Cataract

The decision is based on how much the cataract affects your daily life — not on how the cataract looks or what an eye chart says. Indicators that surgery is appropriate: difficulty driving (especially at night due to glare and halos), struggling to read despite glasses, difficulty recognising faces, problems with your usual work or hobbies, or the cataract preventing adequate examination or treatment of another eye condition (like diabetic retinopathy). There is no benefit to waiting longer than necessary — cataracts don't become 'more operable' with time, and very dense cataracts are actually harder to remove. If your vision is not bothering you, surgery can wait. If it is affecting your independence and quality of life, that is the right time.

Phacoemulsification (phaco) is the standard technique: the eye is numbed with drops or a small injection around the eye (general anaesthesia is rarely needed). A tiny incision (2-3mm) is made at the edge of the cornea. An ultrasound probe breaks the cloudy lens into fragments, which are gently suctioned out. A folded artificial intraocular lens (IOL) is inserted through the same incision and unfolds in place — no stitches needed. The whole procedure takes 15-20 minutes. The eye is covered with a shield for protection. Vision often improves within 24 hours, though some blurring initially. Full stabilisation takes 4-6 weeks. The less common SICS (small incision cataract surgery) is used in advanced cataracts or lower-resource settings — equally effective but a slightly larger incision.

The standard monofocal IOL corrects vision for one distance — most surgeons aim for distance vision, and reading glasses are then needed. Premium IOL options: multifocal IOLs restore vision at multiple distances and reduce dependence on glasses — suitable for patients who strongly prefer spectacle independence, though some experience halos and glare. Extended depth-of-focus (EDOF) IOLs give a broader range of clear vision with fewer halos than multifocals. Toric IOLs correct astigmatism simultaneously. Premium lenses cost significantly more and are not available under government schemes. Important caveat: no lens gives perfect spectacle independence in all situations, and patients with certain retinal conditions, severe dry eyes, or irregular corneas may not be good candidates for premium lenses — discuss your lifestyle needs and eye health with your surgeon.

Cataract surgery is extremely safe — serious complications occur in under 1% of cases at experienced centres. The most significant complication is posterior capsule rupture (tearing of the membrane behind the lens) during surgery, occurring in about 1-2% of cases — managed at the time of surgery, usually without long-term consequences. Posterior capsule opacification (PCO) — a secondary 'after-cataract' where the remaining membrane becomes cloudy months to years later — occurs in 20-40% of patients and is treated with a simple 5-minute laser procedure (YAG laser capsulotomy) done in clinic. Post-operative infection (endophthalmitis) is rare (1 in 1000-3000) but serious — report any increasing pain, redness, or vision loss in the days after surgery immediately. Overall, the risk of serious permanent visual loss from surgery is far lower than the risk of leaving a visually significant cataract untreated.

The first 24 hours: rest, avoid rubbing the eye, wear the provided eye shield when sleeping. Use prescribed antibiotic and anti-inflammatory eye drops as instructed — typically for 4-6 weeks, tapering. Avoid water entering the eye for 1-2 weeks (no swimming, careful washing). Don't lift heavy objects or strain for 2 weeks — raised intraocular pressure during this period can stress the wound. Light activities resume in 1-2 days; driving when vision is adequate (typically 1-2 days for the operated eye). The final glasses prescription is given at 4-6 weeks when the eye has stabilised. The other eye is typically done 2-4 weeks later if both need surgery. Seek urgent review if you develop increasing pain, significant redness, discharge, or sudden vision change at any point — these need same-day assessment.