What are the disadvantages of cataract surgery?​

Cataract surgery is one of the most successful, safest, and most commonly performed vision-restoring procedures in the world. Millions of people undergo it every year to regain clear eyesight, restore independence, and improve their quality of life. However, despite its extraordinary success rate, it is still a surgical procedure — and like any surgery, it comes with potential disadvantages, risks, limitations, and rare complications.

Understanding these disadvantages does not mean the surgery is unsafe; rather, it empowers you to make informed decisions, set realistic expectations, and have productive discussions with your ophthalmologist. A well-educated patient is always a safer patient.

This comprehensive guide covers every possible disadvantage, from common and temporary post-operative side effects to long-term concerns and rare but serious complications.

Understanding Cataract Surgery: The Context Behind Its Risks

Before looking at disadvantages, it’s important to know the baseline:

• Success rate: Greater than 98% worldwide
  
  
• Procedure type: Phacoemulsification with an artificial intraocular lens (IOL)
  
  
• Duration: 10–20 minutes per eye
  
  
• Recovery: Fast, usually within 1–4 weeks
  
  

Even with these extraordinary statistics, no medical procedure is entirely risk-free. The disadvantages of cataract surgery range from temporary discomfort to rare complications involving the cornea, retina, or eye pressure.

Let’s explore them in detail.

Common, Temporary, and Expected Disadvantages

These are not complications, but natural parts of the healing process. Almost every patient experiences at least one of them.

Post-Operative Discomfort and Redness

What You Feel

• Scratchy sensation
  
  
• Mild irritation
  
  
• Watering
  
  
• Redness or bloodshot appearance
  
  

Why It Happens

Small incisions and microscopic instruments temporarily disturb the corneal surface and conjunctival blood vessels.

Duration

• Discomfort: 24–48 hours
  
  
• Redness: Up to 7–14 days
  
  

Management

• Lubricating drops
  
  
• Prescribed anti-inflammatory drops
  
  
• Avoid rubbing the eyes
  
  

This is a minor disadvantage but very common.

Blurred or Fluctuating Vision

What You See

• Hazy vision immediately after surgery
  
  
• Fluctuating clarity for several days
  
  
• “Milky” vision due to corneal swelling
  
  

Why It Happens

The cornea swells slightly during surgery, and your brain needs time to adjust to the new intraocular lens.

Duration

• Major improvement: 24–72 hours
  
  
• Full stabilization: 4–6 weeks
  
  

Management

Follow post-operative care, avoid strenuous activity, and use drops regularly.

This is one of the most frequently reported disadvantages — but completely normal and temporary.

Dry Eye or Worsening of Pre-Existing Dry Eye

Symptoms

• Burning
  
  
• Stinging
  
  
• Grittiness
  
  
• Excessive watering
  
  

Why It Happens

The surgery temporarily disrupts corneal nerves responsible for tear regulation.

Duration

• Several weeks to months
  
  

Who Is More Likely

• Older patients
  
  
• People with computer-related dry eye
  
  
• Contact lens users
  
  
• Women aged 45+
  
  

Treatment

• Preservative-free artificial tears
  
  
• Warm compresses
  
  
• Omega 3 supplementation
  
  

Post-operative dry eye is extremely common and considered a manageable disadvantage.

Light Sensitivity and Glare

What Happens

• Difficulty in bright sunlight
  
  
• Sensitivity to headlights
  
  
• Temporary “halo-like” effects
  
  

Why

The healing cornea scatters light more easily during recovery.

Duration

• Common for 1–4 weeks
  
  
• Usually resolves as the eye heals
  
  

Vision-Related Disadvantages After Cataract Surgery

These disadvantages depend on your intraocular lens (IOL) choice and individual healing characteristics.

Need for Reading Glasses (Monofocal IOL)

What Happens

If you choose a standard monofocal lens, you will:

• See clearly at one distance (usually far)
  
  
• Require reading glasses for phone, books, or computer
  
  

Is This a Complication?

No. It is an expected trade-off and the most common disadvantage of choosing monofocal IOLs.

Why It Happens

Monofocal lenses do not focus light at multiple distances.

Halos, Starbursts, and Night Vision Issues (Multifocal/Trifocal IOL)

Premium IOLs offer spectacle-independent vision but introduce optical compromises.

Typical Disadvantages

• Halos around headlights
  
  
• Starbursts around bright lights
  
  
• Reduced contrast sensitivity
  
  
• Difficulty driving at night
  
  

Why It Happens

Multifocal IOLs split light into multiple focal points, leading to light-scattering effects.

Duration

• May improve over 3–6 months
  
  
• In some cases, may persist long-term
  
  

Who Should Avoid Them

• Night-time drivers
  
  
• Precision workers
  
  
• People sensitive to glare
  
  

Vision Not as Expected

Why This Happens

• Pre-existing corneal irregularities
  
  
• Mis-calculated IOL power
  
  
• Unstable dry eye
  
  
• Rare healing variations
  
  

Solution

• Glasses
  
  
• Laser fine-tuning
  
  
• In rare cases, IOL exchange
  
  

This is a disadvantage that affects a small percentage of patients.

IOL-Related Disadvantages

Sometimes the implanted lens itself causes side effects.

IOL Decentration or Dislocation (Rare)

What Happens

The artificial lens may shift slightly from its optimal position.

Causes

• Trauma
  
  
• Weak capsular bag
  
  
• Complications during surgery
  
  

Symptoms

• Blurred vision
  
  
• Double vision
  
  
• Glare
  
  

Management

Surgical repositioning (rarely required).

Posterior Capsule Opacification (PCO)

The most common long-term disadvantage of cataract surgery.

What Happens

Months or years after surgery, cloudy cells grow behind the IOL.

Symptoms

• Blurred vision
  
  
• Glare
  
  
• Decreased contrast
  
  

Treatment

A quick, painless YAG laser capsulotomy — completed in 1–2 minutes.

Important

This is not a complication — it’s an expected possibility.

Rare but Serious Surgical Complications

These risks are extremely low in the hands of experienced surgeons but must still be understood.

Infection (Endophthalmitis)

The most feared complication due to its potential severity.

Risk

• Occurs in 1 in 1,000–3,000 cases
  
  

Symptoms

• Severe pain
  
  
• Sudden vision loss
  
  
• Extreme redness
  
  
• Pus-like discharge
  
  

Treatment

• Emergency antibiotic injections
  
  
• Immediate medical intervention
  
  

Although rare, this is a serious disadvantage patients should know.

Retinal Detachment

People with high myopia before surgery have slightly higher risk.

Symptoms

• Flashes
  
  
• Floaters
  
  
• Curtain-like shadow
  
  

Treatment

Urgent retinal surgery.

Increased Eye Pressure (Ocular Hypertension)

Why It Happens

• Swelling
  
  
• Inflammation
  
  
• Retained surgical gel (viscoelastic)
  
  

Symptoms

• Headache
  
  
• Pain
  
  
• Blurred vision
  
  

Management

Temporary glaucoma drops.

Corneal Edema (Swelling)

Who Is At Risk

• Elderly patients
  
  
• People with Fuchs’ dystrophy
  
  

Management

• Steroid drops
  
  
• Hypertonic saline drops
  
  
• Rarely, corneal transplant
  
  

Cystoid Macular Edema (CME)

What Happens

The retina’s central area (macula) becomes swollen.

Symptoms

• Central blurring
  
  
• Distorted vision
  
  

Treatment

• Anti-inflammatory eye drops
  
  
• Steroid therapy
  
  

Intraoperative Complications (Extremely Rare)

• Posterior capsule rupture
  
  
• Zonular dehiscence
  
  
• Lens drop into the vitreous
  
  
• Incomplete cataract removal
  
  

These are managed by experienced surgeons during the operation.

Lifestyle and Activity-Related Disadvantages

Restrictions After Surgery

For 1–4 weeks, you must avoid:

• Swimming
  
  
• Gym workouts
  
  
• Eye makeup
  
  
• Dust exposure
  
  
• Rubbing the eye
  
  

These temporary lifestyle limitations can feel inconvenient.

Driving Limitations

Some patients may temporarily struggle with:

• Night driving
  
  
• Bright sunlight
  
  
• Halos/glare
  
  

Until visual stability is achieved.

Cost Considerations

Premium IOLs that reduce spectacle dependence may:

• Increase cost significantly
  
  
• Not be covered by insurance
  
  
• Require more detailed testing
  
  

This is a practical disadvantage for some patients.

Psychological Disadvantages: Fear, Anxiety, Unrealistic Expectations

Common Issues

• Anxiety about surgery
  
  
• Worry about vision outcomes
  
  
• Fear of complications
  
  
• Over-expectation from premium lenses
  
  

Proper counselling can eliminate most of these concerns.

Are the Disadvantages Worth It? A Balanced Perspective

Despite the disadvantages, cataract surgery remains one of the most life-changing procedures in medicine.

Benefits that outweigh the risks

• Clear vision restored
  
  
• Colors appear vibrant
  
  
• Improved safety while driving
  
  
• Reduced risk of falls
  
  
• Greater independence
  
  
• Permanent removal of the cataract
  
  
• Opportunity for spectacle freedom
  
  

For the vast majority of patients, the disadvantages are either:

• Temporary
  
  
• Mild
  
  
• Correctable
  
  
• Or extremely rare
  
  

How to Minimize the Disadvantages

Choose a skilled surgeon

Experience reduces the risk of complications dramatically.

Share your full medical history

Especially diabetes, high myopia, glaucoma, dry eye.

Follow post-operative care strictly

Drops
Activity restrictions
Follow-ups

Choose your lens carefully

Match the lens to your lifestyle, not your desire to avoid glasses.

Manage expectations

No surgery guarantees perfect, flawless vision.

Final Thoughts

Cataract surgery is overwhelmingly safe and effective, but understanding its disadvantages helps you prepare mentally, physically, and financially. Almost all temporary side effects resolve on their own, and serious complications are extremely rare. The key is to:

• Choose the right surgeon
  
  
• Understand your IOL options
  
  
• Follow your care routine
  
  
• Keep realistic expectations
  
  

When done well, cataract surgery remains one of the greatest medical advancements ever developed — restoring vision, independence, and quality of life for millions every year.