If you are like most people, you’ll probably learn you have a cataract during a routine eye exam. Your regular eye doctor will probably recommend that you visit an ophthalmologist.

Your ophthalmologist will probably:

• Diagnose any refractive error you have and measure both the curvature of your cornea and the length of your eye to help determine the type and power of lens you will need.
• Examine the external parts of the eye, such as the eyelids, cornea, pupil and lens.
• Place drops in your eye to dilate your pupil so he or she can look closely at the back of your eye.
• If you have had laser vision correction, he or she may conduct additional tests and may ask you to obtain your pre- and post-operative LASIK data for reference, if possible.

Your ophthalmologist will also ask for a full health history, including what medications you are currently taking and what medications you have taken in the past. Certain health conditions, including diabetes, diabetic retinopathy, autoimmune diseases, glaucoma, corneal disease and age-related macular degeneration may need special discussion. Some of these may hasten or delay when you’ll need to have cataract surgery and may make you more prone to some complications.

It is especially important that you tell your ophthalmologist if you have ever taken alpha-blockers, including Flomax® or Rapaflo®. Alpha-blockers are muscle-relaxing medications to treat prostate enlargement and other conditions. If you have ever taken these medications, they can cause the iris of the eye to be "floppy" during surgery, increasing the possibility of a complication, so it is very important to tell your ophthalmologist if you have taken these medications.

In order to decide which type of lens replacement is right for you, your doctor will also consider your overall visual needs. To prepare for this conversation with your doctor, you may want to write down answers to the questions in the cataract surgery decisions section and bring them with you to your first appointment. Your ophthalmologist can help you weigh your personal goals against your medical needs to decide which type of lens is right for you.

There is no perfect time to have cataract surgery. Together, you and your doctor will decide when the time is right.

Most doctors recommend surgery once daily tasks become difficult or your quality of life is affected. If you have cataracts in both eyes, your doctor may recommend having surgery on the eye with the most advanced symptoms first.

If you also have other diseases or conditions, your doctor may recommend surgery even if your vision is only mildly impaired. This could happen, for example, if the cataract is interfering with the examination or treatment of other parts of your eye.

Lifestyle factors may also be important in your decision about when to have cataract surgery. You and your doctor must weigh the possible risks and costs of cataract surgery against the possibility of having better quality of vision for many more years.

Many patients ask their spouse, friend or caregiver to attend their pre-operative appointment, to serve as an extra set of ears to hear the doctor's recommendations and directions.

Bring all your current medications to this appointment. Your doctor may recommend that you stop taking certain medications at least a few days prior to your procedure, such as aspirin and other blood-thinning drugs (anticoagulants like Coumadin®). But it may be fine to continue other important medications.

In addition, doctors often prescribe eye drops for a few days before surgery, to prevent infection and inflammation.

Don't forget to schedule time off from work. The entire process from check-in to checkout will probably last about two to three hours, but most patients need at least one day to recover before resuming their regular work schedules.

You won’t be able to drive for at least 24 hours after lens replacement surgery, so:

• Ask someone to drive you to and from the procedure.
• Arrange ahead of time for someone to pick up any medications you may need immediately after surgery.
• Ask someone to give you a ride to your follow-up exam the next day.

Patients are usually asked not to drink alcoholic beverages for at least 24 hours prior to lens replacement surgery. Some doctors allow their patients to eat a light breakfast on the day of surgery, while others recommend skipping the morning meal.

Make sure you are clear about which medications you must avoid taking on the morning of surgery. Some medications are fine to take, while others are not.

To help maintain a clean surgical environment, you should shower and wash your hair on the day of surgery. Wear clean, comfortable clothes.

Your doctor will be an ophthalmologist trained in eye surgery-and cataract surgery/lens replacement in particular. He or she will lead a team that includes a technician and a nurse and possibly other assisting staff.

The operating room will be treated to prevent infection, as it is for any surgery. The team will wear scrubs, gowns, gloves and masks to help preserve this sterile environment.

Advances in surgical techniques make general anesthesia unnecessary except under rare circumstances that may affect your ability to hold still. Your doctor or nurse will instead apply a local anesthetic that will numb and perhaps immobilize your eye.

Thanks to the anesthetic and medications to help you relax, the procedure involves minimal discomfort. You will remain awake and alert but probably will not see any of the surgery.

Your nurse may start intravenous fluids and attach you to a heart rate monitor. A drape will be placed around your face so that only the eye to be operated on is visible.

Most people experience little or no pain or discomfort during cataract surgery. If you feel any discomfort, let your doctor know. Most patients are aware of the surgical team and environment but can't make out images.

The doctor will make a very small incision at or near the cornea. In most cases, the incision is so small (an eighth of an inch or less) that few stitches, if any, are required at the end of cataract surgery.

These days, virtually all cataract surgeries performed in the U.S. remove the clouded natural lens using a technique called phacoemulsification. That means your doctor will use a thin probe to break up and remove the cataract with ultrasonic energy.

Then, the intraocular lens is rolled up, inserted through the same incision, unrolled and set into its permanent position. Small arms (haptics) extend from the lens to hold it in place. During insertion, the microscope light may seem very bright.

In some cases, your doctor may use a more rigid plastic lens and a slightly longer incision may be necessary. If so, you will likely need a stitch or two.

This is a colloquial way of saying that the cataract affects vision enough that the benefits of removing it outweigh the risks. As the risks of cataract surgery have decreased, the degree of vision deterioration required to be eligible for surgery has been decreasing, as well.

Typically, doctors will perform surgery in the second eye two or three weeks after the first eye. All patients are different, so talk to your doctor about what is right for you.