Cataract surgery is one of the most commonly performed procedures in the world. Every year, millions of people undergo it with the expectation of seeing more clearly and regaining confidence in daily life. Most of the time, those expectations are met. More than 95% of patients experience a significant improvement in vision after cataract surgery, and many studies put the success rate closer to 98%, with serious complications remaining very rare.
But it’s important to remember that no surgery is without drawbacks. Even a safe and routine procedure like cataract removal carries risks, and the outcomes don’t always align perfectly with what patients imagine beforehand. Some people experience complications, while others find that their visual results fall short of expectations. Knowing these possibilities in advance allows you to approach the decision with a realistic mindset.
This article is not here to frighten you but to give you clarity. We’ll look at the disadvantages of cataract surgery in detail, covering rare but serious complications, common side effects, and the emotional adjustments that sometimes follow. By the end, you’ll be in a stronger position to decide whether the benefits outweigh the risks for your situation.
Why Talk About Disadvantages at All?
It’s natural to feel reassured when you hear that cataract surgery is “routine” or “straightforward.” Surgeons, nurses, and even friends who have been through it often emphasise how quick and painless it can be. While that positivity is helpful, it can also create unrealistic expectations. If you only hear the success stories, you may be shocked if your own experience feels more complicated.
Acknowledging the disadvantages is about balance. Most people will never experience the serious complications we’ll discuss. Yet, some will encounter milder annoyances—glare, dry eye, or lingering need for glasses—that they didn’t anticipate. Others may belong to groups with higher risks, such as people with diabetes or very high levels of short-sightedness.
Having the full picture allows you to prepare mentally. If you know that glare may last for months or that recovery can be slower if you have another eye condition, you won’t feel caught off guard. Instead, you’ll understand that these are recognised possibilities, not signs that something has gone terribly wrong.
Surgical Risks: Rare but Important to Know
Like any operation, cataract surgery carries risks. Even though modern techniques have made it one of the safest procedures in medicine, there are still potential complications to be aware of.
Infection (Endophthalmitis)
Infection inside the eye after cataract surgery is extremely rare, occurring in fewer than 1 in 1,000 cases. When it does happen, however, it can be serious, leading to pain, redness, and even permanent vision loss if not treated quickly. Surgeons take great care to minimise this risk, using antiseptic preparations and prescribing antibiotic drops. But as a patient, you should know that infection remains one of the most feared complications.
Inflammation and Swelling
Some degree of inflammation is expected after surgery—it’s part of the healing process. Usually, it’s mild and settles within a week or two with prescribed anti-inflammatory eye drops. In a minority of cases, though, inflammation can be more intense or prolonged, sometimes affecting the cornea (the clear front surface of the eye) or the macula (the central retina). These cases may require stronger medication or a longer recovery period.
Bleeding Inside the Eye
Bleeding during surgery is uncommon, but if it occurs it can complicate the procedure. Post-operative bleeding into the eye (called suprachoroidal haemorrhage) is rarer still but can threaten sight. Surgeons reduce this risk by careful technique and by advising patients on controlling blood pressure or stopping certain medications before surgery.
Retinal Detachment
This complication is rare, but it is more common in people who are highly short-sighted or who have had previous retinal problems. Retinal detachment means the light-sensitive layer at the back of the eye peels away, causing sudden flashes, floaters, or loss of vision. While treatable with urgent surgery, it can permanently affect vision.
These risks are low, but they exist. Understanding them doesn’t mean you should avoid surgery—it means you’ll recognise warning signs early and seek help without delay if something feels wrong.
Visual Side Effects: What You Might Notice
Not all disadvantages are about dangerous complications. For many people, the more noticeable issues are changes in how they see the world after surgery.
Glare and Halos
One of the most common complaints is glare around lights, particularly at night. Headlights may appear to have starbursts around them, or streetlights may seem too bright. This effect is more common with premium lenses such as multifocals, which split light to provide focus at different distances. Some people adapt and find their brain “tunes out” the halos over time, while others continue to find them distracting, especially when driving at night.
Reduced Contrast Sensitivity
Even when your vision is measured as “20/20” or “6/6,” you may notice that things don’t look as sharp as expected. This is due to reduced contrast sensitivity, which makes it harder to distinguish objects in dim lighting or against similar backgrounds. Again, this is more common with multifocal lenses, but even standard monofocals can produce subtle changes.
Night Vision Difficulties
For some patients, night vision never feels quite the same after surgery. The combination of glare, halos, and reduced contrast can make night driving less comfortable. Surgeons usually discuss this possibility before offering multifocal lenses, as people who drive a lot at night may be better suited to monofocals.
These side effects don’t mean surgery has failed—they’re part of the trade-offs that come with artificial lenses.
Lens-Related Limitations
Cataract surgery doesn’t just remove the cloudy natural lens—it replaces it with an artificial intraocular lens (IOL). That new lens is designed to last a lifetime, but it comes with its own set of limitations.
Monofocal Lenses and the Need for Glasses
The most common lens type is the monofocal lens, which focuses at one distance—usually far. This means that while your distance vision may be excellent, you’ll likely still need reading glasses for close work. Many patients are surprised by this, having assumed surgery would eliminate glasses altogether.
Premium Lenses and Trade-offs
Multifocal or extended depth-of-focus (EDOF) lenses are designed to reduce dependence on glasses. They can provide vision at multiple ranges, but the trade-off is a greater likelihood of glare, halos, and reduced contrast. Choosing these lenses requires a careful discussion of lifestyle needs versus tolerance for side effects.
Lens Dislocation
Very rarely, the implanted lens can move slightly out of place, either soon after surgery or years later. This can cause double vision or blurriness, sometimes requiring another procedure to reposition or replace the lens. It’s not common, but it’s another example of how outcomes may not always be permanent without additional intervention.
Post-Operative Issues
Even after successful surgery, some problems can emerge weeks, months, or even years later.
Posterior Capsule Opacification (PCO)
PCO, sometimes called “secondary cataract,” occurs when the thin membrane holding the artificial lens becomes cloudy. It can develop months or years after surgery and is one of the most common long-term side effects. Fortunately, it can be treated quickly with a YAG laser procedure, restoring clarity almost immediately. But it does mean another appointment and a small additional risk of complications.
Dry Eye Syndrome
Many patients notice their eyes feel gritty or uncomfortable after surgery. For most, this is temporary, but those who already have dry eye disease may find symptoms persist or worsen. Regular use of lubricating drops often helps, but it can feel frustrating if you expected only improvements from surgery.
Floaters
Surgery can make existing floaters more noticeable, or in some cases new ones may appear. While floaters are usually harmless, they can occasionally signal more serious issues like retinal tears, so they should never be ignored.
Recovery Challenges
Recovery after cataract surgery is often quick, with many people seeing better within a few days. But this isn’t guaranteed for everyone. Some patients experience lingering blurriness, light sensitivity, or discomfort that takes weeks to resolve. Those with other eye diseases, such as macular degeneration or diabetic retinopathy, may find the improvement limited compared to people with otherwise healthy eyes.
Emotionally, recovery can also feel harder than expected. Some people are unsettled by the rapid change in vision or by differences between their two eyes if surgery is done one at a time. Others struggle if their vision doesn’t seem as “perfect” as friends or relatives described from their own surgeries.
Who Faces Higher Risks?
Not all patients share the same risk profile. Certain groups are more likely to encounter complications or limitations.
- Diabetics may be at higher risk of swelling in the retina (macular oedema) after surgery.
- Highly short-sighted patients have a higher chance of retinal detachment.
- Glaucoma patients may find that pressure control is more difficult after surgery.
- Those with macular degeneration will not gain as much visual improvement, since the retina is already damaged.
Understanding these differences is essential. For someone with multiple eye conditions, cataract surgery may still be worthwhile, but expectations need to be set differently compared to someone with healthy eyes.
Balancing Risks and Benefits
So where does this leave you? On the one hand, cataract surgery is safe, quick, and life-changing for most people. On the other, it carries risks—rare but real complications, and more common inconveniences like glare or the continued need for glasses.
The disadvantages don’t necessarily mean you shouldn’t have surgery. They mean you should go into it with your eyes open, both literally and figuratively. Knowing what to expect makes recovery easier and ensures you can spot problems early if they arise.
FAQs: Disadvantages of Cataract Surgery
1. Can cataract surgery make my vision worse?
Although cataract surgery is generally very safe and effective, there is a small chance that vision may become worse after the operation. This can happen if a complication arises, such as infection, bleeding inside the eye, or retinal detachment. These events are rare, but they can cause long-lasting damage if not treated quickly. Sometimes, vision may also seem worse temporarily because of post-operative swelling or inflammation, which usually settles with treatment. It’s important to remember that these risks exist, but the likelihood is very low compared to the huge number of people who benefit from improved sight.
2. Will I definitely need glasses after cataract surgery?
Many people expect cataract surgery to free them from glasses completely, but the reality is more nuanced. With standard monofocal lenses, most patients will still need glasses for reading or computer work, even if their distance vision is clear. Premium lenses, such as multifocal or extended depth-of-focus designs, can reduce reliance on glasses, but even with these there may be situations—like reading very fine print or driving at night—where glasses are still helpful. It’s best to think of surgery as improving vision significantly, but not always eliminating glasses entirely.
3. How common are glare and halos after cataract surgery?
Glare and halos are among the most frequently reported side effects after cataract surgery, particularly noticeable around car headlights or street lamps at night. For most people, these disturbances are mild and gradually improve as the brain adapts to the new way of processing light through the artificial lens. However, a smaller group of patients continue to find glare or halos troublesome long-term, especially if they have premium lenses that split light to focus at different distances. Knowing this in advance helps manage expectations and allows patients to weigh the trade-offs between different lens choices.
4. Can cataract surgery cause dry eye?
Yes, cataract surgery can make the eyes feel drier, even in people who had no issues beforehand. This happens because the small incision in the cornea and the changes to the tear film during surgery can temporarily disrupt the eye’s natural balance. For many, these symptoms improve within weeks, but people with a history of dry eye disease may find their condition worsens and needs ongoing treatment with lubricating drops. While not dangerous, it can be frustrating to experience dryness just when you expected your eyes to feel better.
5. What is posterior capsule opacification?
Posterior capsule opacification (PCO), often nicknamed a “secondary cataract,” is the most common long-term disadvantage of cataract surgery. It occurs when the thin membrane that holds the artificial lens in place becomes cloudy, causing blurred vision similar to the original cataract. This doesn’t mean the cataract has “come back,” but it does mean vision can deteriorate months or even years after surgery. Thankfully, treatment is straightforward: a quick, painless laser procedure called YAG capsulotomy restores clear vision in most cases.
6. Can the new lens move out of place?
In rare situations, the artificial lens implant can shift from its intended position. This can happen soon after surgery if the capsule supporting the lens is weak, or later in life if the structures holding the lens loosen. A dislocated lens may cause blurred or double vision and can make the eye feel “out of focus.” In these cases, another procedure may be needed to reposition or replace the lens. While not common, it is a reminder that the artificial lens, though designed to last a lifetime, is not immune to complications.
7. Is cataract surgery riskier if I have other eye diseases?
Yes, pre-existing eye conditions can make cataract surgery more complex and may reduce the level of improvement you can expect. For example, macular degeneration may limit central vision even after a perfectly performed cataract operation, while glaucoma can make eye pressure more difficult to control afterwards. Patients with diabetes are at higher risk of retinal swelling, and highly short-sighted patients face a greater risk of retinal detachment. These factors don’t mean you shouldn’t have surgery, but they do mean your results may differ from someone with otherwise healthy eyes.
8. How long does recovery usually take?
Most people notice significant improvement within a few days, but full recovery takes several weeks. During this time, you may experience fluctuations in clarity, sensitivity to light, or mild discomfort. The healing process is gradual as the eye adapts to the new lens and the tissues settle. For those with additional eye conditions or slower healing in general, it can take longer to feel fully “back to normal.” Being patient and following your surgeon’s advice on using drops and avoiding strain helps ensure the best recovery.
9. Can cataract surgery trigger retinal detachment?
Yes, though it is rare, cataract surgery can slightly increase the risk of retinal detachment. This is more likely in people who are very short-sighted or who already have weak spots in their retina. Retinal detachment is a serious condition where the retina peels away from the back of the eye, causing sudden flashes, floaters, or a shadow across your vision. While the overall risk is low, it’s important to seek urgent care if you notice these symptoms, as prompt surgery gives the best chance of saving sight.
10. What if I feel anxious about cataract surgery?
Anxiety before cataract surgery is extremely common, and it’s a disadvantage that isn’t often talked about. Many people worry about being awake during the procedure or about the possibility of complications. Talking openly with your surgeon or care team can make a big difference—they can explain what to expect and reassure you about the safety measures in place. Knowing the risks are low and that most patients do very well helps put nerves into perspective, but it’s important to acknowledge that fear and prepare emotionally as well as physically.
Final Thoughts
Cataract surgery is one of modern medicine’s great success stories, but it is not flawless. The disadvantages range from rare but serious complications, like infection or retinal detachment, to everyday annoyances, like dry eye or night glare. Some patients find they still need glasses afterwards, while others are surprised by the emotional adjustment that follows.
Being aware of these possibilities helps you prepare for the journey. Instead of being disappointed by imperfections, you’ll understand them as normal outcomes that many people share. And when you balance them against the benefits—clearer vision, more independence, and reduced risk of falls—it becomes clear why so many people choose to go ahead.
The decision is yours, but with realistic expectations, you can make it with confidence.
Final Thoughts
Cataract surgery is widely regarded as one of the greatest achievements in modern medicine. For the vast majority of patients, it restores clarity, sharpens detail, and allows them to return to activities they may have given up—whether that’s reading comfortably, driving with confidence, or simply recognising faces more easily. But like any procedure, it has another side to the story. Risks, side effects, and limitations are part of the picture, and ignoring them does a disservice to patients who deserve full transparency.
The disadvantages range in scale. At one end, there are rare but serious complications such as infection or retinal detachment, which can threaten vision if not treated quickly. At the other, there are everyday annoyances like glare, dry eyes, or the unexpected need for glasses after surgery. Most people fall somewhere in between—enjoying much clearer vision overall, but still finding that surgery is not the “perfect fix” they imagined.
It’s important to emphasise that disadvantages don’t automatically mean failure. A patient who needs reading glasses after surgery hasn’t had an unsuccessful outcome; they’ve simply experienced the realistic limitations of current lens technology. Someone who notices glare at night may still find the benefits of sharper daytime vision far outweigh the inconvenience. The key is perspective—understanding these possibilities ahead of time so you can set your expectations at the right level.
Ultimately, the decision to have cataract surgery should be based on a careful weighing of benefits against risks. For most people, the balance strongly favours surgery. Living with cataracts can restrict independence, increase the risk of falls, and diminish quality of life, while surgery usually provides lasting improvement. By going into the process informed about both the upsides and the downsides, you’ll be better prepared to handle whatever your own journey looks like.
At London Cataract Centre, we believe that informed patients achieve the best results. Our team takes time to discuss not only the benefits but also the possible disadvantages of cataract surgery, so you know exactly what to expect. If you’re considering treatment, booking a consultation with us can give you a personalised assessment and the reassurance that your decision is based on clear, honest information.
References
- Lundström, M., Barry, P., Henry, Y., Rosen, P., Stenevi, U. & Tassignon, M-J. (2012). Evidence-based guidelines for cataract surgery: Guidelines based on data in the European Registry of Quality Outcomes for Cataract and Refractive Surgery database. Journal of Cataract & Refractive Surgery, 38(6), pp.1086-1093. Available at: https://escrs.org/media/rzodvbsy/evidence-based_guidelines_for_cataract_surgery.pdf (Accessed 17 September 2025).
- NHS. (2025). Cataract surgery — risks and what to expect. Available at: https://www.nhs.uk/tests-and-treatments/cataract-surgery/ (Accessed 17 September 2025).
- Hey NHS. (2018). Risks and Benefits of Cataract Surgery (Patient Leaflet). Available at: https://www.hey.nhs.uk/patient-leaflet/risks-benefits-cataract-surgery/ (Accessed 17 September 2025).
- Imperial College Healthcare NHS Trust. (2023). Cataract Surgery – Patient Information Leaflet. Available at: https://www.imperial.nhs.uk/-/media/website/patient-information-leaflets/ophthalmology/cataract-surgery.pdf?rev=e403fa2ccdf7494db003168e78b49b6b&sc_lang=en (Accessed 17 September 2025).
- Russells Hall Hospital, The Dudley Group NHS Foundation Trust. (n.d.). Cataract Surgery leaflet. Available at: https://www.dgft.nhs.uk/leaflet/cataract-surgery/ (Accessed 17 September 2025).