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Cataracts: Should I Have Surgery?

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. If it can't be replaced, you'll wear thick glasses or contact lenses instead.
  • You may still need to wear glasses or contacts after surgery to see well.
FAQs

What is cataract surgery?

Cataract surgery removes the lens that has the cataract , which is a painless, cloudy area in the lens of the eye. In order for you to see, the lens must be replaced. This happens in one of two ways:

  • During the surgery, the doctor places an artificial lens in your eye. This is how most cataract surgery is done. Some people also need to wear glasses or contact lenses after surgery.
  • In a few cases, the doctor can't replace the lens. If that happens, you'll wear thick glasses or contact lenses instead.

Because the surgery replaces the lens in your eye, it's important to talk to your doctor about your choices.

If you have an astigmatism , your surgery may cost more. Talk to your doctor about your treatment options and costs.

How well does cataract surgery work?

Cataract surgery usually works very well.

If you don't have another eye problem, such as glaucoma or problems with your retina , your chances of seeing better after cataract surgery are very good. But you may still need reading glasses or glasses for distance vision.

If you are nearsighted or farsighted , or if you have astigmatism, you may not need your glasses or contacts as much after surgery. This is because replacing the lens can improve these problems. But the surgery is not done for this reason alone.

What are the risks of cataract surgery?

Cataract surgery doesn't usually cause problems. Your vision may be cloudy for up to 3 months after surgery. But this is normal and will go away as your eye heals.

Cloudy vision sometimes comes back

The most common problem after surgery is a gradual return of cloudy vision several months or years after surgery. The problem happens when a part of the remaining lens cover becomes cloudy. The clouding can be fixed with laser surgery.

Serious problems aren't common

Out of 100 people who have this surgery, fewer than 10 have serious problems. 1 This means that at least 90 out of 100 people do not have serious problems.

Newer surgery techniques, such as using a laser for part of the surgery, make it less likely for problems to occur during or after surgery.

Serious problems that can happen include:

  • Swelling of the retina or cornea. This may cause blurry vision that often goes away on its own. If it doesn't, more treatment may be needed.
  • New or different astigmatism, which can usually be treated with glasses or contact lenses.
  • Infection in the eye. A very serious infection called endophthalmitis can lead to blindness. This type of infection is rare. Other eye infections, such as uveitis , may affect your vision until you get treatment.
  • Problems caused by bits of the cataract left behind. Your doctor may need to do surgery to remove these bits and improve your vision.
  • Glaucoma .
  • Retinal detachment . After you have had cataract surgery, your risk for retinal detachment is higher than normal.

Some of these problems can be fixed with other treatment. But you may still have poor vision or blindness in the affected eye. In some cases, the treatment itself may also cause more problems.

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. To prevent permanent vision loss, it is very important to remove cataracts before the child is 3 months old.

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 operation. 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 for up to 3 months. 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:
  • 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

Are you interested in what others decided to do? Many people have faced this decision. These personal stories may help you decide.

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 46

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, and my doctor specializes in it. 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?

  • Yes Sorry, that's wrong. Not all cataracts need to be removed. It depends on how much they bother you.
  • No That's right. Not all cataracts need to be removed. It depends on how much they bother you.
  • I'm not sure It may help to go back and read "Get the Facts." 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, that's wrong. Poor eyesight caused by cataracts happens slowly over time, so you probably don't need to rush into having surgery.
  • No You're right. Poor eyesight caused by cataracts happens slowly over time, so you probably don't need to rush into having surgery.
  • I'm not sure It may help to go back and read "Get the Facts." 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
3.

Use the following space to list questions, concerns, and next steps.

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 and References

Credits
Credits Healthwise Staff
Primary Medical Reviewer Kathleen Romito, MD - Family Medicine
Specialist Medical Reviewer Carol L. Karp, MD - Ophthalmology

References
Citations
  1. Harper RA, Shock JP (2008). Lens. In P Riordan-Eva, JP Whitcher, eds., Vaughan and Asbury's General Ophthalmology, 17th ed., pp. 170–178. New York: McGraw-Hill.
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. If it can't be replaced, you'll wear thick glasses or contact lenses instead.
  • You may still need to wear glasses or contacts after surgery to see well.
FAQs

What is cataract surgery?

Cataract surgery removes the lens that has the cataract , which is a painless, cloudy area in the lens of the eye. In order for you to see, the lens must be replaced. This happens in one of two ways:

  • During the surgery, the doctor places an artificial lens in your eye. This is how most cataract surgery is done. Some people also need to wear glasses or contact lenses after surgery.
  • In a few cases, the doctor can't replace the lens. If that happens, you'll wear thick glasses or contact lenses instead.

Because the surgery replaces the lens in your eye, it's important to talk to your doctor about your choices.

If you have an astigmatism , your surgery may cost more. Talk to your doctor about your treatment options and costs.

How well does cataract surgery work?

Cataract surgery usually works very well.

If you don't have another eye problem, such as glaucoma or problems with your retina , your chances of seeing better after cataract surgery are very good. But you may still need reading glasses or glasses for distance vision.

If you are nearsighted or farsighted , or if you have astigmatism, you may not need your glasses or contacts as much after surgery. This is because replacing the lens can improve these problems. But the surgery is not done for this reason alone.

What are the risks of cataract surgery?

Cataract surgery doesn't usually cause problems. Your vision may be cloudy for up to 3 months after surgery. But this is normal and will go away as your eye heals.

Cloudy vision sometimes comes back

The most common problem after surgery is a gradual return of cloudy vision several months or years after surgery. The problem happens when a part of the remaining lens cover becomes cloudy. The clouding can be fixed with laser surgery.

Serious problems aren't common

Out of 100 people who have this surgery, fewer than 10 have serious problems. 1 This means that at least 90 out of 100 people do not have serious problems.

Newer surgery techniques, such as using a laser for part of the surgery, make it less likely for problems to occur during or after surgery.

Serious problems that can happen include:

  • Swelling of the retina or cornea. This may cause blurry vision that often goes away on its own. If it doesn't, more treatment may be needed.
  • New or different astigmatism, which can usually be treated with glasses or contact lenses.
  • Infection in the eye. A very serious infection called endophthalmitis can lead to blindness. This type of infection is rare. Other eye infections, such as uveitis , may affect your vision until you get treatment.
  • Problems caused by bits of the cataract left behind. Your doctor may need to do surgery to remove these bits and improve your vision.
  • Glaucoma .
  • Retinal detachment . After you have had cataract surgery, your risk for retinal detachment is higher than normal.

Some of these problems can be fixed with other treatment. But you may still have poor vision or blindness in the affected eye. In some cases, the treatment itself may also cause more problems.

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. To prevent permanent vision loss, it is very important to remove cataracts before the child is 3 months old.

2. Compare your options

  Have cataract surgery Wait and see
What is usually involved?
  • You will probably be awake during the operation. 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 for up to 3 months. 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:
  • 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

Are you interested in what others decided to do? Many people have faced this decision. These personal stories may help you decide.

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 46

"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, and my doctor specializes in it. 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.

3. Use the following space to list questions, concerns, and next steps.

 
Credits
By Healthwise Staff
Primary Medical Reviewer Kathleen Romito, MD - Family Medicine
Specialist Medical Reviewer Carol L. Karp, MD - Ophthalmology

References
Citations
  1. Harper RA, Shock JP (2008). Lens. In P Riordan-Eva, JP Whitcher, eds., Vaughan and Asbury's General Ophthalmology, 17th ed., pp. 170–178. New York: McGraw-Hill.

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.

Last Revised: August 8, 2013

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