Not Seeing Well After Cataract Surgery

There can be several reasons why you are not seeing well after cataract surgery. These range from a normal process of mild intraocular inflammation after surgery to complications such as retinal detachment and macular edema. In this article we will discuss various causes of blurred vision after cataract surgery.

The meaning of the word cataract is clouding of the eye's lens. Normally the lens is transparent, thereby allowing light rays to pass through it and reach the retina at the back of the eye. When it loses its transparency and becomes cloudy, there is difficulty in distance vision, reading, and night vision, and in addition one may suffer from glare and halos around lights.

Cataract surgery is a common procedure that involves removing the eye's lens and replacing it with an artificial intraocular lens (IOL), which fulfills the role of the removed lens. Over 90% of patients report a marked improvement in vision following cataract surgery.

Blurred Vision After Cataract Surgery

Blurred vision is a common and normal condition after cataract surgery during the recovery period. It takes the eyes time to heal and adjust to the new lens that was implanted. Not everyone recovers from cataract surgery at the same pace. Some people will see clearly within a day of surgery, and for others it may take a few days.

Although cataract surgery is a safe procedure, every procedure has risks and a chance of complications that may increase the risk of prolonged blurred vision after surgery. If the blurred vision continues for several weeks after surgery, you should see the ophthalmologist in order to rule out potential complications. We will detail some complications that can manifest as blurred vision after surgery.

Blurred Vision After Cataract Surgery Due to Inflammation

Inflammation is actually a healthy response of the immune system to the surgical intervention performed during the surgery. However, inflammation can temporarily affect vision and cause blurring and discomfort. The inflammation is expected to improve within a few days, and eye drops given after surgery can accelerate the healing process.

Not Seeing Well After Cataract Surgery Due to Dry Eyes

Dry eyes are a common cause of blurred vision after cataract surgery. The surgery increases the risk of dry eye through several mechanisms, including long-term use of antibiotic and steroid eye drops before and after surgery, damage to the tear ducts during surgery, and a decrease in tear production and tear lubricant due to the surgical incision. Over half of patients will experience relatively mild dry eyes after cataract surgery. One way to cope with this side effect is the use of over-the-counter tear substitutes, which may bring improvement in the blurred vision.

Secondary Cataract Together With Blurred Vision After Cataract Surgery

Also called posterior capsular opacification (PCO). This is a condition in which the back part of the lens capsule becomes cloudy. The condition develops in about 20% of cataract surgery patients months or years after surgery. This opacity can cause blurred or hazy vision, similar to the symptoms experienced during a primary cataract. Treatment involves a quick, painless procedure called capsulotomy with a YAG laser, which is done in the clinic and effectively resolves the problem.

Retinal Detachment

This condition occurs when the retina detaches from the eye. This causes a sensation of a curtain blocking the vision, blurred vision, flashes of light, or a sensation of floating bodies in the field of vision. This is a rare complication following cataract surgery, but people who suffer from additional eye problems before surgery are at increased risk of it. Retinal detachment is an ocular emergency; if not treated it may lead to permanent vision loss.

Not Seeing Well After Cataract Surgery Due to Macular Edema

After cataract surgery, the central part of the retina (the macula) may become swollen, causing blurred and distorted vision. The condition exists in about 2% of patients who undergo cataract surgery and appears around 6 to 8 weeks after surgery. The edema is treated with non-steroidal anti-inflammatory eye drops (NSAIDs) and usually resolves within a few months.

Recovery From Cataract Surgery

As noted, the blurred vision during recovery from surgery should begin to improve within a few days. The recovery process may take a few months until full healing, but it can be accelerated by:

Keeping to an eye shield at night for at least a week after surgery, using eye drops alone or in combination with additional medications given by the treating physician, avoiding strenuous activity for a few weeks after surgery, avoiding rubbing or touching the eyes and materials that may cause eye irritation such as soap, dust, and makeup, not swimming for 4 to 6 weeks, and of course conducting regular follow-up with the ophthalmologist.

Can You Drive After the Surgery?

Since the surgery is performed under local anesthesia and, as noted, blurred vision immediately after surgery is a common and normal condition — you cannot drive immediately after surgery. At a later stage this varies from patient to patient. Most patients will be able to drive about two days after surgery, depending of course on their personal recovery.

When Can You Return to Work?

The blurred vision in the recovery stage may make it difficult for the patient to return to work, as with driving, and this depends on personal recovery and the type of work, since it may be dangerous. Office workers can return to work faster than workers in a dusty environment, and it should be remembered that dust may harm recovery from surgery, so it is advisable to postpone returning to this type of work.

Prof. Michael Mimouni is an eye surgeon specializing in cataract, cataract surgery, secondary cataract, and cornea, with over a decade of experience in advanced cataract treatments.