How to Prepare for Cataract Surgery When You Have Diabetes

A cataract is a clouding of the eye's natural lens, making it harder to see. If you have diabetes, you may be more likely to develop cataracts. You also may have more steps to follow before, during, and after cataract surgery.

This article will cover why cataracts are more likely to develop when you have diabetes and how to prepare before, during, and after cataract surgery.

Why Cataracts Are More Common in Diabetes

Cataract development is most commonly associated with aging. By age 80, more than 50% of adults in the United States have had a cataract or cataract surgery. During cataract surgery, the eye surgeon removes the eye's natural lens with the cataract and replaces it with an artificial lens.

If you have type 1 or type 2 diabetes, your risk of developing cataracts is higher compared to people who do not have diabetes. This is because, over time, high blood sugar levels can cause changes to the lens that will speed up cataract development.

Factors that may affect whether or not you develop cataracts when you have diabetes include:

• How long you have had diabetes
• How often your blood sugar spikes above your target range
• Whether or not you have fluid that builds up in your macula, which is located in the center of the light-sensitive tissue called the retina in the back of the eye

In addition to aging, other factors that contribute to cataract development include:

• Excessive sun exposure
• Smoking
• Steroid use

Whether or not you have diabetes, it may not be possible to prevent cataracts entirely. Still, you can try to slow cataract development.

A 2018 study that included more than 56,000 people newly diagnosed with diabetes aged 40 and above in the United Kingdom compared with a group that did not have diabetes found that the risk for cataracts doubled among those with diabetes. Cataracts were more common at younger ages than in the non-diabetic group, but they also were more common among those with a longer duration of diabetes.

With any surgery, people with diabetes are at a higher risk for slower healing and infection at the surgery site. However, even with these risks, cataract surgery can be done and often helps improve vision.

Preparing for Cataract Surgery

If you have diabetes and have a cataract in one or both eyes, your optometrist or ophthalmologist may want to initially monitor the cataract or prescribe new eyeglasses. When it affects your vision more profoundly, the ophthalmologist may recommend removing the cataract. When you have diabetes, your ophthalmologist may recommend surgery earlier on to ensure better results.

The ophthalmologist who will perform surgery, and the medical team, will provide instructions on how to prepare for surgery. These instructions will be similar to those shared with people who do not have diabetes.

However, your ophthalmologist may spend more time comparing your vision symptoms to your cataract severity. For instance, if you have visual effects that seem worse than the extent of your cataract, your ophthalmologist may further examine whether there is a problem in the retina contributing to visual symptoms. That is because diabetic retinopathy, a problem that can affect the retina when you have diabetes, also may affect your eyes.

Your ophthalmologist will let you know if you need to avoid any medications before surgery. For example, if you wear contact lenses, you will be asked not to use them for a week or so leading up to surgery. However, you may be instructed to use certain types of eye medications in the few days before surgery. These can include drops that will help prevent infection and promote better healing in the eye. While these drops are common for any person before cataract surgery, they are especially important when you have diabetes to reduce the chance of complications.

During Cataract Surgery

Ask your ophthalmologist if you can take your diabetes medication on the day of your surgery. You may be asked to avoid diabetes medications, including insulin, on the morning of your surgery. The surgical team may schedule your surgery early and ask you to bring your diabetes medications.

For the cataract surgery, you will most likely not be asleep. You may receive a sedative to keep you calm along with local anesthesia.

While performing surgery, your ophthalmologist may slightly change how surgery is done to help avoid complications more common in people with diabetes. These changes could include:

• Using less energy in the phacoemulsification machine. Phacoemulsification is the most common approach to modern cataract surgery in the U.S.
• Using less fluid in the eye. Phacoemulsification involves the control of fluid in the eye during surgery.
• Injecting certain medications in the eye to assist with the surgery, such as triamcinolone or anti-vascular endothelial growth factors.
• Avoiding certain types of artificial lens replacements (called intraocular lenses or IOLs) that may be more likely to cause problems if there are complications from the cataract surgery

After Cataract Surgery

After cataract surgery, your ophthalmologist may prescribe a steroid, and nonsteroidal anti-inflammatory eye drops to help control inflammation. These also can help prevent and treat swelling of the macula, also called macular edema. The surgical team will give you a schedule to indicate how often to use these drops. Sometimes, you may not have to take these drops because the ophthalmologist will inject them into the eye at the conclusion of surgery.

If you have diabetes, you may be more prone to certain complications after cataract surgery. These include:

• Decreased sensitivity in the cornea, which is the dome-shaped part of the eye
• Endophthalmitis, a rare but serious infection in the eye. There is a 31% higher rate of endophthalmitis among those who have diabetes compared with those who do not have diabetes.
• More swelling in the macula, called diabetic macular edema. This condition can affect your vision, but there are treatments for it.
• Posterior capsular opacification, which is a loss of clarity in the capsule that holds the IOL. This can cause blurry vision and glare. This is often treatable with the use of a special laser.
• Worsening diabetic retinopathy or new development of diabetic retinopathy

It is possible to improve your cataract surgery results by:

• Doing your best to keep your blood sugar under control.
• Using eye drops as recommended by your ophthalmologist.
• Keeping all follow-up appointments with your ophthalmologist, even if your vision is good and you do not have any questions or concerns.
• Having your eyes monitored by a retinal specialist if needed. The ophthalmologist who performed your cataract surgery may recommend this if there are concerns about diseases of the retina caused by diabetes or worsened during cataract surgery.
• Following all other instructions given by your surgical team.

When to See Your Healthcare Provider

Your ophthalmologist will tell you know how long it will take to notice an improvement in your vision after cataract surgery. Many people will notice a difference in one to three days, but it may take several weeks for your vision to fully recover.

Your ophthalmologist also will schedule follow-up appointments to monitor how your eye is doing after surgery. In addition to these follow-ups, you should call the ophthalmologist after cataract surgery if you have the following:

• Eye pain
• Worsening vision
• A sudden loss of vision
• New flashes of light or other changes in your line of vision

Summary

Cataracts can develop more often and at a younger age when you have diabetes. Eye doctors use certain strategies to help monitor your eyes and improve the chances of successful cataract surgery when you have diabetes. This can include using special surgical techniques and prescribing eye drops that can lessen the chance of problems. Worsening diabetic retinopathy and posterior capsular opacification are some of the risks after cataract surgery when you have diabetes.

A Word From Verywell

Cataract surgery is the most commonly performed surgery in the United States. Cataract surgery can help you to see more clearly. Because any surgery has risks, you can do your part to ensure success by following instructions from your ophthalmologist and working with your healthcare team (including your primary healthcare provider) to keep your blood sugar under control and using any medications as advised.