Photojournalist Stephen Shames had been told for several years that he would eventually need to have cataract surgery. But as he was having more difficulty reading, driving and focusing his camera lens, he decided it was time.
In March 2024, he had surgery in one eye. Then, in April 2024, he had it in the other. He recovered quickly from each surgery and is thrilled with the outcome.
“Being a photographer, I was obviously worried about the surgery and the possibility that something could go wrong,” Shames says. “But now, at the age of 77, my vision is clearer, colors are brighter, and I have the happy problem of having to wear sunglasses on a bright, sunny day.”
Cataracts, a type of eye disease, are the leading cause of blindness worldwide and of vision loss in the United States. The American Academy of Ophthalmology estimates that more than 20 million Americans over the age of 40 have cataracts in one or both eyes and 6.1 million have had cataract surgery. As the population ages, those numbers will significantly increase.
While highly unusual, cataracts can also be found in younger people and sometimes even in infants. Although it’s very common in the older population, the good news is that cataract removal is a safe and widely available outpatient surgical procedure.
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What Are Cataracts?
Cataracts are cloudy areas in the lens of the eye. The lens of the eye is made up primarily of water and protein that keeps the eye clear and allows light to pass through. It helps focus light onto the retina (the light sensitive layer of tissue in the back of the eye), which allows you to see clearly.
However, as we age, proteins in the lens of the eye clump together. When cataracts form, they prevent light from passing easily through the lens. As a result, vision becomes blurry and hazy, and colors tend to look less vibrant — like looking through a cloudy or dusty car windshield.
Over time, cataracts get bigger and thicker, causing the lens to turn yellow or brown. If they’re not removed, they can lead to vision loss.
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What Is Cataract Surgery?
Cataract surgery is a safe, quick and effective way to get rid of cataracts.
By the age of 80, most people either have cataracts or have had cataract surgery, according to the National Eye Institute. In fact, more than 3 million Americans opt for the surgery every year.
“Cataract surgery is a very deliberate and precise surgery that involves the surgeon’s hands,” says Dr. Kevin M. Miller, chief of the cataract and refractive surgery division in the department of ophthalmology at UCLA Geffen School of Medicine.
Cataract surgery is typically performed as an outpatient procedure at a hospital or ambulatory surgery center, where patients can receive same-day surgical care.
During the procedure, an ophthalmologist (an eye care medical specialist) removes the clouded lens of the eye and replaces it with an artificial lens called an intraocular lens (IOL). A small incision is made along the side of the cornea (the outermost clear layer of the eye), the clouded lens is removed through the opening and a clear lens or IOL replaces it. Most of the capsule or membrane that surrounds the lens is left in place. This capsule holds the new lens, while also helping to keep fluids behind the lens undisturbed. The incision usually heals on its own without stitches.
The procedure typically takes under an hour. The patient is typically awake during the procedure, but may receive local anesthesia or sedation. Vision usually improves within a few days. It’s important to use eye drops as prescribed and avoid strenuous activities for a few weeks. Most patients regain full vision within a few months.
If you need to have surgery in both eyes, the first eye should be given a couple of weeks to a month to stabilize and recover before the second procedure is performed.
In addition to restoring vision loss, cataract surgery can also correct errors such as nearsightedness (myopia) and farsightedness (hyperopia).
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Types of Cataract Surgery
There are three types of cataract surgery — all of which involves removing the existing opaque lens and replacing it with an artificial implant.
— Phacoemulsification (phaco). Also referred to as phaco for short, phacoemulsification is the most common type of cataract surgery performed in the U.S. A small incision is made on the side of the cornea (the clear dome-shaped surface that covers the front of the eye) through which an ultrasound probe emits ultrasonic waves that soften and break up the lens. Once the cataract has been broken up, the pieces are removed by the surgeon through gentle suction.
— Femtosecond laser assisted surgery (FLACS). FLACs is a minimally invasive procedure in which a laser is used to make the initial incisions and break up the eye’s lens into fragments, which are then removed by suction. A replacement lens is then inserted. While ultrasound is still used in this procedure, current studies have not demonstrated an improvement in outcomes or safety with this method. The use of FLACS is normally not covered by medical insurance.
— Extracapsular. In rare cases, if the cataract cannot be broken down by ultrasound because it’s too advanced, the surgeon may recommend extracapsular surgery. In this procedure, a longer incision is made towards the outer end of the cornea. The front of the capsule that holds the lens in place is carefully opened and the cloudy core of the lens is removed in one piece. Suction is used to remove any of the smaller pieces.
Intraocular lenses (IOLs) for cataract surgery
There are many options for IOLs. These options are continually evolving, but not all patients are eligible for all lenses.
IOLs are generally made of acrylic or silicone. The most common ones are soft and foldable. Some are rigid, but the vast majority are flexible to allow for an ophthalmologist to fold and insert into the capsule where the original lens has been removed. Once inside the eye, the folded IOL unfolds and fills the empty capsule.
The most common IOLs being used to replace a clouded lens include the following.
— Monofocal IOLs. These are the standard, high-quality lenses covered by most health insurers. They usually correct for distance vision and require patients to use glasses for reading, computer use and other up close visual activities.
— Multifocal IOLs. These lenses correct for both near and far vision, allowing both near and far objects to be in focus at the same time. Usually, glasses will no longer be needed for many activities when these lenses are implanted. Multifocal IOLs tend to work better if implanted in both eyes. However, some people may not be eligible for this lens — including those with diabetic retinopathy, epiretinal membranes and macular degeneration. Because it’s considered a specialty lens, it may be more expensive than a monofocal lens.
— Toric IOLs. These are a type of monofocal lenses that help correct astigmatism. They’re also considered a specialty lens and may cost more than other monofocal lenses.
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Who Should Have Cataract Surgery?
Experts generally recommend surgery when cataracts start getting in the way of everyday activities, like driving, reading, watching TV or using a computer.
“It’s important to see an eye specialist regularly,” says Dr. Michael Sulewski, Jr, assistant professor of ophthalmology at Johns Hopkins School of Medicine. “Together, you and your ophthalmologist may come to a mutual decision about when to have the procedure.”
Certain kinds of cataracts develop quickly and others more slowly, but many of them will eventually reach a point at which surgery will be needed to see clearly and maintain vision.
Signs that you may need cataract surgery include the following:
— Colors appear faded
— Inability to read without stronger light
— Difficulty seeing well at night
— Seeing ghosted images out of eye
— Lamps, sunlight or headlights causing glare
— Seeing halos around lights
— Double vision that may go away as cataracts get bigger
— Rapid changes in glasses or contact lens prescriptions
Cataract Surgery Risks
Cataract surgery is a very common procedure and among the safest and most effective surgeries in the U.S. However, any surgery comes with a risk of complications.
While complications from cataract surgery are uncommon, they may occur but are usually treatable.
“The biggest worry is the risk of infection, but that risk happens in 1 out of every 5,000 procedures,” says Dr. Doug Wisner, chief of cataract and primary service at Wills Eye in Philadelphia.
Some of the risks that may occur include:
— Infections and bleeding
— Swelling of the retina (the nerve layer at the back of the eye)
— Vision loss or double vision
— Unusual changes in eye pressure
— Detached retina, a condition in which the retina moves out of place
— Pain that doesn’t get better with over-the-counter medications
— Blurred vision
— Seeing halos, glares or dark shadows
— Detachment of the IOL implant. It may move out of place
— Drooping eyelid
— Glaucoma, an eye condition that damages the optic nerve, a bundle of fibers that are responsible for transmitting visual information to the brain
You may be at higher risk for complications if you have another eye disease.
Where Should You Have Cataract Surgery?
Cataract surgery is usually performed at an eye center by an ophthalmologist.
“Make sure you find a surgeon you can trust, who comes recommended and has a good reputation,” Wisner says.
To find the best ophthalmologist for you, talk to family and friends who’ve had the surgery about their experience. You may also want to ask how many procedures a doctor has performed. Use the Find Ophthalmologists tool from U.S. News, which allows you to filter by location, insurance accepted, years of experience and more.
Some doctors offer specialty lenses (sometimes called premium lenses) that others don’t, and you may want to determine which lens an ophthalmologist has experience with and what kinds of lenses they recommend.
How to Prepare for Cataract Surgery
Before the surgery
— Schedule a surgical consultation with your doctor. During a surgical consultation a week or two before the procedure, your doctor will perform tests to measure the size and shape of your eye to determine which IOL to implant. The doctor will determine the strength of the lens to be placed inside the eye after removing the cataract. With your doctor, you’ll decide what focusing power of lens is best for you (near, intermediate, distance or both).
— Clean your eyelids and eyelashes. Your doctor will advise you to thoroughly clean your eyelids and eyelashes to get rid of germs and bacteria that could cause infection before surgery. This means not wearing any makeup beforehand.
— Stop taking medications. Tell your doctor about all the medications you’re currently taking. You may be instructed to stop taking certain medications before surgery, as they can interfere with the procedure.
— Avoid eating or drinking before the procedure. You’ll be asked not to eat or drink for about 12 hours prior to surgery.
— Be prepared to ask questions. It’s important to come prepared with a list of questions to make sure you understand what you will need to do before and after the surgery.
After the surgery
The surgery typically takes less than an hour. After the procedure, you can expect to:
— Wait in the recovery area. Immediately after surgery, your surgical team will have you wait for a moment in the recovery room to make sure there are no complications.
— Protect the eye. You will continue to wear an eye patch or shield to protect the eye from foreign objects as it heals.
— Take prescribed antibiotic eye drops. Your doctor will prescribe you special eye drops formulated to reduce inflammation and prevent infection. Your eye may feel uncomfortable, itchy, sore or sensitive to light and touch, but that will get better after one to two days. Your vision may be blurry while you recover.
— See your doctor after surgery. To make sure you are healing properly, your doctor will likely schedule a follow-up appointment to check on your eye. After that, if you have problems like vision loss or pain that won’t go away with medication, very red eyes, floaters, flashes of light, small dark spots in the eye or squiggly lines that float across vision, call you doctor immediately.
The National Eye Institute says that 9 out of 10 patients see better once they’ve healed after surgery, making proper recovery all the more important.
While you’re healing, here are instructions that will ensure a good outcome:
— Don’t rub or press on the eye
— Wear a protective eye shield — with or without a patch — at all times until your doctor tells you to stop
— Avoid getting soap in your eye
— Wear sunglasses outside to protect your eye from sun and wind
— Don’t exercise, run, bend over or other strenuous activities until your doctor says it’s OK
— Don’t wear eye makeup
— Avoid hot tubs
— Don’t swim
You should fully recover after eight weeks. Once completely healed, you may need new eyeglasses or contact prescription.
Wisner says it’s possible that some patients will develop posterior capsular opacification, also referred to as a secondary cataract. In approximately 20% of patients, a clouding of the capsule behind an IOL may cause blurring of vision and appear months or years after surgery. However, it’s easily and painlessly corrected using a procedure called a posterior capsulotomy (or YAG laser capsulotomy), which uses a laser to create an opening in the cloudy lens capsule to restore vision.
Cataract Surgery Costs
Costs for cataract surgery vary depending on the ophthalmologist, the state in which the surgery is performed and the operating facility at which it’s performed.
According to Medicare in 2023, based on 2022 payments, cataract surgery costs between $1,800 and $2,800 for each eye for just the surgery and the facility. But estimates vary widely. According to other health care systems and physicians, the average cost of cataract surgery can be anywhere from $3,500 to $7,000 for each eye.
Before you have surgery, try to get an estimate of the costs. As of 2022, as per the No Surprises Act, people who don’t have insurance or aren’t planning on submitting a claim, are entitled to a “good faith estimate” from health care providers.
Is cataract surgery covered by insurance?
Yes, when considered a necessary medical procedure, most medical insurance companies, including Medicare, cover 80% of allowed charges whether surgery is performed conventionally or with laser-assisted equipment. The patient is responsible for the deductible and the remaining 20%, which may be covered by a supplemental health policy.
Specialty lenses will usually cost more than traditional monofocal lenses and will likely not be covered by insurance.
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Cataract Surgery: What It Is and How Much It Costs originally appeared on usnews.com
Update 03/12/25: This story was published at an earlier date and has been updated with new information.
