Your mother has stopped driving at night, complains that the colors in her garden look washed out, and recently missed a step on the porch. Her eye doctor says she has cataracts in both eyes and asks whether she'd like to schedule surgery. She's 84 and nervous about anyone operating on her eyes.
Here's what families should know to help a parent decide and get through the process.
What a cataract is
A cataract is a cloudy area in the lens of the eye, the clear part that helps focus light1. Cataracts are very common with age: more than half of Americans 80 or older either have cataracts or have had surgery to remove them1. Most cataracts come from normal changes in the eye as people get older, though they can also follow an eye injury or surgery for another eye problem1. They can form in one or both eyes but don't spread from one eye to the other1.
At first, a cataract may cause no symptoms. Over time it can make vision blurry, hazy or less colorful, making reading and everyday tasks harder1. Other signs include sensitivity to light, trouble seeing at night, double vision, and needing frequent changes in glasses prescriptions1. These can also signal other eye problems, so an eye exam is important1. See vision loss in the elderly.
When surgery makes sense
Whatever the type of cataract, surgery is the only treatment1. An eye doctor will usually suggest surgery when vision loss gets in the way of everyday activities like reading, driving or watching TV2. Sometimes surgery is recommended even when cataracts aren't the main cause of vision problems, so the doctor can see into the back of the eye to track other conditions2. There's usually no need to rush; your parent can ask about the risks and benefits and decide when it's right2.
For older adults, the question is often less about the eye and more about daily life. Is your parent struggling to read medicine labels, recognize faces, or get around safely? Poor vision raises the risk of falls and can make driving unsafe. Clearer sight can bring back independence in reading, cooking, hobbies and getting around. See fall prevention for the elderly and when should the elderly stop driving.
Other eye conditions
Many older adults have more than one eye problem. If your parent also has glaucoma, macular degeneration or diabetic eye disease, cataract surgery may improve vision less than hoped, because the other condition limits how well the eye can see. Ask the eye doctor what improvement to expect given your parent's whole eye health. See glaucoma in the elderly, macular degeneration and diabetes in the elderly.
Preparing for surgery
About a week before surgery, the eye doctor will measure the size and shape of the eye to choose the right artificial lens, called an intraocular lens or IOL2. Your parent may be prescribed eye drops to help prevent infection2. Make sure the eye doctor knows every medicine your parent takes; if a medicine could increase bleeding, the doctor may ask your parent to stop it for a while2. Don't stop a blood thinner without checking with the doctor who prescribed it.
Your parent may be told to stop eating and drinking several hours before surgery, and to clean their eyelids and lashes with baby shampoo the night before and the morning of surgery2. Plan for a friend or family member to come along, since your parent won't be able to drive afterward2. If your parent has memory problems, write down the instructions and help with the schedule of drops. See transportation for seniors.
What happens on surgery day
During surgery, the eye doctor removes the cloudy lens and replaces it with an artificial lens; the operation lasts about an hour and is almost painless2. Your parent will usually be awake and may notice lights or motion but won't see what the doctor is doing; medicine can help them stay relaxed2. Afterward, your parent rests in a recovery area and the team checks the eye before they go home2.
If your parent has both eyes affected, each eye is done at a separate time, usually about a month apart2. That means two surgery days, two sets of drops, and two recoveries, which is worth planning around.
Helping with recovery
The eye doctor will give eye drops to help healing, and your parent may need to wear a special eye shield or glasses2. They may need to avoid touching the eye, bending over or lifting heavy things for a few weeks2. The eye may feel itchy, uncomfortable and sensitive to light at first, and should feel better after a day or two2. Most people are completely healed about 8 weeks after surgery, with checkups along the way2.
Drops are often the hardest part for older adults. Several kinds may be prescribed on different schedules for weeks. Arthritis, tremor or memory problems can make them hard to manage. A written chart, a pill-organizer style reminder, or a family member or home care aide stopping by can help. Your parent may need to sleep with the shield on to avoid rubbing the eye. For extra help at home, see companion care for seniors.
Warning signs after surgery
Your parent should call the eye doctor right away for problems such as vision loss, increasing pain, or new flashes of light or many floaters across the vision2. Cataract surgery is safe and effective, but like any surgery it has risks, and problems are best treated early2. Go to every checkup.
Some people develop a secondary cataract, also called posterior capsule opacification, weeks, months or even years later; the eye doctor can fix it with a laser2. If your parent's vision gets cloudy again after surgery, this is often the reason.
Vision after surgery
About 9 in 10 people who have cataract surgery see better afterward, though vision may be blurry at first while the eye heals2. Many notice colors look brighter, because the new lens doesn't have the yellow or brown tint of the cataract2. Once the eye is fully healed, your parent may need a new glasses prescription2. Plan for this before assuming the surgery didn't work.
Lens choices
Standard lenses correct vision for one distance, usually far away, so your parent may still need reading glasses. Premium lenses can correct astigmatism or offer more than one focal distance, but they cost more and aren't covered by Medicare beyond the standard lens. Ask the surgeon about the tradeoffs, including glare and night halos with some premium lenses, and whether your parent's eye health makes a premium lens a good fit. Avoid feeling pressured into upgrades.
What Medicare covers
Medicare Part B covers cataract surgery that implants a conventional intraocular lens3. After the Part B deductible, your parent pays 20 percent of the Medicare-approved amount for the lens and the surgery to implant it, with payments to both the facility and the surgeon3. Medicare doesn't usually cover eyeglasses, but Part B covers one pair of glasses with standard frames, or one set of contact lenses, after each cataract surgery that implants a lens3.
Medigap may help with the coinsurance, and Medicare Advantage plans cover cataract surgery but may require prior authorization or in-network surgeons. See Medigap vs. Medicare Advantage.
Cataract surgery and dementia
Poor vision can make confusion worse, and some families find that clearer sight helps a parent with dementia stay oriented and engaged. But surgery and recovery take cooperation: lying still, using drops, not rubbing the eye. Talk with the surgeon about sedation options and whether a family member can stay close. Watch for confusion after surgery, which can be a sign of delirium; see delirium in the elderly.
If your parent isn't ready for surgery
Early on, a new glasses or contact lens prescription can help your parent see better with cataracts1. Brighter lights at home, magnifying lenses for reading, and anti-glare sunglasses also help1. At home, add lamps by reading chairs, light the stairs and bathroom, and use high-contrast tape on step edges. These steps buy time, but they don't stop a cataract from growing, so keep up with regular eye exams and revisit the surgery question when daily tasks get harder.
Questions to ask the surgeon
Bring a list to the consultation: How much better should my parent's vision be, given their other eye conditions? Which eye goes first, and when will the second be done? Which lens do you recommend and why? What sedation will be used? Which medicines should be stopped, and who decides? How many drops, how often, and for how long? What activities should be avoided, and for how long? When are the follow-up visits? Who do we call after hours if something seems wrong? Will my parent need new glasses, and when?
An example
When Rosa's mother agreed to surgery, Rosa came to the pre-op visit and wrote down the drop schedule. She drove her mother home afterward and set up a chart on the fridge. A neighbor helped with drops on weekdays. Within a week, her mother said colors looked brighter. A month later they repeated the process for the other eye. With new reading glasses, her mother was back to her crossword and walking the porch steps with confidence. This is an illustration; recovery varies.
