In most cases, cataract surgery is an elective procedure, meaning it is not an emergency medical procedure and is typically scheduled in advance. 

However, while elective, cataract surgery becomes necessary / urgent when:

• Cataract symptoms (blurred vision, reduced night vision, difficulty reading small print, etc.) become advanced enough to interfere with a patient's quality of life, daily activities, and/or ability to perform tasks safely. 

• A cataract is causing complications. For example, if the cataract is causing a space problem by occluding the anterior chamber of the eye, it is a significant risk for glaucoma (increased eye pressure) and should be removed sooner rather than later. 

• A cataract prevents and/or interferes with the treatment of another eye condition. For example, cataract surgery may be recommended if the cataract makes it difficult for your ophthalmologist to examine the back of your eye to monitor or treat another eye condition, such as age-related macular degeneration or diabetic retinopathy.

If you are happy with your vision as it is and your cataract/s is/are not causing any pathology or complications, you do not have to undergo cataract surgery right away. 

Cataract surgery (phacoemulsification and lens implant) typically involves removing the cataractous natural lens and replacing it with a clear artificial lens, called an intraocular lens (IOL). The following steps are usually involved:

1. Anaesthesia. Most cataract surgeries are done under local anaesthesia with some form of conscious sedation, so you are partially awake but do not feel any pain.

2. Incision. The ophthalmologist makes a tiny incision (1.6mm-3mm) at the corneal edge. Usually, this incision is self-sealing and does not need stitches. 

3. An opening is created in the front portion of the capsular bag (where the natural lens is located). This opening allows for removal of the cataract without disturbing the support system, into which the IOL will later be inserted.

4. Phacoemulsification. A ‘phaco tip’ is placed into the incision. This small, pen-like device emits ultrasound waves which break the cataract into small fragments. The fragments are then removed using gentle suction.

5. IOL implantation. An artificial IOL is folded and inserted through the incision. The implant unfolds and opens inside the capsular bag, where the cataract had rested. 

6. Final result. The IOL implant is centered and assumes the role of the natural lens, enabling proper focusing of light on the retina. The surgeon will tape an eye patch and/or shield over the eye to protect it.

Implanting an intraocular lens (IOL) at the time of cataract surgery is almost always the standard protocol for adult patients. This is because we are not able to see properly without a lens (natural or artificial) to give focus to the eye’s optical system.

The IOL implant restores visual function when a cataract is removed. If you do not have an IOL implanted, there will be no lens in the eye to focus light onto the retina, and your vision will be blurry.

The procedure itself typically takes about 15-20 minutes. Although the procedure is usually the same in its nature, variability in techniques used can have different time factors. 

The entire process, from hospital admission to discharge, usually takes approximately 2-3 hours. This is because the processes around the procedure (hospital admission, theatre preparation, post-operative observation, and hospital discharge) can take some time. 

NOTE: The exact duration is variable between patients, and even your own eyes. 

Cataract surgery is typically done under local anaesthesia (with conscious sedation). The goal is to have no pain or discomfort during the procedure. 

NOTE ON LOCAL ANAESTHESIA: There is great patient-to-patient (and even eye-to-eye)  variability in response to the local anaesthesia. 

• Some patients still see, others cannot see any light, and then there is any variant in between. 

• Sensation is also different, anything from complete numbness of the entire side of the face to just pain-sensation loss of the actual eye. 

• Some patients may experience dull movement or a slight stretching sensation, but this is usually not painful or uncomfortable. 

Most patients report feeling no pain during the procedure.

Yes, cataract surgery is one of the safest and most successful procedures in medicine. 

Please keep in mind, however, that cataract surgery is still surgery. While it is low risk, is not ‘zero risk’.

From a vision restoration perspective, the primary aim of cataract surgery is to remove the cloudy natural lens (cataract) and replace it with a clear intraocular lens (IOL). The IOL restores basic visual function to the ocular system by allowing unimpeded, focused light transmission onto the retina.

IOLs are available in varying dioptric (focusing) powers. This means that, with the use of certain IOL implant calculations, cataract surgery can also be used as an opportunity to give the eye/s a new focus point - to a certain degree of accuracy (90% accuracy). 

A perfect result cannot be guaranteed because IOL implant calculations are not ‘an exact science’. With all focus point tactics (except multifocal IOLs), some form of spectacle is usually still necessary at least some of the time after surgery. 

If we want to achieve 100% accuracy, we will need to include a second optimization procedure. Please see comments on multifocal IOLs and achieving true spectacle independence. LEARN MORE

This procedure is covered by most medical aids in South Africa. The practice will contact your medical aid on your behalf to apply for authorisation. We will contact you before the procedure if:

• There are any problems with the authorisation process and/or

• The full amount is not covered by your medical aid.

Our primary aim is service delivery. Therefore, a rule in our practice is that patients should have little to no co-payment on this procedure. 

IMPORTANT NOTE ON LENSES: there are various types of intraocular lenses (IOLs) that can be implanted during cataract surgery. It is important to note that not all IOL types are covered by medical aid. 

• Monofocal IOLs: The standard choice as a lens type. The cost of these lenses is covered by most medical aids.

• Multifocal IOLs: Also known as premium IOLs. Medical aids DO NOT cover the cost of these lenses. If you choose to implant multifocal IOLs, out of pocket expenses will be incurred.

• Toric IOLs: If you suffer from more than one diopter (1.0 D) of astigmatism, these specialized lenses can be implanted to reduce the amount of astigmatism. Toric IOLs are now covered by some medical aids, however, a co-payment may be required depending on the specific plan that you are on.

If there is any lens-related co-payment / out-of-pocket cost, we will communicate this to you prior to your procedure.

IMPORTANT NOTE ON MEDICAL INSURANCE: Medical insurance is NOT the same as medical aid. Our practice is not contracted into any medical insurance plans. Medical insurance patients will need to settle their account/s privately and can then claim back from their medical insurance, if they wish to do so. 

HPCSA Ethical Guidelines prohibit us from placing procedure costs on our website. Please contact our practice for information pertaining to the cost of this procedure.

• Arrange transportation. Due to the effects of sedation, you CANNOT drive on the day of surgery. 

• Bring your ID and MEDICAL AID CARD.

• Make and bring a list of your CONDITIONS, MEDICATIONS, and ALLERGIES. 

• REMOVE ALL MAKEUP. Please do not wear ANY makeup on the day of surgery. This includes foundation/base.

• Avoid bringing excessive accessories and dress comfortably. The theatre gown provided will be worn over your own clothes.

Cataract surgery is usually done under LOCAL ANAESTHESIA (with conscious sedation). The type of anaesthesia chosen (local or general) will always be confirmed and clearly communicated to you at the time of your consultation and/or when making your theatre booking.

Whether you are having local anaesthesia or general anaesthesia you are not allowed to eat or drink before the procedure:

• NO INTAKE for 6 HOURS before the procedure - solid food and milk products.

• Permitted up to 2 hours before the procedure - clear fluids (water, apple juice without pulp, rooibos or black tea without milk).

Yes, you can continue taking your chronic medication. No change in your medication routine is required, even if you are undergoing general anaesthesia.

Please inform the anaesthetist of ALL medications used, especially anticoagulants (e.g. Warfarin, Disprin, Plavix, etc.).

The following post-operative experiences are normal / to be expected following cataract surgery:

On the Day of Surgery: the involved eye will be covered with a patch and shield to protect it. This will be removed at your post-operative review the next day. 

• Your forehead, scalp, and cheek may (not always) be numb from the anaesthesia. This numbness usually resolves within 6-8 hours.

• Experiencing a mild headache is normal.

• Normal post-operative discomfort / mild irritation is expected, but the eye is usually not painful.

Day 1 Post-Operatively: the patch and shield is removed and the eye is reviewed.

• Feeling off-balance is completely normal after the patch and shield have been removed. This feeling usually subsides within a few hours.

• The eye is usually blurry after the procedure. This is because the pupil is still dilated, the eye could be swollen slightly, or the tear film is abnormal with sediment and ointment. This blur usually resolves in a day or two, and improvement is possible as the eye heals over weeks. 

• Double vision (mild and temporary) is also common initially. This is because the eye muscles are numbed by the anaesthesia.

• Redness may occur due to a small conjunctival bleed after anaesthetic injection. This usually resolves within weeks.

• Slightly high eye pressures are not uncommon on Day 1. Tablets or drops may be prescribed to manage this. 

Overall, some discomfort is normal, and certain temporary visual changes are common. It is important to use your eye drops as directed and follow the post-operative instructions provided.

NOTE ON DRY EYE SYMPTOMS. As this is still an operation, one can feel irritation for the first few weeks after the procedure. This is very variable between patients. Some will experience dry eye symptoms up to 3 months after the procedure. Most patients, however, have no symptoms after a week. 

Although cataract surgery is extremely safe, it is still surgery and complications, while very rare, can occur.  The signs and symptoms below could indicate post-surgical complications. 

Please contact our rooms or call the emergency number provided if you experience any of the following:

Serious Red Flags [P.A.I.N.]

• Pain (severe) - some post-operative discomfort / mild irritation is normal and expected, but severe pain is quite unusual.

• Abnormal vision loss - sudden and significant loss of vision. This includes seeing a dark shadow or a ‘curtain’ across your field of vision.

• Increased redness - notably worsening eye redness, especially if accompanied by pain and/or decreased vision.

• Nausea and vomiting associated with pain.

Additional Warning Signs:

• New floaters and flashes - a sudden, marked increase in the number, size, or darkness of floaters in your visual field, or seeing sudden, bright flashes of light (photopsia), especially in your peripheral vision.

• Discharge / pus - a thick, yellowish/greenish discharge coming from the eye.

IN SUMMARY: if your eye is feeling worse than it did the day before, or if you experience any severe pain, worsening redness, sudden vision loss, and/or new floaters or flashes - please contact us.

Eye drops (or a prescription for eye drops) will be received at your Day 1 post-operative review. 

• These are antibiotic-steroid combination drops (usually TOBRADEX or MYDEX). One bottle is provided per eye operated. 

• Start using the drops immediately / as soon as you can. 

• Standard protocol is to insert 1 drop, 3 times per day. This will be confirmed verbally.

• It is important to continue using the drops until they are finished. If both eyes were operated, use one bottle on both eyes until it is empty and then the second bottle on both eyes until it is empty.

NOTE ON INSTILLING EYE DROPS: It is preferred to pull the bottom eyelid down to insert the drop, rather than trying to pull the upper eyelid up. This is to prevent pressure on the eye, the same as NO RUBBING.

The time it takes for visual system to fully settle / stabilise following cataract surgery can vary significantly from patient to patient and may, in some cases, even vary from eye to eye. 

Generally, patients can expect stabilisation to follow this timeline:

• As soon as the patch and shield are removed (Day 1) you may notice an immediate improvement in brightness, clarity, and colour richness. Temporarily blurry or distorted vision can be expected due to pupil dilation, residual ointment in the eye, and/or swelling of the cornea. 

• Vision typically improves rapidly over the first 3 days as the pupil returns to normal, residue clears, and corneal swelling subsides. 

• Minor fluctuations in vision can be expected in the first 4 weeks. This is often due to dry eyes.

• At about 1 month, the eye is fully healed and vision has largely settled/stabilized. This is when patients can return to their optometrist for formal optimization spectacles (if needed).

• Minor fine-tuning and adaptation can continue for up to 6 months while the eye fully adjusts to the intraocular lens (IOL) implant. This is usually more noticeable for patients who choose a multifocal IOL, which requires the brain to adapt to multiple focal points.

NOTE: several factors can influence the timeline above. Some of which include corneal health, previous corneal procedures (RKs, LASIK, corneal transplant), surgery complexity, post-surgical complications, concurrent eye conditions, diligence in complying with post-operative instructions, adherence to the eye drop schedule, and the choice of IOL implant.

No, a cataract cannot return once the natural lens of the eye has been removed.

During cataract surgery, the cataract is removed but the lens’ capsular bag (skin lining) is left behind to support the intraocular lens (IOL) implant. Sometimes, the skin of the capsular bag can become cloudy and cause blurred vision. Patients may also see streaks or halos around lights. This is called posterior capsular opacification (PCO), sometimes also referred to as a ‘secondary cataract’.

PCO is easily rectified with a YAG capsulotomy. The YAG capsulotomy is performed in-rooms using a disruptive YAG laser. This procedure is not painful and takes about a minute or two. 

At our practice, we routinely review again at 3 months after surgery to assess for PCO and determine whether a YAG capsulotomy (or ‘polishing of the lens’) is necessary. In line with international statistics, approximately 30% of our patients will need a YAG capsulotomy.

Yes, you can continue as normal. 

Just be sure to AVOID:

• Eye rubbing or squeezing, and  

• Tap water going directly into the eye/s for the first week. 

Most people can return to work within a few days after their cataract surgery. This is especially true for patients with desk-based or light duty jobs. 

Of course, the exact nature of your job (visual acuity requirements, working environment, physical demand) and/or your individual recovery rate may influence this timeline.

Dr Botha will discuss and advise accordingly.

If you are comfortable with your vision, you can drive the next day. 

Fly the next day.

We usually advise that patients avoid wearing makeup, especially eye makeup (eyeshadow, mascara, eyeliner), for at least one week after cataract surgery. This restriction aims to:

• Minimise the risk of infection.

  • Makeup products and application tools inherently harbour bacteria. Applying eye makeup risks introducing bacteria near the surgical site.

  • Eyeshadow powder or other makeup particles can flake off and enter the eye, causing irritation and inflammation.

• Prevent irritation and rubbing of the eye/s.

• Makeup particles can enter the eye causing foreign body sensation / irritation. If our eye feels irritated our natural reaction is generally to rub it. Remember, NO EYE RUBBING, SQUEEZING, OR PRESSURE is allowed in the first week following surgery.

• Removing eye makeup usually requires rubbing and applying pressure. Again, NO EYE RUBBING, SQUEEZING, OR PRESSURE is allowed.

Having said the above, you can wear makeup sooner if you absolutely have to. The risk is low enough. Please just keep the above in mind.