Pain can be a subjective experience. Ask one person who just got an immunisation injection and they may say they felt nothing at all, yet the next person getting the same jab by the same nurse found it a very painful procedure. Procedures in eye care are no different. If you’re contemplating undergoing cataract surgery, you may have been told some horror stories by friends or family who had a bad experience. Is cataract surgery painful and is it something you should be afraid of?
What Happens During Cataract Surgery?
Cataract surgery is performed exceedingly often in the developed world. This is due to cataracts being considered part of the natural human ageing process. It is found less commonly in developing countries not due to a lower incidence of cataracts but because of poorer accessibility to trained doctors and eye care facilities.
During cataract surgery, the pupil of the eye is dilated, or widened, with eye drops. This allows the cataract surgeon to access the cataract behind the iris. Your eye is also numbed with topical anaesthetic eye drops or a local anaesthetic injection, and many surgeons will provide a light sedative to help you relax.
The removal of the cataract involves a few steps, including a small incision made through the cornea, which is the clear dome of tissue at the front of the eye. This incision is typically created near the edge of the cornea and may be performed with either a manual blade as in conventional cataract surgery or with a computer-guided femtosecond laser. This corneal incision then allows the cataract surgeon to insert various tools into the eye to work on the cataract, including opening the membrane containing the cataract, breaking the cataract into smaller fragments, and then suctioning these pieces out from the eye. An artificial lens implant, called an intraocular lens, is then inserted into the membrane through the corneal incision.
All these invasive steps as part of a routine cataract operation may leave you questioning, “is cataract surgery painful?”
Is Cataract Surgery Painful During the Operation?
All eye care professionals will reassure you that cataract surgery is generally considered a painless procedure. However, as previously mentioned, the perception of pain and discomfort can be subjective. If you’re leading up to a cataract operation yourself, it’s important to know that the experience of pain doesn’t mean that something has gone wrong. For example, some people find that dilating eye drops can be painful while others have no issue at all. For those who do notice any discomfort, this experience can range from a mild sting to a significant burning sensation.
There is a lot of research dedicated to reducing pain and discomfort for patients during cataract surgery, such as the type, dosage, and timing of anaesthetic. There are also preventative steps your cataract surgeon can take to minimise the risk of causing any discomfort that may occur during the operation, some of which may be as simple as ensuring the adhesive of the sterile drapes used to cover the skin around the eye is not roughly ripped off after the procedure.
Some patients may have a heightened pain response, which can make eye care procedures more uncomfortable. People with anxiety who are on oral anti-anxiety medications may be more sensitised to the sensation of pain.
Cataract surgeons will typically administer a light intravenous sedative in preparation for the surgery. For some people who are particularly anxious, the dosage may need to be increased or the surgeon may need to use a stronger sedative.
However, very rarely are heavy sedatives used as the cataract operation is more successful and less risky if you are kept awake. Despite this, the light sedation tends to be enough for most people to largely be unable to recall the procedure afterwards.
Is Cataract Surgery Painful Post-Operatively?
It is not uncommon for patients to feel some degree of discomfort after a cataract operation though this isn’t often reported as significant pain. One of the most common sources of post-operative discomfort after a cataract procedure is dry eye. As the operation involves disrupting the corneal nerves, post-operatively, the eye may be temporarily impaired in tear production, leading to a dehydrated corneal surface. Experiences of people with dry eye, including those not induced by cataract surgery, can range from mild irritation of the eye to severe, debilitating pain. Fortunately, there are ways to help alleviate dry eyes, such as artificial tears or medicated eye drops.
Prolonged eye inflammation is another potential source of pain or discomfort, and is part of your body’s natural healing response to the surgery. Your eye surgeon will have given you a prescription for anti-inflammatory medications to use in the postoperative period, including a steroid eye drop and a non-steroidal anti-inflammatory. It’s important to use these medications as frequently and for as long as you’ve been instructed.
Some people experience glare in the weeks after having their cataracts removed. This is entirely normal but can be a source of discomfort for some. Over time, your glare sensitivity will settle.
If you are particularly anxious about pain during cataract surgery, discuss your concerns with your cataract surgeon as they may be able to offer you reassurance and strategies to reduce your anxiety.
Note: Any surgical or invasive procedure carries risks. Before proceeding, you should seek a second opinion from an appropriately qualified health practitioner.