bother you.

Key points to remember

  • Not all cataracts need to be removed. It depends on how much they bother you. Many people get along very well without surgery by wearing contact lenses or glasses.
  • Poor eyesight caused by cataracts happens slowly over time, so you probably don't need to rush into having surgery.
  • Most people who have cataract surgery see better after it. Serious problems from surgery aren't common.
  • Surgery removes the lens from your eye. The lens has to be replaced.
  • You may still need to wear glasses or contacts after surgery to see well.
FAQs

What is cataract surgery?

Cataracts are cloudy areas in the lens of your eye. Your lens is behind the colored part of your eye (iris). Its job is to focus light onto the back of your eye. In some people, cataracts prevent light from reaching the back of the eye. This can cause vision problems.

Cataract surgery helps you see better. It replaces your natural lens, which has become cloudy, with a clear artificial one.

There are several types of cataract surgery. They include:

  • Phacoemulsification. This is the most common type. The doctor makes a small cut (incision) in your eye. A special ultrasound tool is used to break your cloudy lens apart. Then the small pieces of the lens are removed and replaced with an artificial lens. Most people do not need stitches because the incision is so small.
  • Extracapsular extraction. This uses a larger incision to remove the lens in one piece. It is replaced with an artificial lens. And the cut is stitched.
  • Femtosecond laser-assisted cataract surgery (FLACS). This uses laser technology and replaces the natural lens with an artificial lens.

How well does cataract surgery work?

Cataract surgery is successful for most adults. Surgery may also improve vision in infants who have cataracts.

Both phacoemulsification cataract surgery and femtosecond laser-assisted cataract surgery (FLACS) work about equally well for treating cataracts in adults. FLACS is more expensive, but it may be a better option in some cases. For example, people who are going to have multifocal lenses placed may choose FLACS.

People who have surgery for cataracts usually have:

  • Improved vision.
  • Increased mobility and independence.
  • Relief from the fear of going blind.

What are the risks of cataract surgery?

Although the risk is low, surgery for cataracts does involve the risk of partial to total vision loss if the surgery is not successful or if there are complications. Some complications can be treated and vision loss reversed, but others cannot. Complications that may occur with cataract surgery include:

  • A torn lens covering (posterior capsule rupture).
  • Infection in the eye (endophthalmitis).
  • Swelling and fluid in the center of the nerve layer (cystoid macular edema).
  • Swelling of the clear covering of the eye (corneal edema).
  • Bleeding in the front of the eye (hyphema).
  • Detachment of the nerve layer at the back of the eye (retinal detachment).

Complications that may occur some time after surgery include:

  • Problems with glare.
  • Clouding of the back portion of the lens covering (capsule) that remains after surgery. (Your doctor can easily treat this using a laser.)
  • Glaucoma.
  • Retinal detachment.
  • Astigmatismorstrabismus.
  • Sagging of the upper eyelid (ptosis).

What are the risks of not having cataract surgery?

Usually, a cataract that isn't removed will slowly get worse and make your eyesight worse:

  • You may no longer be able to do your usual daily activities.
  • You may not be able to drive safely, especially at night.
  • You may be more likely to fall or hurt yourself.

The cataract may make it hard for your doctor to check for other eye problems, such as damage from diabetes.

When a cataract isn't treated until after it has become severe, the surgery may be harder to do. Also, you may be more likely to have problems after surgery or have a slower recovery than someone who had surgery for a less severe cataract.

Why might your doctor recommend cataract surgery?

Your doctor might recommend surgery if:

  • Poor eyesight is affecting your ability to do your job or take part in some leisure or social activities.
  • Surgery would help your doctor keep track of another eye problem, such as a problem with your retina.
  • You do not have glaucoma, diabetic retinopathy, or macular degeneration. Surgery may not improve eyesight in people who also have these eye problems.

When children have cataracts that cause vision problems, surgery is usually needed.

2. Compare your options

Have cataract surgery Wait and see
What is usually involved?
  • You will probably be awake during the surgery. You may feel pressure, but you shouldn't feel pain.
  • You will go home the same day.
  • You will decide when the cataract is affecting your vision and your life enough to have surgery.
What are the benefits?
  • Surgery works well to restore poor eyesight caused by cataracts.
  • Cataract surgery also improves eyesight for people who are nearsighted, are farsighted, or have astigmatism.
  • You avoid the risks of surgery.
What are the risks and side effects?
  • Your vision may be cloudy right after surgery. This will go away as your eye heals.
  • You may need laser surgery a few months or years later if your vision clouds up again.
  • Serious problems are not common but include:
    • A torn lens covering (posterior capsule rupture).
    • Infection in the eye (endophthalmitis).
    • Swelling and fluid in the center of the nerve layer (cystoid macular edema).
    • Swelling of the clear covering of the eye (corneal edema).
    • Bleeding in the front of the eye (hyphema).
    • Detachment of the nerve layer at the back of the eye (retinal detachment).
  • You may still need glasses or contact lenses after surgery.
  • Your eyesight will continue to slowly get worse.
  • You may have a slightly higher risk of problems from surgery if you wait to have surgery until your cataract is severe.

Personal stories

Personal stories about cataract surgery

These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.

"My left eye is so clouded that I feel like I'm looking through tinted plastic wrap. I'm a little nervous about the surgery, but I need to have good eyesight to read, play cards, and do other things like that. I will talk to my doctor and get more information about what to expect, then maybe I won't be so nervous."

— Betty, age 72

"I didn't even know that I had a cataract until my eye doctor told me about it during my last eye exam. I suppose my eyesight has changed a little bit, but it has happened so slowly that I haven't noticed it much. So long as I am still able to pass my driver's test and see well enough to do what I need to do, I don't plan to have surgery."

— Bob, age 69

"I have known about my cataract for a long time. Only recently has it started to bother me. It is very hard for me to drive at night, and I attend a lot of meetings in the evenings. Most people I know have had a good experience with cataract surgery. So I feel confident that the surgery is right for me and will help me see better at night."

— Harold, age 67

"I am very nervous about any surgery on my eyes. I know that cataract surgery is very safe, but it is still surgery on my eye, and the thought of blindness scares me. So far I am able to manage fine, and my eyesight is only affected a little bit. I am going to put off having surgery for as long as I can."

— Marie, age 55

3. What matters most to you?

Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.

Reasons to have cataract surgery

Reasons to wait and see

My poor eyesight is affecting my ability to do my job.

My work isn't affected by my poor eyesight.

More important
Equally important
More important

The glare from the sun or headlights bothers me when I drive.

I don't notice glare from the sun or headlights when I drive.

More important
Equally important
More important

Because of my eyesight, I can't take part in activities the way I'd like to.

I am able to take part in activities well enough.

More important
Equally important
More important

I'm afraid I might fall and hurt myself because I don't see well.

I'm not worried about falling or hurting myself.

More important
Equally important
More important

The thought of having surgery on my eye doesn't bother me.

I don't want surgery if I can possibly avoid it.

More important
Equally important
More important

My other important reasons:

My other important reasons:

More important
Equally important
More important

4. Where are you leaning now?

Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.

Having cataract surgery

Waiting

Leaning toward
Undecided
Leaning toward

5. What else do you need to make your decision?

Check the facts

1. Do you need to have your cataract removed even if it doesn't really bother you?

  • Yes
  • No
  • I'm not sure
That's right. Not all cataracts need to be removed. It depends on how much they bother you.

2. Do you have to decide right away about surgery?

  • Yes
  • No
  • I'm not sure
You're right. Poor eyesight caused by cataracts happens slowly over time, so you probably don't need to rush into having surgery.

Decide what's next

1. Do you understand the options available to you?

2. Are you clear about which benefits and side effects matter most to you?

3. Do you have enough support and advice from others to make a choice?

Certainty

1. How sure do you feel right now about your decision?

Not sure at all
Somewhat sure
Very sure

2. Check what you need to do before you make this decision.

  • I'm ready to take action.
  • I want to discuss the options with others.
  • I want to learn more about my options.
Credits
By Healthwise Staff
Primary Medical Reviewer Kathleen Romito MD - Family Medicine
Primary Medical Reviewer Adam Husney MD - Family Medicine
Primary Medical Reviewer Heather Quinn MD - Family Medicine

Note: The "printer friendly" document will not contain all the information available in the online document some Information (e.g. cross-references to other topics, definitions or medical illustrations) is only available in the online version.

This information does not replace the advice of a doctor. Healthwise, Incorporated, disclaims any warranty or liability for your use of this information. Your use of this information means that you agree to the Terms of Use. Learn how we develop our content.

© 1995-2021 Healthwise, Incorporated. Healthwise, Healthwise for every health decision, and the Healthwise logo are trademarks of Healthwise, Incorporated.