If you’re living with diabetes, you already know how important it is to keep an eye on your health – literally. Diabetic retinopathy is one of the most common complications of diabetes, and if you also develop cataracts, things can get a bit more complicated. But don’t worry – with the right planning and the right team, cataract surgery is still very much possible, and often beneficial, even if you have diabetic retinopathy. The key lies in good timing, tailored treatment, and close monitoring.
This article walks you through everything you need to know about having cataract surgery when diabetic retinopathy is in the picture. We’ll cover how the retina is evaluated, when surgery is recommended, and what steps are taken to protect your vision before, during and after the procedure.
Understanding Diabetic Retinopathy
Diabetic retinopathy is a condition where high blood sugar levels damage the tiny blood vessels in the retina. These vessels can leak, become blocked, or grow abnormally, affecting how the retina functions. Over time, this can lead to blurred vision, floaters, or even permanent sight loss if not treated properly.
There are different stages of diabetic retinopathy. In the early stages (non-proliferative), changes in the retinal blood vessels are relatively mild. In advanced stages (proliferative), new, fragile blood vessels can form, which are prone to bleeding and scarring. Additionally, diabetic macular oedema (DMO) can cause swelling in the macula, the central part of your retina responsible for sharp vision.
The severity of your retinopathy plays a big role in how cataract surgery is planned. If your retinopathy is active or advanced, it needs to be stabilised before considering surgery. That said, cataracts themselves can make it difficult to monitor and treat the retina, which is why managing both conditions together is so important.
Cataracts in People with Diabetes
Cataracts are more common and tend to develop earlier in people with diabetes. A cataract is a clouding of the lens inside your eye, which can make everything look blurry, dim or yellowed. For someone with diabetic retinopathy, cataracts don’t just reduce vision – they can also make it harder for your retinal specialist to get a clear view of the retina during exams or laser treatments.
That’s one of the reasons cataract surgery might be recommended even if your cataract doesn’t seem “ripe” yet. Improving lens clarity can help your eye care team better assess and treat your diabetic retinopathy. In many cases, doing cataract surgery at the right time can make ongoing retina treatment more effective and allow better monitoring.
However, surgery in diabetic eyes isn’t always straightforward. There’s a higher risk of inflammation, macular oedema, and delayed healing. That’s why the timing and coordination with your retina team is so crucial.
Preoperative Retinal Assessment
Before cataract surgery, your retina needs a full assessment. This usually involves a dilated eye exam and optical coherence tomography (OCT) to check for macular oedema or subtle changes. In some cases, fluorescein angiography may be used to assess the blood vessels in more detail.
If active retinopathy or macular oedema is detected, treatment will likely be needed first. This might include laser photocoagulation, anti-VEGF injections (like aflibercept or ranibizumab), or corticosteroids to reduce swelling and stabilise the retina. The goal is to make the retinal environment as stable as possible before surgery.
Some patients may need multiple injections in the months leading up to their operation. In others, a single preoperative injection might suffice. Your retina specialist will guide the timing to balance risk and benefit, aiming to keep the macula dry and stable before lens removal.
Planning the Timing of Surgery
When both cataracts and diabetic retinopathy are present, the decision to go ahead with surgery isn’t just about how cloudy your vision is. It’s about weighing how much the cataract is affecting your ability to manage the retina, and whether the retina is stable enough to handle surgery.
If the cataract is so dense that it prevents monitoring or treatment of the retina, surgery may be needed sooner. In contrast, if retinal disease is very active, surgery might be delayed until things settle down. The timing has to be just right – not too early to risk worsening the retina, but not too late to compromise your overall eye health.
In many cases, the decision is made jointly between your cataract surgeon and retina specialist. This collaborative approach ensures your retina is protected before, during and after surgery, with both teams coordinating on your medications, treatment schedule, and follow-up care.
Surgical Considerations in Diabetic Eyes
Cataract surgery in patients with diabetic retinopathy often involves a few extra precautions. Surgeons may use additional anti-inflammatory drops, adjust the choice of intraocular lens (IOL), and carefully control fluid levels during surgery to avoid retinal stress.
In some cases, a combined procedure might be performed – for instance, cataract surgery with intravitreal anti-VEGF injection at the end of the operation. This can help reduce the risk of macular swelling after surgery. Some clinics also consider preoperative steroids or NSAIDs to lower inflammation risk.
The IOL chosen is typically monofocal and acrylic, with good optical quality and low inflammatory response. Multifocal lenses are generally avoided in diabetic eyes, especially if there’s any risk of macular oedema or retinal damage, as they can affect contrast sensitivity and clarity.
Postoperative Care and Monitoring
The postoperative period is critical when you have diabetic retinopathy. Inflammation can linger longer, and there’s a greater risk of developing macular oedema after surgery. You’ll likely be given a tailored regimen of steroid and NSAID eye drops, sometimes for several weeks or even months.
Your retina will be closely monitored in the weeks following surgery. OCT scans may be done periodically to check for swelling, and follow-up injections may be recommended to prevent or treat oedema. If you have proliferative disease, additional laser treatments may be planned post-surgery.
The key is to stick to your follow-up schedule and alert your team if your vision worsens or becomes distorted. With the right care, many patients with diabetic retinopathy recover well and even notice a marked improvement in vision after cataract surgery.
Realistic Expectations
It’s important to set realistic expectations when having cataract surgery with diabetic retinopathy. If your macula or retina is already damaged, surgery won’t reverse that. However, it can still offer visual improvement by clearing the cloudy lens and making retinal treatment easier going forward.
In some cases, vision may improve only slightly, or you might still need glasses or low vision aids. But many patients do notice brighter, clearer vision and feel more confident in their daily activities post-surgery. Your surgical outcome will depend on your retina’s health, the presence of macular oedema, and how well your diabetes is controlled overall.
Managing your blood sugar, attending all follow-ups, and following your medication plan is just as important as the surgery itself in achieving the best possible result.
How to Choose the Right Clinic for Cataract Surgery with Diabetic Retinopathy
When you’re living with diabetic retinopathy, having cataract surgery isn’t just about removing a cloudy lens. It’s about choosing a clinic that understands the complexities of retinal disease. Not all eye centres are equipped to manage the added risks and requirements that come with diabetes-related eye conditions. That’s why it’s worth taking the time to find a team that regularly handles cases like yours, with both cataract surgeons and retinal specialists involved in your care plan from the outset.
Look for a clinic that offers advanced diagnostic tools such as OCT imaging, which is essential for monitoring macular oedema before and after surgery. Ask if they have protocols in place for administering anti-VEGF or steroid injections, either during surgery or in the post-op period. Ideally, the clinic should also coordinate closely with your diabetologist or GP to ensure your systemic health is optimised around the time of the procedure.
At a more practical level, choose a clinic that has clear follow-up pathways, short waiting times, and a team that takes the time to explain your options. A good provider will be transparent about expected outcomes, realistic about the risks, and proactive in managing both your cataract and retinopathy together. The difference this makes to your safety, vision, and long-term eye health cannot be overstated.
Frequently Asked Questions
- What is the biggest risk of cataract surgery in someone with diabetic retinopathy?
The most significant risk is developing or worsening diabetic macular oedema after surgery. This condition causes fluid to collect in the macula, which is the part of the retina responsible for sharp central vision. In diabetic eyes, inflammation from the surgery can aggravate blood vessel leakage, making the macula swell and reducing visual clarity. However, with preoperative planning and postoperative care involving anti-inflammatory drops or injections, the risk of macular oedema can be reduced significantly, making cataract surgery a safe and effective option for many patients. - Will I need injections before or after cataract surgery?
Yes, injections are commonly used to help manage the retinal risks in people with diabetic retinopathy undergoing cataract surgery. These are usually anti-VEGF injections, which work to reduce abnormal blood vessel growth and leakage. Some patients receive them before surgery to stabilise the retina, while others may get them at the time of surgery or in the weeks that follow to prevent swelling. The timing and frequency depend on how active your retinopathy is and whether you’ve had macular oedema before. - Does cataract surgery make diabetic retinopathy worse?
Cataract surgery itself doesn’t directly make diabetic retinopathy worse, but it can unmask or accelerate existing retinal issues if not carefully managed. The inflammation caused by surgery might trigger retinal changes, especially if the condition is already active. That’s why it’s important to assess the retina thoroughly before the operation and ensure it’s as stable as possible. With proper planning and coordinated care between your surgeon and retinal specialist, the risk of worsening is minimal. - Can I have laser treatment and cataract surgery at the same time?
Laser treatment and cataract surgery are usually performed separately to reduce strain on the eye and allow healing between procedures. Laser therapy may be done in the weeks before surgery to control any retinal bleeding or swelling. While it’s technically possible to combine them, it’s generally not recommended unless absolutely necessary. Treating the retina first often leads to a more predictable and safer surgical outcome, and laser treatment afterwards can also be done if changes arise post-op. - How long will recovery take?
Recovery after cataract surgery in people with diabetic retinopathy tends to be a bit longer than in those without underlying eye disease. Most patients notice improved vision within a few days, but complete healing and retinal stability can take several weeks or even months. This extended timeline is due to the increased risk of inflammation or fluid accumulation in the retina. Your eye care team will usually keep you on a longer schedule of eye drops and follow-up visits to monitor for complications. - Can I get a multifocal lens if I have diabetic retinopathy?
Multifocal lenses are generally not advised for people with diabetic retinopathy. These lenses split light into multiple focal points, which can reduce contrast sensitivity – a problem if the retina is already compromised. In eyes with macular damage or a history of swelling, a monofocal lens provides clearer, more reliable vision and doesn’t rely on a perfectly functioning retina. Your surgeon will likely recommend a monofocal lens aimed at maximising sharpness and stability rather than correcting for multiple distances. - What if my cataract is so dense they can’t see my retina?
When the cataract is extremely dense, it can obscure the retina entirely, making it difficult or impossible to assess the extent of diabetic retinopathy. In such cases, cataract surgery is sometimes necessary not just to improve vision but to allow proper retinal examination and treatment. After surgery, your eye care team will be able to re-evaluate the retina more clearly using OCT and other imaging techniques, ensuring that any hidden issues can be addressed without delay. - Do I need to control my blood sugar before surgery?
Yes, maintaining good blood sugar control before cataract surgery is essential. High glucose levels can impair healing, increase the risk of infection, and make inflammation harder to manage. A well-controlled diabetic status supports better surgical outcomes and reduces the chance of postoperative complications like macular oedema. Your eye surgeon may consult with your GP or endocrinologist to ensure your diabetes is stable enough to proceed safely with the operation. - Can I go blind from cataract surgery if I have diabetic retinopathy?
While blindness from cataract surgery is extremely rare, the risks are slightly higher in patients with advanced diabetic retinopathy. These include complications such as severe macular oedema, retinal bleeding, or tractional retinal detachment. However, such outcomes are typically preventable with early detection, proper preoperative management, and close collaboration between your surgical and retinal care teams. When performed under the right conditions, cataract surgery can significantly improve vision even in diabetic eyes. - How soon can I go back to normal activities?
Most people can return to light activities like walking, reading, and watching television within a couple of days after cataract surgery. However, for those with diabetic retinopathy, a more cautious approach is often recommended. You’ll need to avoid heavy lifting, bending over, or rubbing the eye for a few weeks, and stick to your eye drop schedule religiously. Post-op check-ups will ensure your retina is stable before resuming more strenuous tasks or travelling long distances.
Final Thoughts
Cataract surgery when you have diabetic retinopathy isn’t something to rush into – but it’s also not something to fear. With proper preoperative assessment, good retinal stability, and close collaboration between your cataract surgeon and retina specialist, the procedure can be safe and effective.
At London Cataract Centre, we regularly care for patients with complex eye conditions, including diabetic retinopathy. Our team understands how to balance the timing, monitor your retina carefully, and ensure your recovery is as smooth as possible. If you’re living with diabetes and considering cataract surgery, don’t hesitate to speak to a specialist about the best plan for you.
References
1. West, J.A., Dowler, J.G.F., Hamilton, A.M.P., Boyd, S.R. and Hykin, P.G., 1999. Panretinal photocoagulation during cataract extraction in eyes with active proliferative diabetic disease. Eye, 13(Pt 2), pp.170–173. Available at: https://pubmed.ncbi.nlm.nih.gov/10450376/ [Accessed 20 Jul. 2025].2. Zhao, L.-Q. and Cheng, J.-W., 2019. A systematic review and meta‑analysis of intravitreal anti‑VEGF treatment immediately after cataract surgery in patients with diabetic retinopathy. Journal of Ophthalmology, 2019, Article ID 2648267. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6501156/ [Accessed 20 Jul. 2025].
3. Lois, N. et al., 2023. Optimizing treatment for diabetic macular oedema during cataract surgery. Frontiers in Endocrinology, 14, Article 1106706. Available at: https://www.frontiersin.org/journals/endocrinology/articles/10.3389/fendo.2023.1106706/full [Accessed 20 Jul. 2025].
4. Retinal Today Editorial Board, 2010. Cataract surgery in diabetic patients: integrating retinal management. Retina Today, July–August 2010. Available at: https://retinatoday.com/articles/2010-july-aug/cataract-surgery-in-diabetic-patients [Accessed 20 Jul. 2025].
5. Diabetes Care Editorial Group, 2011. Optimal timing of panretinal photocoagulation and cataract surgery: ETDRS recommendations. Diabetes Care, 34(7), p.e123. Available at: https://diabetesjournals.org/care/article-abstract/34/7/e123/38698 [Accessed 20 Jul. 2025].