Cataract Surgery
Frequently Asked Questions

Cataract surgery is one of the most common procedures in ophthalmology. A cataract occurs when the eye’s natural lens becomes cloudy, making it harder to see clearly. During surgery, the cloudy lens is carefully removed and replaced with a clear artificial lens called an intraocular lens (IOL). This restores sharper, brighter vision. Modern cataract surgery is quick, safe, and highly effective, with millions of people benefiting from it each year. At Zelenak Eye Institute, Dr. Zelenak performs cataract surgery using advanced technology to ensure the best possible outcome for each patient.

When you have cataract surgery, you can choose from different types of IOLs depending on your vision goals. Monofocal lenses provide clear vision at one distance, usually set for distance vision, and glasses may still be needed for reading or computer work. Toric lenses are designed for patients with astigmatism, correcting irregular curvature of the cornea while restoring clear vision. Multifocal lenses allow you to see at multiple distances, often reducing or eliminating the need for glasses after surgery. Extended depth of focus (EDOF) lenses provide a continuous, natural range of vision from distance to intermediate. Dr. Zelenak will discuss which lens option is best suited to your eyes, lifestyle, and visual goals.

Most adults diagnosed with visually significant cataracts are good candidates for cataract surgery. Generally, if your cataracts are affecting your quality of life and your eyes are otherwise healthy, surgery is a safe and effective option. Certain conditions such as advanced glaucoma, macular degeneration, or other retinal diseases may affect your expected outcome, and Dr. Zelenak will discuss this with you honestly during your consultation. The best way to determine if you are a candidate is to schedule a comprehensive eye exam. Dr. Zelenak will evaluate your eyes thoroughly, review your medical history, and give you his honest recommendation based on what is best for your individual situation.

Dr. Zelenak recommends considering cataract surgery when his patients start to experience visual disturbances that are impacting their daily lives. Typically, the first sign of cataracts is increasing glare while driving at night, especially in the rain. Once you do start to notice issues with your vision, symptoms tend to worsen with time. If you are experiencing glare, trouble seeing writing on the TV, or difficulty with small print, the first suggestion would be to check if glasses can help. If glasses offer no improvement, it may be time to consider a cataract evaluation with an ophthalmologist.

Dr. Zelenak will evaluate the severity of your cataracts and discuss your symptoms and lifestyle during your consultation to help determine the right time for you. The goal is never to rush surgery, but also never to let cataracts unnecessarily limit your quality of life. Because cataracts grow slowly, nearly every patient is surprised how much their vision was actually suffering after having their cataracts removed.

Most patients are surprised at how comfortable the procedure is. Cataract surgery is performed using numbing eye drops, so you remain awake but feel no pain. You may notice some pressure or slight movement during the procedure, but it is not painful. After surgery, mild irritation, dryness, or a scratchy feeling is normal for a short time and usually improves quickly.

The procedure itself typically takes less than 10 minutes per eye. However, plan to be at the surgical center for 2 to 3 hours to allow time for preparation, anesthesia, and recovery before heading home. Patients go home the same day and are able to resume light activities within 24 hours.

On the day of your cataract surgery, plan to arrive at the surgical center approximately one to two hours before your scheduled procedure. You will be checked in, and the nursing staff will prepare you for surgery, which includes placing dilating drops and numbing drops in your eye and administering mild sedation through an IV to keep you relaxed and comfortable. The procedure itself takes less than 10 minutes, after which you will rest briefly in the recovery area before being discharged. You will need someone to drive you home. Most patients feel well enough to resume light activities later that same day, though your vision may be blurry for the remainder of the day. Dr. Zelenak will see you for a follow-up appointment to check on your healing and answer any questions you may have.

If both eyes need cataract surgery, they are typically done two weeks apart. This allows the first eye to heal and your vision to stabilize before operating on the second eye. During the period between surgeries, some patients notice a feeling of visual imbalance between the two eyes. This is completely normal and resolves once the second eye has been treated. Dr. Zelenak finds that two weeks is usually enough time to allow the first eye to heal while minimizing the period of imbalance as much as possible.

Recovery is generally smooth and quick. Most patients notice clearer vision within a few days, though it can take a few weeks for your eyesight to fully stabilize. Eye drops will be prescribed to prevent infection and reduce inflammation. You may experience mild blurriness, light sensitivity, or dry eye symptoms at first. Most people return to normal routines within a week, but final healing can take up to a month.

While recovery is fast, there are a few temporary restrictions to protect your eyes. Avoid rubbing or pressing on the eye. Do not lift heavy objects or do strenuous exercise for at least a week. Keep water, soap, and dust out of your eyes. Avoid swimming and hot tubs until your doctor clears you. Dr. Zelenak will provide you with detailed aftercare instructions tailored to your healing process.

You will not be able to drive yourself home after surgery, as mild sedation is used during the procedure. Driving is restricted for 24 hours following surgery, so please arrange for someone to drive you home and be available to assist you that day. Most patients feel comfortable driving to their follow-up appointment the next day. However, we ask that you only drive if you feel safe doing so. If you have any doubt, please arrange for someone to drive you. Dr. Zelenak will confirm when it is safe for you to resume driving at your follow-up appointment.

Whether you need glasses after cataract surgery depends largely on the type of lens implant you choose. Patients who choose a basic monofocal lens will typically still need glasses for reading and may need them for distance as well if they have any astigmatism. Patients who choose a premium lens such as a multifocal, EDOF, or toric IOL can expect a significant reduction in their dependence on glasses, and many are able to go through most of their daily activities without them.

It is important to have realistic expectations. No lens implant can guarantee complete freedom from glasses in every situation, and Dr. Zelenak will give you an honest assessment of what to expect based on your eyes and the lens you choose. Patients who choose a premium lens are typically very satisfied with their level of visual independence after surgery.

Basic cataract surgery involves removing the cloudy lens and replacing it with a basic monofocal IOL, which provides clear vision at one distance, typically distance vision. Basic lenses do not correct astigmatism, so most patients will still require glasses to see their best at distance, as well as bifocals or reading glasses for near tasks such as computers or reading. This option is covered by Medicare and most insurance plans.

Premium cataract surgery uses advanced technology lenses, including multifocal, EDOF, and toric IOLs, to provide a broader range of vision and reduce or eliminate dependence on glasses after surgery. Premium lenses are an elective upgrade and involve additional out-of-pocket costs not covered by insurance.

The right choice depends entirely on your lifestyle, your vision goals, and your eye health. Dr. Zelenak takes the time to understand what matters most to you before making any recommendation. Some patients are perfectly happy with distance vision and glasses for reading. Others place a high value on not needing glasses every day. There is no one-size-fits-all answer, and Dr. Zelenak will never suggest any lens upgrades if it is not appropriate or in the patient’s best interest.

Yes, Medicare covers cataract surgery when it is medically necessary. It is the patient’s responsibility to understand their own insurance policy and any copays, deductibles, or coinsurance they may be responsible for. We are happy to help however possible with this. Cataract surgery with the implantation of a basic monofocal lens is usually covered. However, premium lenses such as multifocal, EDOF, or toric IOLs are considered an elective upgrade and are not fully covered by insurance. Patients choosing premium lenses will have additional out-of-pocket costs, but patients who choose these upgrades find them a very worthwhile investment in their long-term vision and lifestyle satisfaction.

Medicare and most private insurance plans cover the cost of cataract surgery itself, including the removal of the cataract and the implantation of a basic monofocal lens, when the surgery is medically necessary. Premium lens implants, including trifocal, EDOF, and toric lenses, involve additional out-of-pocket costs that insurance does not cover. The reasoning from the insurance company’s perspective is straightforward: since glasses can correct your vision after surgery, a premium lens implant is not considered medically necessary, even if it would dramatically improve your day-to-day quality of life.

Many patients understandably find this frustrating. The goal of a premium lens implant is not simply to restore vision, it is to restore the kind of vision that lets you live your life the way you want to, whether that means driving comfortably at night, reading without reaching for glasses, or staying active without worrying about eyewear. That improvement in quality of life is real, and for most patients who choose a premium lens, it is the most important outcome of their surgery.

It is also worth considering the long-term value. Glasses and contact lenses are an ongoing expense, typically every two to three years for updated prescriptions and new frames or lenses. A premium lens implant is designed to last the rest of your life. When patients think about it that way, many find the out-of-pocket cost a very worthwhile investment. Dr. Zelenak’s team will walk you through all of the costs clearly during your consultation so you can make the decision that is right for you.

The honest answer is that there is no single best lens for every patient. The right lens depends on your vision goals, your lifestyle, the health of your eyes, and how much you rely on glasses today.

Patients who are comfortable wearing glasses for reading and just want clear distance vision after surgery often do very well with a basic monofocal lens. Although distance vision can be quite good with a basic monofocal, most patients end up being disappointed with their reading vision without glasses. Patients who want to reduce their dependence on glasses for most daily activities, including distance, intermediate, and near tasks, are typically better candidates for a trifocal or EDOF lens. If your eyes have astigmatism, there are special versions of most premium lenses made specifically to address it, and choosing the right one can give you better vision at all distances compared to the basic monofocal.

Dr. Zelenak offers the full range of premium IOLs from Alcon, Johnson and Johnson Vision, and Bausch and Lomb, and takes the time during your consultation to understand your priorities before making any recommendation. The goal is to help you pick the lens that will best meet your expectations and help you see your best for the rest of your life.

Both trifocal and EDOF lenses are premium lens implants that give you a much broader range of vision than a basic monofocal lens, but they work differently and suit different types of patients.

Trifocal lenses are designed to give you clear vision at three distinct distances: far, intermediate, and near. Think of them like trifocal glasses, with three distinct zones of vision built into the lens. They are the best option for patients who want the most complete freedom from glasses, including for reading fine print up close. The tradeoff is that some patients notice halos or rings around lights at night, particularly in the first few months after surgery. For most patients this improves significantly over time as the brain adapts.

EDOF lenses work differently. Rather than targeting three fixed focal points, they create a continuous extended range of vision from distance through intermediate, more like progressive no-line glasses than traditional bifocals or trifocals. Most patients find them excellent for driving, computer work, and everyday tasks. Reading very fine print up close may still require readers in some situations, but many patients find this a worthwhile tradeoff for the smoother, more natural quality of vision EDOF lenses provide, particularly at night.

The right choice between the two comes down to what matters most to you. If maximum independence from glasses at all distances is the priority, a trifocal is usually the better fit. If you are more sensitive to nighttime visual disturbances and willing to occasionally use readers for very fine print, an EDOF lens may suit you better. Dr. Zelenak will walk you through both options during your consultation and help you decide which is the right fit for your eyes and your lifestyle.

Standard cataract surgery alone does not correct astigmatism. However, with the right lens choice, astigmatism can be addressed at the time of cataract surgery. Toric IOLs are specifically designed to correct astigmatism, and when combined with the precise pre-operative measurements taken with the Zeiss Atlas Topographer and ARGOS Biometer, along with real-time alignment guidance from the ORA System during surgery, Dr. Zelenak is able to achieve very accurate astigmatism correction for most patients.

For patients with astigmatism who choose a basic monofocal lens, the astigmatism remains untreated and glasses will be required to see their best at distance along with a bifocal for reading. If you have astigmatism and are considering cataract surgery, Dr. Zelenak will discuss your options during your consultation and recommend the best approach for your individual situation.

Dr. Zelenak uses advanced technology at every stage of the cataract surgery process to ensure the most accurate and personalized outcome possible. Prior to surgery, the Zeiss Atlas Topographer maps the curvature of your cornea and the ARGOS Biometer takes precise measurements of your eye, both of which are critical for selecting the correct lens power and achieving the best possible vision after surgery.

During surgery, the ORA System with VerifEye+ Technology provides real-time guidance, allowing Dr. Zelenak to verify lens selection and placement while you are on the operating table, including precise alignment for toric astigmatism correcting lenses. This level of intraoperative precision is particularly valuable for patients choosing premium lenses, where accuracy is essential to achieving the best results. Together, these technologies allow Dr. Zelenak to achieve the best outcomes currently possible for his patients.

Laser cataract surgery, also called femtosecond laser-assisted cataract surgery or FLACS, uses a computer-guided laser to perform several of the steps that are traditionally performed by the surgeon during cataract surgery. The most commonly marketed systems include LenSx by Alcon, Catalys by Johnson and Johnson Vision, and LENSAR.

During traditional cataract surgery, the surgeon uses a specialized blade, often made of diamond, to create the corneal incision to enter the eye and access the cataract, performs the capsulotomy (the circular opening in the lens capsule that allows the cataract to be removed, also called the rhexis), and uses ultrasound energy to break up and remove the cloudy lens. In laser cataract surgery, the femtosecond laser takes over the first three of these steps: making the corneal incision, creating the capsulotomy, and pre-softening the lens to reduce the amount of ultrasound energy needed to remove it.

It is important to understand that in both laser and traditional cataract surgery, the actual removal of the cataract is performed the same way. The surgeon uses a phacoemulsification handpiece to break up and aspirate the lens from the eye. The laser does not remove the cataract. That step is identical in both approaches.

The theoretical advantages of the laser are improved precision in the incision and capsulotomy, and reduced ultrasound energy delivered to the eye during lens removal. Whether these theoretical advantages translate into meaningfully better outcomes for patients in real-world practice is a separate question, and one worth asking.

This is one of the most important questions a cataract surgery patient can ask, and it deserves an honest, evidence-based answer.

Laser cataract surgery is heavily marketed, and the appeal is understandable. A computer-guided laser sounds more precise and more advanced than a surgeon using a blade. But the clinical reality is more nuanced. A study published in JAMA Ophthalmology comparing femtosecond laser-assisted cataract surgery to traditional phacoemulsification found no significant difference in visual outcomes between the two approaches, while the cost of laser-assisted surgery was roughly double that of traditional surgery.

Here is why an experienced surgeon using the right instruments can match or exceed what the laser offers. The corneal incision in traditional surgery is made with a specialized diamond blade. Diamond incisions are exceptionally clean and precise, and in experienced hands produce results that are equal to or better than a laser incision. The capsulotomy, the circular opening made in the lens capsule to access the cataract, is performed manually by the surgeon in traditional surgery. A skilled manual rhexis produces smoother, more even capsule edges than a laser capsulotomy. And a prechopper, a specialized instrument used to mechanically divide the lens before removal, can achieve the same reduction in ultrasound energy that the laser is designed to provide. In each of the three areas where laser surgery claims an advantage, surgical experience and technique achieve the same result.

Laser cataract surgery also adds cost. The laser fee alone typically adds $500 to $1,500 per eye on top of whatever the patient is already paying for a premium lens implant. Dr. Zelenak was surprised to discover that some practices in Michigan charge $10,000 to $15,000 for a premium cataract surgery package that includes laser. At Zelenak Eye Institute, the out-of-pocket cost for premium lens surgery ranges from approximately $1,600 to $3,000 per eye depending on the lens selected, with no laser fee added on top. That price reflects the full premium lens experience: ARGOS Biometer pre-operative planning, ORA System intraoperative guidance, the additional planning and calculations needed for the precision required to maximize the investment you made in a premium lens implant, and Dr. Zelenak’s personal attention at every step of your care.

Dr. Zelenak has evaluated femtosecond laser technology carefully. If he believed it would give his patients better outcomes, he would use it without hesitation. The published clinical evidence and his own surgical experience tell him otherwise, and his patients deserve that honest assessment.

Choosing the right cataract surgeon is one of the most important decisions you will make for your long-term vision. Cataract surgery is permanent, and the lens implanted in your eye is designed to last the rest of your life. Here are the questions worth asking before you commit.

Does the same surgeon who evaluates you perform your surgery? In some larger practices, the surgeon you meet at your consultation is not necessarily the surgeon who operates on your eyes. At Zelenak Eye Institute, Dr. Zelenak personally sees every patient at every visit, performs every surgery himself, and is present for every follow-up appointment. You will never wonder who is taking care of you.

Is the practice physician-owned? Private equity consolidation in ophthalmology has accelerated significantly in recent years. In PE-owned practices, surgical volume and revenue targets can influence clinical decisions in ways that may not always align with the individual patient’s best interest. Dr. Zelenak owns and operates Zelenak Eye Institute independently, with no outside ownership or financial incentives beyond doing right by his patients.

What technology does the practice use for surgical planning and intraoperative guidance? Precise pre-operative measurements are critical to achieving the best possible outcome, particularly with premium lens implants. Ask whether the practice uses advanced biometry such as the ARGOS Biometer, and whether intraoperative guidance such as the ORA System with VerifEye+ Technology is available during surgery.

Does the surgeon offer the full range of premium lens options? Some practices have preferred lens relationships that may limit your choices. Dr. Zelenak offers the complete range of premium IOLs from Alcon, Johnson and Johnson Vision, and Bausch and Lomb, and recommends lenses based solely on what is best for each individual patient.

Where is the surgery performed? Dr. Zelenak performs cataract surgery at Novi Surgery Center and Corewell Health Surgery Center in Livonia, both fully accredited ambulatory surgery centers serving patients from Novi, West Bloomfield, Northville, and throughout Metro Detroit.

A few more things I think are worth saying directly. If a surgeon is not willing to spend meaningful face-to-face time with you before your surgery, ask yourself whether that same surgeon will take the care and attention during your actual procedure to assure an excellent outcome and minimize any risk of complications. The two tend to go together.

If a surgeon promises you that you will absolutely never need glasses again for anything, ever, under any circumstances, I would encourage you to look elsewhere. No honest surgeon can make that promise, and one who does is telling you more about their sales approach than their surgical judgment.

And finally, even if you have been referred to a specific surgeon or practice, if your instincts tell you it is not the right fit, trust them. A referral is a starting point, not an obligation. You only have one set of eyes, and you deserve a surgeon you genuinely trust with them.