Cataract Surgery:
from Start to Finish


The most important consideration is whether you are experiencing problems from the cataract or not. The question you need to ask yourself is this:
      Is your vision interfering with your quality of life?
      Is your vision affecting the way you manage your day-to-day activities?

If you have cataracts but are managing well with your vision, then it is unlikely that you require cataract extraction.

During your cataract assessment, your ophthalmologist will look at your eye to confirm the suitability for cataract surgery and to look for other eye disease, such as glaucoma or age-related macular degeneration. Your ophthalmologist will pay particular attention to features that may make the surgery more difficult, such as a small pupil, dense cataract and small eye. Visual acuity and refractive error are checked.

Biometry is performed to determine the strength of the intraocular lens that will be implanted inside the eye. The intraocular lens implant replaces the natural lens, and acts to focus light onto the retina. Various factors need to be taken into account for intraocular lens power calculations, including the size of the eyeball and amount of curvature of the cornea. It is vital that biometry is as accurate as possible to provide the best visual outcome after surgery. The implanted intraocular lens will become part of your eye and will not feel any different from your previous natural lens.

Biometry is an essential step in the cataract surgery evaluation process. It allows your ophthalmologist to determine the intraocular lens implant that best fits your eye for the desired visual outcome.

(Image adapted from the internet)

In fact, this process of calculating intraocular lens power has become so precise so much so that some people are having refractive lens exchange procedures. Refractive lens exchange is a procedure where the clear lens (not a cataract) is removed and replaced with an intraocular lens to correct for refractive error.

Note: Remember that the standard intraocular lens is rigid and is unable to change shape. This means that you will lose the ability to focus at different distances after cataract surgery. The most common practice is to choose a lens that focuses for distance. This way, the vision is good for distance but glasses would be required for reading. Additional glasses may even sharpen up the focus for distance to normal 20/20 (or 6/6) vision!

(Image adapted from the internet)

The standard intraocular lens that is implanted during cataract surgery is rigid, and only has a specific focal length each (except for multifocal and accommodative lenses). This means that after implantation of the lens, you will only be able to focus clearly at a specific distance. You will therefore usually need reading glasses for close up work.

Some people prefer monovision – distance vision in the dominant eye and reading vision in the non-dominant eye. However, this option may cause disorientation because we are used to our eyes working together in sync. Contact lenses can be used to test your suitability for monovision. There are now also different intraocular lens types that allow focusing at a range of distances. Make sure you discuss your vision needs at length with your ophthalmologist before surgery to avoid dissatisfaction later on.


Each step listed during phacoemulsification below needs to be performed skillfully, so that the next step becomes easier. The better performed each step, the less chance of complications during surgery.

1. Eye drops to dilate the pupil
2. Anesthesia - topical, subtenon, peribulbar, retrobulbar, or general
3. Cleaning of the eye with antiseptic (povidone iodine or chlorhexidine)
4. Opening of the eyelids and exposure of the eyeball with a lid clip
5. Entry into the eye through a small micro-incision (up to 3 mm)
6. Viscoelastic injection - the viscoelastic is a thick jelly-like substance that maintains the shape and pressure of the eyeball during surgery
7. Capsulorrhexis - this is where a round opening is created at the front of the bag containing the lens/cataract. This opening gives your surgeon access to the cataract.

(Image adapted from the internet)

Steps in phacoemulsification cataract surgery: corneal wound incision to allow entry into the eye (left), and capsulorrhexis to create an opening at the front of the capsular bag (right)

8. Hydrodissection - fluid is injected between the lens and the bag. This loosens and separates the lens from the bag
9. Phacoemulsification (ultrasound sculpting) of the cataract into small fragments. The small fragments are then aspirated out of the bag.
10. Intraocular lens implantation. The lens implant is usually folded prior to insertion through the wound. Once the lens is inside the bag, it becomes unfolded and positions itself in the correct location.

(Picture taken from the internet)

Steps in phacoemulsification cataract surgery: phacoemulsfication ultrasound sculpting of the cataract into little pieces to allow easy removal (left), and implantation of the intraocular lens into the capsular bag (right)

11. Removal of the viscoelastic
12. Wound sealing. Usually no stitches are needed unless there is wound leak. If stitches are put in, these will normally either dissolve by themselves or be removed after a few weeks.
13. Antibiotic to prevent infection. Some antibiotic is usually given right at the end of surgery, either as an injection around the eye or into the eyeball itself. You will also be given some antibiotic drops to put in the eye for up to 4 weeks after surgery.


You will be given around 30 minutes after surgery to recover your senses and regain your bearings. A nurse will speak to you about how to look after your eyes in the next few weeks. You will either be given your postoperative eye drops or a prescription for them. Your ophthalmologist would probably arrange to see you at the end of the surgical theatre list or within the next day or two.

Your next visit to your ophthalmologist would subsequently be 3 to 6 weeks after surgery. You should keep putting in the eye drops as instructed. After this visit, you may discontinue your eye drops, go to your optometrist for an eye test and if appropriate, obtain a new spectacles prescription to sharpen up your focus.

If you are at any time worried about any aspect of your eye following your cataract operation, DO NOT hesitate to get in touch with your ophthalmologist. If you were unlucky enough to develop a complication after surgery, it is far better to have the complication treated earlier rather than one week later. In the case of severe infection after surgery (infective endophthalmitis), a delay of treatment by even a day may result in blindness.

Postoperative infective endophthalmitis, or severe infection in the eyeball, is one of the most feared complications after cataract surgery. If not treated promptly, it usually results in blindness. Despite stringent aseptic and prophylactic techniques to reduce the risk of infection, it still occurs in approximately 1 in every 1000 modern-day cataract operations.

(Image adapted from the internet)

Learn more about what you can expect before, during and after surgery

Learn more about complications during cataract extraction

Learn more about early complications of cataract extraction

Learn more about late complications of cataract extraction

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