A cataract is a clouding of the eye's naturally clear lens. The lens sits behind the iris and focuses light onto the retina; as it clouds, less light gets through and what does get through is scattered. Vision becomes blurred, colours dull, and glare from headlights and sunlight becomes difficult.

Cataracts are not a disease so much as an eventual fact of life. Nearly everyone develops them given enough years.

Meet your surgeon

Dr. Mark Goulas has performed more than 15,000 cataract surgeries. He founded this practice in Bluffton in 2006 and is board-certified by the American Board of Ophthalmology, having completed his ophthalmology training at Texas Tech University.

There is good evidence that surgical volume matters in cataract surgery — that outcomes and complication rates track with how many of these a surgeon has actually done. Fifteen thousand is a substantial number by any measure.

Dr. Erin Benjamin also performs cataract surgery, with an emphasis on micro-incision technique, and has performed thousands of procedures using current approaches.

Both operate here in the Lowcountry. You are not being asked to travel to Savannah or Charleston for this.

How do you know when it is time?

This is the question we are asked most, and the honest answer is that you largely decide, not us.

In most cases, waiting does no harm to your eye. A cataract does not damage anything by being left alone, and if your vision is still serving you well, surgery can wait — sometimes for years. There is no prize for having it done early.

The right time is when the cataract is interfering with the life you want to lead. In practice that usually means:

Night driving has become uncomfortable or you have quietly stopped doing it
Glare from oncoming headlights, or from sun off the water, is genuinely difficult
Reading takes more light than it used to, or has stopped being enjoyable
Colours look faded or yellowed
You have changed your glasses prescription recently and it did not help much
Activities you care about — golf, boating, needlework, screens — have become harder

There is one exception worth naming: if a cataract is dense enough to prevent us from examining the back of your eye, we may recommend surgery sooner so that macular degeneration, diabetic retinopathy, or glaucoma can be monitored properly.

What actually happens

The consultation. We confirm the cataract is what is limiting your vision, examine the rest of your eye, and take careful measurements of its length and curvature. Those measurements determine the power of the lens implant, and getting them right is a substantial part of getting the outcome right. We will discuss lens options at this visit.

Surgery day. The procedure is done on an outpatient basis — you go home the same day. Drops dilate the pupil, the eye is numbed with local anaesthetic, and you are given a sedative so you are relaxed and comfortable. You are not asleep, but you are not uncomfortable either, and most people find the experience far less dramatic than they had braced for.

The clouded lens is broken up and removed through a very small incision, and a clear artificial lens — an intraocular lens, or IOL — is folded, inserted into the same capsule the natural lens occupied, and allowed to unfold into position. It becomes a permanent part of the eye. You cannot see it or feel it, and it needs no care.

The operation itself typically takes well under an hour. Most of your day is preparation and recovery, not surgery.

If your other eye also needs surgery, it is scheduled separately, usually a few weeks later.

Recovery

Vision usually begins improving within a few days, though it can take a few weeks to settle fully. Many patients notice on the first day that colours look startlingly brighter and bluer — the yellowed filter of the cataract having been removed.

Expect some grittiness, mild light sensitivity, and a little blurring early on. You will have a follow-up the day after surgery, and again over the following weeks.

You will be asked to avoid rubbing the eye, to keep water and soap out of it, to avoid heavy lifting and strenuous exercise briefly, and to wear a shield at night at first. Most people return to ordinary activities quickly, and driving resumes once vision meets the legal standard and we have confirmed it.

Because the lens implant has a fixed focus, most patients still use glasses for some tasks — commonly reading. Which tasks depends heavily on which lens option you choose.

Dropless cataract surgery

The post-operative drop regimen is historically the most complained-about part of cataract surgery — expensive, confusing, and genuinely difficult to administer for anyone with arthritis or a tremor.

We offer dropless cataract surgery, in which a compounded antibiotic and anti-inflammatory is placed inside the eye at the time of surgery and released over the healing period. It removes the cost, the confusion, and the uncertainty about whether the drop actually went in.

Risks

Cataract surgery is among the safest operations in medicine, and serious complications are uncommon. They are not zero, and you should hear them: inflammation, infection, bleeding, swelling, retinal detachment, raised eye pressure, clouding of the capsule behind the implant, and — rarely — loss of vision.

Most complications are treatable when caught promptly, which is what the follow-up schedule is for. Risk is higher if you have another eye condition or a significant medical condition, which we will discuss specifically with you rather than in general terms.

Capsule clouding is common enough to mention separately: months or years later, the capsule holding the implant can become hazy. It is corrected with a painless few-minute laser procedure, and it does not recur.

Cost and insurance

Cataract surgery involves three separate charges: the surgeon's fee, the surgical facility fee, and the anaesthesia fee. Standard cataract surgery with a monofocal lens is typically covered by Medicare and most commercial insurance.

Premium lens options that reduce your dependence on glasses generally carry an additional out-of-pocket cost, because insurance covers the cataract, not the upgrade. We will give you a written estimate before you commit to anything. See insurance and fees.

Cataract Surgery in Bluffton & Hilton Head Island