Cataracts: What Happens at Your Evaluation, and Your Care Before and After Surgery

A cataract is a clouding of the natural lens inside your eye, which makes vision dim, blurry or full of glare. At a cataract evaluation, your eye doctor checks how much the cataract affects your life and whether the rest of your eye is healthy. After surgery, follow-up visits track your healing until your vision settles.

I tell my patients that cataracts are part of the deal of getting older, like gray hair. Nearly everyone gets them eventually. At Bolt Eye Group, we co-manage cataract surgery. We do your evaluation before surgery and your care after it, and the surgeon performs the surgery. We don't perform surgery at Bolt Eye Group.

What is a cataract?

Behind the colored part of your eye sits a clear lens. It focuses light onto the retina, the light-sensing layer at the back of the eye. Over time, proteins in that lens clump together, and the lens turns cloudy and often yellow. It's a bit like looking through a window that keeps getting smudgier.

Age is the most common cause. Diabetes, smoking, years of sun exposure, long-term steroid use and past eye injuries can make cataracts show up sooner. If you have diabetes, our diabetes eye care page explains why yearly eye exams matter.

What are the symptoms of cataracts?

Cataracts usually grow slowly. Common signs:

• Cloudy or dim vision. Like a film over everything.
• Glare and halos at night. Headlights look starry or blinding.
• Faded colors. Whites look yellowish, and blues and purples look dull.
• Frequent prescription changes. New glasses help, but not for long.
• Trouble reading or driving at night. You need more light and more effort.

When does cataract surgery make sense?

You may have heard that you have to wait until a cataract is "ripe." That's an old idea. Today, the usual question is simpler: is the cataract getting in the way of your life?

If you can't drive safely at night, read comfortably, or do the things you love, it may be time to talk about surgery. If new glasses still give you good vision, waiting is often fine. We'll keep an eye on it at your yearly exams. The decision is yours, made with your eye doctor and surgeon.

What happens at a cataract evaluation?

Vision and glare testing

We measure how well you see, with and without your best glasses. We may also check how much glare blurs your vision, since a cataract can look mild on a chart but cause real trouble in bright light.

Dilated eye exam

Dilating drops widen your pupil so we can see the whole lens and the back of the eye. This shows us the type and density of the cataract.

Checking the retina and macula

The macula is the center of the retina, the part you use for fine detail. We use OCT imaging, a scan that shows the layers of the retina, to look for problems like macular degeneration, swelling from diabetes or scar tissue. These can limit how well you see after surgery even when the cataract is gone. It's better for everyone to know that ahead of time.

Treating dry eye first

Dry eye can throw off the measurements used to choose your lens implant. If your tears are unstable, we treat that before surgery. Our dry eye page has more on what that can look like.

Measurements and lens choices

The measurements for your lens implant are usually taken by the surgeon's team. During cataract surgery, the cloudy lens is removed and replaced with a clear artificial lens. Your surgeon will talk through the options, which can include:

• Monofocal lenses. Set for one distance, often far. Most people still use glasses for reading.
• Toric lenses. Correct astigmatism, which is when the eye focuses light unevenly.
• Multifocal and extended-range lenses. Aim to give a wider range of focus, which may reduce the need for glasses for some tasks.

Each type has trade-offs, and your surgeon helps you choose based on your eyes and your lifestyle.

What is cataract surgery recovery like?

Follow-up visits

You'll usually be seen the day after surgery and again over the following weeks. The exact schedule is set with your surgeon. At these visits, we check your vision, eye pressure, the healing of the cornea and the position of your new lens.

Eye drops

You'll use prescription drops after surgery, often to prevent infection and calm inflammation. The schedule usually tapers down over a few weeks. Bring your drops and your schedule to each visit so we can review them together.

Protecting your eye

• Wear the shield as directed, especially when you sleep.
• Don't rub or press on the eye.
• Keep water and soap out of the eye, and follow your surgeon's rules about swimming, bending and heavy lifting.
• Wear sunglasses outdoors if light bothers you.

New glasses

Your prescription changes after surgery. We usually update your glasses once your eye has healed and your vision is stable. This is a fun step, and it's a great time to look at new frames.

Clouding later on

Months or years after surgery, some people notice blur coming back. This is often posterior capsule clouding. It's not the cataract returning. The thin clear capsule that holds your new lens turns hazy. A surgeon can clear it with a quick laser treatment in their office.

When to call us the same day

After cataract surgery, call us right away if you notice:

• Pain that is increasing
• Vision that is getting worse
• New flashes, new floaters, or a curtain over part of your vision
• Much more redness than before

New flashes and floaters can be a sign of a retinal tear. Our post on floaters and flashes explains why they matter.

Call us right away or go to the emergency room for sudden vision loss, a curtain or shadow across your vision, new flashes and floaters, or a chemical splash in the eye.

How we do it at Bolt Eye Group

We co-manage cataract surgery with your surgeon. We handle the evaluation before surgery and your follow-up care afterward, and the surgeon performs the surgery. If anything else in your eye needs a specialist, we refer you.

Your evaluation includes a dilated eye-health exam and an OCT scan of the macula. Like every patient, you also get our $39 imaging: retinal photos and a map of the cornea. Afterward, our in-office opticians help with your new glasses, including designer frames from Jacques Marie Mage, Lindberg, Mykita, Lunor and Gucci.

We see patients in Canton, East Cobb/Marietta, Lawrenceville and Riverdale, Georgia, and Johnson City, Tennessee. We accept VSP, EyeMed, Davis Vision, Spectera, Medicare and major medical plans, including Blue Cross Blue Shield, Aetna, UnitedHealthcare, Cigna and Humana. HSA/FSA and CareCredit are welcome.

Frequently asked questions

Can cataracts be treated with eye drops?

No eye drop has been proven to clear a cataract. Early on, updated glasses and brighter lighting can help. When a cataract gets in the way of daily life, surgery is the treatment.

Can a cataract come back after surgery?

The cataract itself can't come back, because the cloudy lens is removed. Some people later get clouding of the capsule behind the new lens. A surgeon can treat that with a quick laser procedure.

Will I need glasses after cataract surgery?

It depends on the lens implant you and your surgeon choose and on your eyes. Many people still use glasses for some tasks, such as reading. We update your prescription once your eye has healed.

Are both eyes done on the same day?

Usually not. Most surgeons operate on one eye at a time, with the second eye a few weeks later. Your surgeon sets the plan with you.

Book an exam at your nearest Bolt Eye Group office

If your world looks dimmer, foggier or full of glare, let's find out why. Book an exam at your nearest Bolt Eye Group office in Canton, East Cobb/Marietta, Lawrenceville, Riverdale or Johnson City, TN. Find locations and directions.