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Exactly How Long Does It Take For Vision To Stabilize After Cataract Surgery

Exactly How Long Does It Take For Vision To Stabilize After Cataract Surgery

The classic recommendation after cataract surgery is to wait a full month before getting an updated pair of glasses (if needed). This gives the eye enough time to heal properly to get a perfect prescription of glasses.

But if you are having trouble seeing, a month is a LONG time! Is this month really necessary?

While the recovery after cataract surgery is quick, it isn’t instantaneous. It will take some time for the vision to fully sharpen up and become stable. But luckily this doesn’t take long.

The great news is that the large majority will have stable prescriptions and vision at about 1-2 weeks after cataract surgery.

But before we end it there, it’s important to mention that not everyone will be stable at that junction. It is also possible to have a stable prescription yet still have blurry or fluctuating vision. So let’s explore why it takes a week for vision to become stable and what can make it take longer.

What Exactly Stabilizes After Cataract Surgery

The biggest limiting factor for vision to stabilize after cataract surgery is the cornea.

During cataract surgery, the cornea can become more swollen. This swelling can change vision and the prescription of the eye.

On the inside of the cornea is a single layer of cells called endothelial cells. These cells have one job - pump water out of the cornea and keep it from getting swollen.

Endothelial cells of the cornea

Endothelial cells of the cornea; Image by StemBook (CC BY 3.0) / modified from original

During cataract surgery, ultrasound energy is used to break up the cataract. This ultrasound energy can “stun” those endothelial cells. This prevents those cells from working well and causes the cornea to have more swelling. In addition, saline can be forced directly into the cornea during cataract surgery - again causing an increase in swelling.

As those cells return to normal function, they pump all the fluid out of the cornea and the vision becomes stable.

Surgeons do use an advanced cushioning gel to protect those cells, but the denser the cataract is and the longer the procedure is, the more swelling can result.

But swelling isn’t the only change to the cornea. A tiny micro-incision is made within the cornea to remove the cataract and to place the new artificial lens. Although small, this incision causes a very small point of instability. Until this incision heals and becomes stronger, the cornea (and thus vision) isn’t fully stable.

Fluctuating vision

On top of all this, blurry vision may come and go for another reason: Dry eye.

After cataract surgery, the eyes will be more dry. Going through a procedure and being on a lot of eye drops for the first few weeks to month can cause more irritation to the eyes. This in turn can dry the eyes out more. When the eyes are dry, the tear film on the surface of the eye can evaporate more quickly and become irregular. This can cause the vision to alternate between being sharp (especially right after blinking) to becoming blurry a few seconds later.

This can last the first few weeks after cataract surgery (and longer for those who already had preexisting dry eyes). Using preservative free artificial tears can help treat this and stabilize the vision faster.

When Vision Is Stable

But in general, all of this heals very quickly! For the vast majority of people, these changes will stabilize by about the first week after cataract surgery.

Beyond a week or two after cataract surgery, the prescription of the eye doesn't significantly change.

If needed, glasses can be prescribed at this point for most individuals.

Getting a pair of glasses earlier to restore vision and improve function is particularly important in a few scenarios:

  • You had astigmatism but opted for the standard monofocal cataract lens. Thus, you will have astigmatism after cataract surgery blurring vision.
  • You were nearsighted before cataract surgery and opted to have your vision corrected for near vision afterwards. Your prescription after cataract surgery probably won’t be close enough to your prescription before cataract surgery and you will need a new pair of glasses for the distance.
  • You are off target after cataract surgery. As much as we want cataract surgery to be 100% accurate, it isn’t. As much as 1 out of every 20 individuals can be significantly off target after cataract surgery. Until this extra prescription is corrected, vision can be blurry.

A final scenario: when you have your eyes corrected for distance vision, you will have difficulty reading up close (unless you opted for an upgraded lens to get out of glasses). If you fall into this category, picking up a cheap pair of reading glasses from any drug store can allow you to see up close. (And there is no major reason to wait for the vision to stabilize since you can pick up another pair in the future also cheaply). Check out What Is The Best Reading Glasses Prescription After Cataract Surgery? to learn more.

But if you need a prescription of glasses to sharpen up your vision and allow you to see well again, waiting a full month is incredibly difficult. (In fact, this may be longer than a month; frequently the glasses prescription is given a month after the SECOND eye. This could mean the first eye goes without being corrected for 5, 6 or even longer after cataract surgery.

However,.. not everyone will have stable vision that quickly.

Why Can Vision Take Longer To Become Stable?

Remember when I said that there can be more swelling with denser cataracts? More swelling means a longer time for the swelling to resolve. While many of those will still resolve within about 1-2 weeks, if you have an especially dense, challenging or complicated cataract, it can take longer for the vision to fully stabilize.

But one of the more common ways vision can take longer to become stable is due to astigmatism correction.

As mentioned above, the tiny micro-incision creates a small area of temporary instability in the cornea. As the incision heals, the cornea becomes stable.

One very common way to correct small amounts of astigmatism is through something known as a LRI or limbal relaxing incision. These are often performed with femtosecond laser cataract surgery to correct vision as much as possible. But these incision are much larger than the main micro-incision. Because of this, it will take longer for these incisions to fully heal and become stable. In fact, it can take up to 10 weeks for the prescription to become fully stable when astigmatism is corrected this way. But despite the extra wait, having no astigmatism is better than having astigmatism.

There are few other uncommon situations that will also prolong the time it takes for the vision to become stable:

  • Some people have a less than healthy corneal endothelial cell layer. This condition is called Fuchs’ Corneal Dystrophy. With this condition, the cornea has a harder time with swelling. It will take longer for all the swelling to resolve.
  • During the 1980’s and the 1990’s a surgery called Radial Keratotomy (also known more simply as RK) was commonly performed to correct nearsightedness. This procedure involved perpendicular incisions into the cornea - sometimes as many as 8 or even 16 incision. As we’ve learned so far, having incisions in the cornea make the cornea less stable after cataract surgery. As a result, for individuals treated with RK, it takes a long time, up to 3 months, after cataract surgery for the vision to stabilize!

Stable Prescription Yet Still Blurry Vision

For most people, it doesn’t take long for the vision to stabilize after cataract surgery. However, this doesn’t mean that the vision will be sharp. It just means the prescription of the eye is done changing.

It is still very possible to have blurry vision for a few other reasons after cataract surgery. The most common causes being:

  • Having some remaining prescription (getting pair of glasses can correct this).
  • Still having dry eye and the fluctuation that comes from it - even despite having a stable prescription.

These are two of the most common causes of blurry vision after cataract surgery. Check out This Is WHY You Have Blurry Vision After Cataract Surgery to learn about a lot more causes.

Finally, vision can also be blurry simply because the eye hasn’t adjusted. Having a cataract removed and having an artificial lens placed to correct vision creates quite a big change for the brain. It can take some time for the brain to adjust to all these changes. As this adjustment occurs, the vision continues to improve over time after cataract surgery. See Adjusting And Training Eyes After Cataract Surgery to learn how this happens.

Summary

For most people after cataract surgery, vision becomes stable after about a week or two. If needed, getting a pair of glasses at this time to correct vision can be a huge benefit. However, it can take longer with certain individuals such as those with a dense and difficult cataract or those who had astigmatism correction. And despite having a stable prescription, there are other ways such as dry eye that can cause the vision to be blurry.

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