Cataracts are primarily caused by the natural ageing process, as the proteins in the eye’s lens begin to break down and clump together, leading to cloudiness and impaired vision. However, several other factors can contribute to or accelerate their development. Prolonged exposure to ultraviolet (UV) rays from the sun, smoking, diabetes, eye injuries, and long-term use of certain medications like corticosteroids can all increase the risk of cataracts. Genetics may also play a role, as cataracts can sometimes run in families. In addition, poor nutrition, excessive alcohol consumption, and previous eye surgeries may contribute to lens damage over time. Although cataracts often develop slowly, they can eventually interfere with daily activities if left untreated.

Cataract surgery is a common and generally safe procedure used to treat cataracts. During the surgery, the cloudy lens is carefully removed and replaced with a clear artificial lens called an intraocular lens (IOL). The procedure is usually performed on an outpatient basis and takes about 20 minutes. It is typically done under local anaesthesia, meaning the patient is awake, but the eye is numbed. Cataract surgery is highly effective in restoring vision, and most people experience significant improvement within a few days. In rare cases, less than 1 in 200 operations, complications can occur, but the success rate is very high, making it one of the most frequently performed and reliable surgeries in the world.

Cataract surgery offers several significant benefits, with the most important being a dramatic improvement in vision. Removing the cloudy natural lens and replacing it with a clear artificial intraocular lens (IOL) restores clarity and sharpness to sight, making daily activities like reading, driving, and recognising faces much easier. Many people also notice brighter, more vibrant colours and improved night vision after surgery. In addition to better vision, cataract surgery can enhance overall quality of life by reducing dependence on glasses or contact lenses and allowing for greater independence and safety. For most patients, the results are long-lasting and life-changing, with a quick recovery and minimal discomfort.

Patients play an essential role in preparing for cataract surgery by following their doctor’s instructions and taking a few simple steps before the procedure.

It begins with attending all pre-surgery appointments, where the eye doctor examines the eyes and takes precise measurements to select the best intraocular lens (IOL). Patients must stop wearing soft contact lenses for at least one week and rigid gas-permeable contact lenses for two weeks before the biometry measurement to ensure high accuracy. 

Patients should inform their doctor about any previous eye condition, eye surgery, refractive laser eye surgery, or contact lens use and bring the previous optician reports. Report any regular eye drops they are taking, especially eye drops, to treat eye pressure. A list of all medications, especially blood thinners. Any allergy to substances and drugs. Report any chronic health issues, including diabetes, kidney disease, high blood pressure or chronic heart issues. Reasonable control of diabetes before and after the surgery is paramount in reducing the risks of complications. 

If the surgery is to be performed under local anaesthetics, patients can drink and eat light meals on the day of the procedure. They should wear comfortable clothing and avoid using makeup, lotions, or perfumes near the eyes or face. Arranging for a friend or family member to provide transportation is also essential, as driving must be avoided for at least a week after the operation. These steps help ensure the surgery goes smoothly and that the patients recover quickly without complications.

cataract surgery, patients have several choices regarding lens implants, also known as intraocular lenses (IOLs), each designed to meet different vision needs.

The most common type is the monofocal IOL, which provides clear vision at one distance—usually for distance vision—meaning patients may still need glasses for reading or close work. This lens implant is used in all NHS patients and is included in Primate Medical Insurance (PMI) if patients have surgery using their PMI policy. 

Enhanced or customised lens implants

An extended depth of focus (EDOF) lens implant is a type of intraocular lens (IOL) used in cataract surgery designed to provide a continuous range of clear vision, particularly from distance to intermediate, with some improvement in near vision. E.g. Rayner Extended Monovision and Rayner Galaxy IOL.

Multifocal IOLs are designed to provide clearer vision at multiple distances (near, intermediate, and far), reducing the need for glasses. However, some people may experience glare or halos around lights, particularly in low-light conditions. 

E.g. Rayner trifocol IOL. 

Toric IOLs are specifically made for patients with astigmatism (the eyeballs usually are oval-shaped rather than round-shaped; highly oval-shaped would give rise to high astigmatism). They help correct the uneven shape of the cornea and improve vision clarity without glasses. The toric correction can be incorporated into the mono-focal, EDOF or multifocal lenses.

The lens choice depends on individual vision goals, lifestyle, and eye health and is usually discussed thoroughly with the eye surgeon before the procedure. There is also cost implication in the choice of lenses. The enhanced IOLs are not normally available for NHS patients, and private patients using their private health insurance commonly need to pay a supplement for the enhanced lenses. The costs vary between clinics, so confirming the expenses with the clinics before surgery is essential. 

Overall, patients generally find the experience painless and surprisingly easy, with only minor discomfort, if any. On the day of cataract surgery, patients can expect a relatively quick and straightforward experience, typically lasting just a few hours from check-in to discharge. Patients should take their routine medicine as usual, particularly medications for diabetes and high blood pressure. 

Upon arrival at the surgical centre or hospital, patients are checked in and prepped for the procedure. This includes receiving eye drops to dilate the pupil and anaesthetic drops to numb the eye. Patients are awake during the surgery. 

During cataract surgery, the patients are typically awake but very comfortable. Some surgeons may give a small local anaesthetic injection at the beginning of surgery. The patient won’t feel much discomfort, though they may be aware of light, movement, or gentle pressure in the eye. It's common to see bright lights or colours during the surgery, but not in a distressing way. The eye is held open with a special instrument, so blinking isn’t a concern, and the surgeon works through a tiny incision to remove the cloudy lens and insert the new artificial intraocular lens (IOL). The procedure is quick, typically lasting 20 minutes, and there are no stitches in most modern surgeries. 

A protective eye shield and pad may be placed over the eye overnight, and detailed instructions for using eye drops and caring for the eye at home will be provided. Commonly, most patients need to use post-operative anti-inflammatory eye drops for 3 to 4 weeks.

Most people notice improvement in their vision within a few days. Patients should avoid driving for about one week to allow adaptation to their new eyesight. Patients can wash their faces and shower normally, but they should be careful not to let water get into the operated eye in the first few weeks. Strenuous exercises should be avoided at least four weeks after surgery to allow the lens implants to stabilise inside the eyes. 

Patients should not travel abroad for at least 2 times 3 weeks if any complication requires attention from their surgeons and surgical centre. 

Most patients do not need to return to the surgical centre the day after cataract surgery. In the morning, they should remove the protective eye shield and cotton pad, clean the eye with a clean cotton pad, and then start using the post-operative eye drops given by the surgical centre.

Vision may be blurry at first as the eye adjusts to the new intraocular lens, but it often begins to improve within a few days. Mild discomfort, itching, or a gritty feeling in the eye is normal, and some sensitivity to light or tearing may occur. Patients are usually given medicated eye drops to reduce inflammation and detailed instructions for post-operative care. A protective eye shield may be worn, especially while sleeping, to protect the eye during the initial healing phase.

Most people can resume light activities within a day or two but should avoid rubbing the eye, heavy lifting, or strenuous activities for the first 3 to 4 weeks. A telephone call is usually conducted by the nurses at the surgical centre to ensure patients are comfortable and their vision is improved. Follow-up appointments with the surgeons or the local community opticians are usually scheduled at 4 weeks to monitor healing and ensure the eye is recovering properly. Complete healing typically takes about four to six weeks, although vision improvement is often noticeable sooner.

Patients usually return to the surgical centre for a second eye cataract operation within a few weeks to a few months to balance the improvement in both eyes. Patients can update their glasses, particularly on reading, usually 4 weeks after surgery. 

After cataract surgery, it’s normal to experience mild symptoms such as blurry vision, itching, watering, light sensitivity, or a foreign body sensation in the eye—these usually improve within a few days. However, there are certain symptoms you should watch out for, as they could indicate a complication:

• Severe or worsening eye pain

• Sudden vision loss or significant drop in vision

• Persistent redness in the eye

• Flashes of light or new floaters

• Nausea or vomiting (especially with eye pain)

• Swelling around the eye or eyelid that doesn’t improve

• Discharge from the eye

If you notice any of these warning signs, it’s important to contact your eye doctor immediately. Early treatment can prevent more serious problems and help protect your vision.