Cataract surgery is a common outpatient procedure to remove a cloudy lens from the eye and replace it with an artificial lens to restore clear vision. Modern cataract surgery is quick, painless, and highly successful, with over 98% of patients achieving better vision after the procedure.
One decision patients and their surgeons make prior to cataract surgery is whether the patient will sit up or lay down during the procedure. Both positions are commonly used during cataract surgery. The choice depends on the patient’s health, the surgeon’s preference, and the type of anesthesia used.
What happens during cataract surgery?
Cataract surgery takes 30-90 minutes and involves the following steps:
- Numbing eye drops are applied to prevent discomfort.
- The eye and surrounding skin are cleaned and draped.
- A small incision is made to access the lens.
- The cloudy natural lens is broken up with ultrasound and removed.
- The artificial replacement lens is inserted into the empty capsular bag.
- The incision is closed with tiny absorbable stitches or allowed to self-seal.
- Antibiotic and anti-inflammatory eye drops are applied.
Throughout the procedure, patients are closely monitored. Vital signs like heart rate and blood pressure are tracked to ensure safety.
Sitting up vs. laying down: what’s the difference?
The biggest difference between sitting up vs. laying down for cataract surgery is the orientation of the patient.
Sitting up:
– Patient is seated in a reclined chair, like a dentist’s chair
– Head is tilted back and supported
– Surgeon stands or sits at the patient’s side or behind their head
Laying down:
– Patient lies on their back on an operating table
– Head may be slightly elevated on a small pillow
– Surgeon stands or sits alongside or above the patient’s head
In both positions, the patient’s face and operative eye are prepped and draped. The eye itself is positioned under the surgical microscope for the procedure.
Anesthesia options
Cataract surgery does not require general anesthesia where the patient is fully asleep. Instead, cataract surgery can be performed using local anesthesia, sedation, or a nerve block.
Local anesthesia involves numbing eye drops applied directly to the eye. The drops prevent discomfort during surgery but the patient remains fully awake. This allows cataract surgery to be performed with the patient sitting up.
Sedation provides medicines through an IV to help the patient relax and be drowsy, but not fully asleep. Mild sedation allows the patient to sit up or lay down. Moderate sedation is only compatible with laying down during the procedure.
Nerve blocks numb sensation in the eye by injecting anesthesia around the nerves. This provides complete pain control for cataract surgery while allowing the patient to remain sitting up or supine.
Why sit up for cataract surgery?
There are several potential advantages to remaining seated for cataract surgery:
- May feel less intimidating than laying down under a surgical light
- Lower risk of anesthesia-related breathing problems
- Quick recovery since no deep sedation is required
- May be more comfortable for patients with back problems
- Easier for the surgeon to have the eye at the ideal angle
Sitting in a reclined chair also keeps the eye still which can allow for a more controlled surgical environment. The surgeon may have an easier time accessing and operating on a stationary eye target.
Candidates for sitting up
Healthy patients who can sit reasonably still are often good candidates for cataract removal while seated upright. This includes most adults getting elective, first-time cataract surgery. It requires cooperative patients able to follow instructions.
Sitting up is also convenient for cataract surgery combined with astigmatism correction, since precise positioning is important. People without extensive health conditions can usually handle sitting up well.
Why lay down for cataract surgery?
There are also some benefits to reclining for cataract surgery:
- Familiar positioning like other surgeries
- Allows use of deeper sedation if desired
- Easier for less mobile patients
- Preferred by some surgeons for ergonomic access
Laying flat on the back is a typical position for many operations. Some patients may find this more comfortable and relaxing. It also provides the option for deeper sedation or general anesthesia for anxious patients.
For people with back issues sitting upright for an extended time, laying down can relieve pressure points. Surgeons may also have an easier time operating from a standing position above a reclined patient.
Candidates for laying down
Patients who may be better suited to laying down for cataract removal include:
- Those desiring deeper sedation
- People with significant back pain or mobility limitations
- Very anxious patients
- Highly claustrophobic individuals
Reclining is also often preferred for complex cataract surgeries expected to take longer or with complications. Patients with breathing disorders or heart disease may tolerate anesthesia better when supine. Laying down also makes it easier to convert to general anesthesia if needed.
Talk to your cataract surgeon
The best way to determine if you should sit up or lay down for cataract removal is to discuss it with your ophthalmologist. They will consider factors like:
- Your overall health
- Complexity of your eye condition
- Type of anesthesia/sedation they recommend
- Their surgical positioning preference
- Your comfort and anxiety level
Be open about any health conditions, motion sickness tendency, back pain, or claustrophobia. This will help determine how you tolerate being reclined under surgical lights. Your doctor can describe the differences between sitting vs. laying down for your situation.
Many cataract surgeons are comfortable performing either seated or supine surgery. Ask what positioning they suggest for you and why. If both options seem reasonable, your personal preference can help decide.
Is one position safer than the other?
In general, there is no significant safety advantage between sitting upright vs. laying down for routine cataract removal. Both allow the surgery to be performed successfully with very low complication rates.
However, there are some differences in risks:
Sitting upright may have lower risks related to:
- Respiratory depression from sedatives
- Post-op nausea
- Cardiac stress
Laying down may have lower risks related to:
- Falling from a seated position
- Surgical precision if the eye moves
- Patient movement or poor positioning
Neither position is considered clearly “safer.” An experienced surgeon can mitigate risks either way. Discuss any specific health concerns with your doctor. Often the safest approach is the one you feel most comfortable with.
What’s the recovery like?
Recovery after cataract surgery is usually quick, with excellent vision improvement seen within a few days. Typical post-op guidelines include:
- Keep the treated eye clean and protected with a shield at night
- Use prescribed antibiotic and anti-inflammatory eye drops for 1-2 weeks
- Avoid strenuous activity for 2-3 days
- Limit bending over and lifting
- Wear sunglasses outside to protect from wind, sun, debris etc.
- Keep follow-up appointments for eye checks
Patients can usually resume most normal activities within 24-48 hours. Complete healing takes about 6 weeks. Positional restrictions aren’t typically imposed after surgery.
Whether you stayed seated or supine during cataract removal should not impact the recovery process. Follow your surgeon’s post-operative instructions for protecting the eye and avoiding infection or complications. Proper rest and ocular protection will help ensure the best outcome.
What about costs?
Out-of-pocket costs for cataract surgery depend on your insurance coverage and healthcare plan. With insurance, you will still pay a co-pay, coinsurance, or deductible amount.
According to the American Academy of Ophthalmology, the average cataract surgery cost in 2021 was:
- Total cost: $3,500 per eye
- Medicare co-pay: $400 per eye
- Private insurance cost: $300-$2900 per eye
Sitting upright vs. laying down does not significantly impact the surgical fee. Added anesthesia or facility fees for an operating room may marginally increase cost for laying down procedures. But in general, the procedure cost is comparable.
Talk to your insurance, doctor’s billing office, and the surgical facility to understand expected out-of-pocket costs. Affordable payment plans or financial assistance are often available if needed.
Conclusion
The optimal position for cataract surgery – sitting up or laying down – is an individual decision. Work with your ophthalmologist to decide what’s right for you based on health factors, anesthesia needs, surgeon preference, and your comfort level.
Many patients do well sitting upright in a reclined chair. This is common for routine, first-eye cataract removal under local anesthesia. Laying down provides an alternative for patients desiring more sedation or those with physical limitations.
With an experienced surgeon, the risks are low and the outcomes successful in either position. Being informed and voicing your positional preference allows you to participate in creating the ideal surgery experience.
