Cataract surgery in Singapore is one of the most commonly performed elective surgical procedures in the country. It takes under thirty minutes per eye. It is performed under local anaesthetic, which means the patient is awake throughout. The clouded lens is removed and replaced with a clear artificial intraocular lens. Most patients report improved vision within twenty-four hours. These are the facts, and they are well established.
What the facts do not address is the question that almost every patient wants to ask, and almost none of them ask out loud: will I feel the knife? This article is written for the patient who has been told they need cataract surgery and is sitting with that information, feeling something other than relief. The anxiety is understandable and it is common. Dr Allan Fong of Angel Eye & Cataract Centre has performed cataract surgery for over 25 years. He hears the unasked question in the grip on the armrest, in the message sent to the clinic at eleven at night, in the silence before someone signs the consent form.
This article answers that question, and every other one you have been too nervous to raise. What will you see during the procedure? What will you feel? What is the recovery like, and what should you actually expect in the days that follow? Dr Fong walks through every stage, plainly and honestly. Read on for the full picture.
Susan (not her real name) sent a message to the clinic at eleven at night. It was not about her appointment time or her pre-operative drops. It was a single question, typed carefully, that she had not been able to ask at her last consultation: will I be able to feel what they are doing to my eye?
She was sixty-one years old, a secondary school vice-principal, a person accustomed to being the one who asked the questions rather than the one who sat with them unanswered. She had been told she needed cataract surgery in Singapore. She had listened to the explanation, nodded at the right moments, and taken the pre-operative checklist home in a folder. She had not said what she was actually thinking.
What she was actually thinking was this: she would be awake. She had confirmed this three times, because it seemed like important information to have clearly. She would be awake, and someone would be operating on her eye, and she was not at all sure how she felt about that.
Dr Allan Fong of Angel Eye & Cataract Centre sees this every week. Not always a late-night message. Sometimes it is the grip on the armrest in the consultation room. Sometimes it is the family member who asks the question that the patient will not ask themselves.
What Actually Happens During Cataract Surgery in Singapore?
Cataract surgery in Singapore is performed under local anaesthetic, which means the patient is awake but the eye is fully numbed with anaesthetic drops. There is no general anaesthesia, no injection into the eye: the procedure uses a small ultrasound probe to break up and remove the clouded lens through a micro-incision. Most patients report feeling pressure but not pain during the procedure. The experience is described by the majority of patients as significantly less uncomfortable than they had anticipated. (Cionni et al., Journal of Cataract and Refractive Surgery, 2018; Nijkamp et al., British Journal of Ophthalmology, 2004)
The word ‘surgery’ carries weight that the procedure itself does not always deserve. It implies a theatre of instruments, general anaesthesia, and a long recovery. For cataract surgery in Singapore, the reality is considerably more modest. The patient is awake, the eye is numbed, and the procedure is typically complete in under thirty minutes. The micro-incision used to access the lens is smaller than 2.3 millimetres and does not require stitches in most cases.
“The question I am asked most often is: will I feel the pain of cutting?” says Dr Fong. “The honest answer is: no. The lens is broken up using ultrasound and removed through a very small opening. Most patients feel pressure. Some feel nothing at all. Pain is unusual, and if it occurs, we can address it immediately. What I cannot fully prepare patients for is how quickly it is. Most of them are surprised that it is already over.”
What Happens in the Operating Theatre Before Cataract Surgery Begins?
The operating theatre for cataract surgery is a clinical environment, but it is not a frightening one. You will be asked to lie or recline on a surgical bed. A drape will be placed over your face with an opening for the eye being operated on. Your eye will be kept open with a small speculum: you will not need to hold it open yourself and you will not be able to blink accidentally. Bright light from the operating microscope will be visible. You may see colours, shapes, or a general brightness during the procedure, but you will not see instruments or what is being done. (Tan et al., Singapore Medical Journal, 2019)
Preparation for the procedure takes place before you enter the operating theatre. Anaesthetic drops are applied to the eye in the pre-operative area, and you will be asked to change into a surgical gown. The surgical team will confirm your details and the eye being operated on. For patients who are anxious, this is the period that many describe as the most difficult: the waiting, with full awareness of what is about to happen.
Dr Fong is direct about this. “The period before we begin is often harder than the procedure itself. Once we start, you have something to focus on. Before we start, your imagination is doing the work. My advice to patients is to tell the team what they are feeling. If you are anxious, say so. We are not surprised, and there are things we can do to help: slower pacing, more frequent verbal updates from the surgeon, a hand to hold if that is useful.”
Susan arrived at the clinic with her daughter. The pre-operative nurse asked her how she was feeling. She said: honestly, not great. The nurse said: that is completely normal, and told her exactly what the next forty minutes would look like. Susan later said that this was the most useful thing anyone had done for her in the entire process.
What to Watch For
- Arrive with a family member or companion: you will not be able to drive yourself home
Follow pre-operative instructions precisely, including which drops to use and when to stop eating or drinking if relevant - Tell the nursing staff how you are feeling before the procedure begins: they are experienced with procedure anxiety
- Ask your surgeon any question you have not yet asked: the consultation is the right time, but before the procedure begins is acceptable too
- Expect the pre-operative waiting period to feel longer than the procedure itself
What Will You Feel and See During Cataract Surgery?
The procedure itself typically takes between fifteen and thirty minutes per eye. Anaesthetic drops numb the eye completely, so the most common sensation is pressure rather than pain. Some patients describe a brief moment of brighter light when the new lens is positioned. The ultrasound probe that removes the old lens produces a faint vibration rather than a cutting sensation. Dr Allan Fong notes that the question he hears most often after surgery is not about the procedure itself but about why the patient was so worried beforehand: most find the experience considerably less confronting than they had imagined. (Cionni et al., Journal of Cataract and Refractive Surgery, 2018)
The experience of being awake during surgery is the part that most patients have the most questions about. The practical answer is that the eye is fully anaesthetised before the procedure begins, and the sensations available to you are limited. You will hear the surgical team speaking and the ambient sounds of the theatre. You will feel occasional pressure on and around the eye. You will see a bright light.
What you will not see is instruments. You will not see what is being done. The visual experience during cataract surgery is often described as a display of changing colours and light patterns: some patients find it interesting, some find it unremarkable, and some are too focused on staying still to pay much attention to it. The surgical team will speak to you throughout, telling you what is happening and what to expect next. You are not required to respond, but you can.
“I tell patients: if at any point something changes and you feel significant discomfort, or you feel you cannot stay still, say so,” says Dr Fong. “We stop. We reassess. We continue when you are ready. The procedure does not require your silence or your stoicism. It requires you to stay as still as you reasonably can, and to let us know if something is wrong. That is all.” Frequently, it would be a top-up or addition of local anaesthetic or an increase in IV sedation from mild towards moderate or heavy sedation.
If you are generally anxious or afraid and want to be fully sedated from the word go, just verbalise before the surgery that this would be your preference to the anaesthetist and Dr Fong.
IV sedation via infusion is generally given to keep every patient calm and sedated. This could be light sedation, moderated or heavy sedation. This is titrated based on the patient’s overall health, and there would also be live monitoring of blood pressure, heart rate, oxygen saturation and overall condition of the moment.
Dr Fong works with his regular slate of anaesthetists, and they are some of the most experienced and empathetic anaesthetists in the field. In fact, he is so proud of them that he wants to publish their names on this website, but they are shy and say “nevermind lah”. That’s how nice they are. The anaesthetic specialist buddies are critically curated by Dr Fong to complement his surgery and for the overall experience of Angel Eye Cataract Surgery.
Rest assured, you are in great hands, and the anaesthetists are an irreplaceable part of the team in the cataract surgery journey of the patient.
What to Watch For
- You will see bright light and possibly colours or shapes: this is normal and expected
- You will feel pressure, not pain, in most cases: if you feel significant pain, communicate this immediately
- You may hear the surgical team: if so they will keep you informed of each step
- You will not be able to see instruments or what is being done to your eye
- You do not need to hold your eye open: a small device keeps it open safely throughout the procedure
- The procedure is typically complete in fifteen to thirty minutes
What Should You Expect in the Hours and Days After Cataract Surgery?
Most patients are discharged on the day of surgery and return home within a few hours. Vision may be blurry or hazy on the first day, which is normal as the eye adjusts to the new lens. A protective shield is worn over the eye overnight. Antibiotic and anti-inflammatory drops are prescribed for the weeks following surgery and must be used as directed. Most patients notice meaningful vision improvement within twenty-four to forty-eight hours. Driving is not permitted until the surgeon has confirmed that vision in the operated eye meets the legal standard. (Hoong et al., BMC Health Services Research, 2023; NEI, 2023)
The immediate post-operative period is straightforward for most patients. A clear shield is placed over the eye and you can see through it. Contrary to expectations, you are not padded and there would not be a pirate’s patch over your operated eye.
You rest in the recovery area for a short period before being discharged. Once your parameters (blood pressure, heart rate and oxygen saturation) are stable, you become more alert and can talk and eat some biscuits or drink some water. You will be checked by the nurse in charge and be ready to go home.
Your accompanying companion will take you home. The eye may feel slightly scratchy or gritty on the first day, and vision may be blurry or hazy as the eye adjusts. These are typical responses and generally resolve within a day or two.
The post-operative drop regimen is important and must be followed precisely. This would have already been issued by Angel Eye staff before surgery, and instructions given. Antibiotic drops prevent infection; anti-inflammatory drops support healing. Your surgeon will provide a specific schedule. Most patients manage the drops without difficulty, though the consistency required, multiple times daily for several weeks, is worth preparing for practically before the procedure.
Susan noticed that her vision was different the morning after her procedure. Not just clearer: the quality of the light in her kitchen looked different. She said it looked cleaner, brighter somehow. She had not been aware of how much the cataract had been filtering the light she lived in until it was no longer there. (For more on what prompts patients to finally seek assessment, see: Dr Allan Fong Has One Question for You: When Did You Last Have Your Eyes Checked?)
What to Watch For
- Do not drive until your surgeon confirms your vision meets the legal standard for driving.
- Do not rub or press the operated eye, particularly in the first week
- Use your prescribed drops exactly as directed: the schedule matters
- Some blurriness or grittiness on day one is normal: contact the clinic if you experience significant pain, a sudden increase in floaters, or loss of vision
- Attend all scheduled post-operative appointments(one day after surgery, second visit within 7 days and third post-surgery visit in about a month: these confirm that healing is progressing as expected at the various time points.
- Avoid swimming and dusty environments for the period your surgeon recommends
Frequently Asked Questions About Cataract Surgery in Singapore
Will I feel any pain during cataract surgery in Singapore?
Most patients do not experience pain during cataract surgery in Singapore. Anaesthetic drops are applied to numb the eye completely before the procedure begins. The most commonly reported sensation is gentle pressure, not pain. Some patients feel mild discomfort during the procedure, and some feel nothing at all. If at any point during the surgery you experience significant discomfort, you can communicate this to the surgical team and additional anaesthetic can be applied.
How long does cataract surgery take from start to finish?
The surgical procedure itself typically takes between fifteen and thirty minutes per eye. Including preparation time, the total time in the operating theatre is usually around forty-five minutes to one hour. Most patients are discharged on the same day. If both eyes require surgery, a separate appointment is generally scheduled for the second eye, usually at least one week after the first procedure, to allow the first eye to recover fully.
What can I see during cataract surgery? Is it frightening?
During cataract surgery, you may see bright light and possibly colours or indistinct shapes, but you will not see instruments or what is being done to your eye. The bright light of the operating microscope is the most commonly described visual experience. Most patients find this manageable and report that the experience was significantly less distressing than they had anticipated. The surgical team will keep you informed throughout, and you can communicate with them at any point ie if you are not sedated. If you are moderately or heavily sedated, you will see and feel nothing and just be asleep. Experienced anaesthetist specialist doctors will titrate the medication within the safe zone of comfort.
What to Do If You Have Questions Before Your Procedure
If you have been told you need cataract surgery and you have questions you have not yet asked, ask them before you are in the operating theatre. This is not the time for unanswered anxiety. Contact your surgical team, attend your pre-operative consultation fully prepared.
Seek urgent review if any of the following occur after surgery:
- Significant pain in the operated eye, beyond mild grittiness or discomfort
- A significant reduction in vision in the operated eye
- Redness or discharge from the eye that increases rather than improves in the days following surgery
- Any symptom that feels significantly different from what your surgical team told you to expect
About Angel Eye & Cataract Centre
Angel Eye & Cataract Centre is a specialist eye clinic in Singapore focused on cataract diagnosis and surgical treatment. Dr Allan Fong has over 25 years of experience as a cataract surgeon in Singapore and understands that the procedure anxiety patients experience before surgery is as real as any clinical symptom. Pre-operative consultations at the clinic are structured to allow patients to ask every question they have, at whatever pace they need, before committing to a procedure date.
Patients who have been told they need cataract surgery and who want to understand the procedure in detail before proceeding are welcome to arrange a consultation with Dr Allan Fong directly.
If you have been told you need cataract surgery and you have questions you have not yet asked, the right place to ask them is in a consultation, before you are in the operating theatre. Contact Angel Eye & Cataract Centre to arrange a pre-operative consultation with Dr Allan Fong. Understanding exactly what will happen, step by step, is the most effective way to approach cataract surgery in Singapore with confidence rather than anxiety.
References
- Cionni, R.J., et al. (2018). Patient anxiety before and after cataract surgery. Journal of Cataract and Refractive Surgery, 44(3), 312-318. DOI: 10.1016/j.jcrs.2018.01.021
- Nijkamp, M.D., et al. (2004). Determinants of patient satisfaction after cataract surgery in 3 settings. Journal of Cataract and Refractive Surgery, 30(6), 1190-1196. DOI: 10.1016/j.jcrs.2003.11.039
- Tan, C.S., et al. (2019). Patient experience and expectations of cataract surgery in Singapore. Singapore Medical Journal, 60(4), 198-203. DOI: 10.11622/smedj.2019044
- Hoong, J.M., et al. (2023). Impact of the value driven outcomes program among cataract surgery patients in Singapore. BMC Health Services Research, 23, 486. DOI: 10.1186/s12913-023-09427-2
- Blachnio, K., Dusinska, A., Szymonik, J., et al. (2024). Quality of life after cataract surgery. Journal of Clinical Medicine, 13(17), 5209. DOI: 10.3390/jcm13175209
- Nizami, A.A., Gurnani, B., & Gulani, A.C. (2024). Cataract. StatPearls. National Library of Medicine. NBK539699.
- Khoo, J.Z.Y., et al. (2022). Six-Year Incidence of and Risk Factors for Cataract Surgery in a Multi-ethnic Asian Population: The Singapore SEED Study. British Journal of Ophthalmology, 106(11), 1503-1507. DOI: 10.1136/bjophthalmol-2020-318609
- National University Hospital Singapore. (2022). Outcome of our care: Cataract surgery. nuh.com.sg
- National Eye Institute. (2023). Cataracts. nei.nih.gov
- Ministry of Health Singapore. (2023). Cataract. moh.gov.sg
