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October 31, 2026
Yes, most people with diabetic retinopathy can have cataract surgery, and most see better afterward [1,2]. Results are best when diabetic macular edema (DME, central retinal swelling) and proliferative disease are treated first, with close retina checks afterward [3,4]. The more advanced the retinopathy, the higher the risk of macular swelling and the smaller the likely gain in vision [5,2].
This article is general education. It does not replace advice from your own cataract surgeon, retina specialist or diabetes team.
Key takeaways
In this article
Call your eye surgeon right away, or go to an emergency room, if you have vision loss, bad pain that medicine does not ease, a very red eye, new flashes or floaters, or a dark curtain over your vision. These can be signs of infection, bleeding or retinal detachment. Having diabetes does not change this advice [1,9].
For a full list of eye symptoms that need same-day care, see our guide to urgent vision changes.
Yes. Diabetic retinopathy does not rule out cataract surgery. In a 2020 US study of 355 diabetic eyes, median gains one year after surgery were 10 to 20 eye-chart letters at every stage. After allowing for starting vision, eyes with severe retinopathy gained less [2].
A cataract is clouding of the eye's natural lens. Diabetic retinopathy is damage to the blood vessels of the retina, the light-sensing layer at the back of the eye. The two often occur together. Diabetes is a known risk factor for cataracts [12]. A UK study found cataracts were diagnosed about twice as often in people with diabetes, and the extra risk was highest at younger ages [13].
Surgery clears the lens. It does not repair the retina. Swelling, poor blood flow in the macula or old scarring can still limit vision afterward. A clearer lens does help your retina specialist see, scan and treat the retina [3]. Learn more about how retinopathy is staged and treated in our diabetic retinopathy guide.
The best time is when the retina is as stable as it can be. Active proliferative retinopathy is usually treated first, often with laser, and DME is treated and monitored. But a cataract that blocks the view or blocks retinal treatment may need to come out sooner. Timing is a shared decision between your surgeons [3].
The table shows how plans often differ by the state of the retina. Your own plan may differ.
| Retina status | Before surgery | Timing | After surgery |
|---|---|---|---|
| Diabetes, no retinopathy | Dilated exam; a macular OCT scan is often done | Based on how much the cataract affects daily life | Usual drops and visits; risk of new swelling is still higher than without diabetes [5] |
| Mild to moderate retinopathy, no DME | Dilated exam and a baseline OCT scan | Usually no need to wait | NSAID drops are often added; OCT if blur returns [6,3] |
| Swelling away from the center, or past DME treatment | OCT; review of past injections | When stable | Closer OCT checks; 10% to 12% developed center swelling by 16 weeks in one study [4] |
| Center-involving DME | Injections or other treatment first when possible | Once swelling is controlled, or sooner if the cataract blocks care | Injections continue on a shared plan [3,14] |
| Proliferative retinopathy (PDR) | Laser (PRP) or injections to calm new vessels | Treat first when possible | Laser soon after surgery if the cataract blocked it; close retina follow-up [3] |
| Cataract too dense to see the retina | Ultrasound scan; planning with a retina specialist | May operate sooner so the retina can be examined and treated | Full retina exam and treatment soon after surgery [3] |
A 2024 review advises that DME be found and managed before cataract surgery. It also says existing DME does not have to delay surgery when there is a clear need for it [3]. In a 2025 study of 153 eyes already treated for center-involving DME, results after surgery were similar whether the swelling was active or quiet at the time. Higher A1C was linked to the swelling coming back or worsening [14].
Cataract surgery does not end an injection schedule. Ask who will decide the timing of your next injection and scan. Read more about diabetic macular edema and its treatment.
Proliferative diabetic retinopathy means fragile new blood vessels are growing on the retina. Many studies recommend laser treatment (panretinal photocoagulation, or PRP) before surgery, because untreated disease can progress quickly afterward [3]. If the cataract blocks the laser, options include laser right after surgery, laser within a week, or cataract removal combined with retinal surgery (vitrectomy) [3]. New vessels on the iris, the colored part of the eye, should also be treated first [3].
A dense cataract can hide the retina. An ultrasound scan can check for major problems such as a detachment [3]. In this case, surgery may be advised partly so the retina can be examined and treated. Some questions about vision may only be answered once the view is clear, so ask what treatment might follow.
Yes, it can trigger or worsen macular swelling. In a UK study of 81,984 eyes, diabetes without retinopathy raised the risk of new macular edema about 1.8-fold, and any diabetic retinopathy raised it about 6-fold. The risk rose with each step of retinopathy severity [5].
Two kinds of swelling can follow surgery. One is DME that appears or gets worse. The other is pseudophakic cystoid macular edema, inflammation-related swelling after the natural lens is replaced with an artificial one ("pseudophakic"). They can look alike, and some eyes have both. OCT scans before and after surgery help tell them apart [3]. Read more about cystoid macular edema.
The DRCR Network followed 293 people with retinopathy but no center-involving DME before surgery. At 16 weeks, none of 17 eyes with no DME developed center swelling. About 10% to 12% of eyes with swelling away from the center did. A past need for DME treatment was the strongest warning sign [4].
A scan before surgery matters. In one study, 12% of eyes that looked normal on exam had OCT changes that could affect the result [15]. Learn what each scan shows in our guide to diabetic eye exams and OCT.
It may in some eyes, but studies disagree. An Australian study found retinopathy progressed about twice as often in operated eyes over 12 months. A smaller UK study of uncomplicated surgery found no difference between operated and unoperated eyes, and linked progression to higher A1C instead [16,17].
A Taiwan insurance study of people with type 2 diabetes and no retinopathy found surgery raised the risk of early (nonproliferative) retinopathy by about 48%. It found no difference in proliferative disease or DME. Surgical complications raised the risk further [18]. Modern small-incision surgery appears to cause less progression than older techniques [16].
Either way, the plan is the same. Get a baseline retina exam, keep your retina follow-up, and keep working on blood sugar, blood pressure and cholesterol [11].
You should have a dilated retina exam and usually a macular OCT scan. Center-involving DME or active proliferative disease is treated first when possible. Dry eye is treated so lens measurements are accurate. Your diabetes, blood pressure and medicines are reviewed, and you should have no eye or eyelid infection at the time of surgery [3,15].
Our guide on when cataract surgery is needed explains the general tests in more detail.
Most people use antibiotic and anti-inflammatory drops after surgery. With diabetic retinopathy, surgeons often add an NSAID drop. In two trials of 1,220 people with retinopathy, nepafenac 0.3% drops lowered macular edema within 90 days from 15.9% to 4.1% compared with placebo drops [6,3].
UK guidance cited in a 2024 review recommends NSAID drops before and after surgery for people at higher risk of swelling, such as people with diabetes [3]. Use each drop exactly as prescribed, and ask for a written schedule if you have several bottles.
Some eyes get an extra treatment at the end of surgery. In the European PREMED trial of 213 people with diabetes, some received a steroid injection under the outer skin of the eye (subconjunctival triamcinolone). It lowered macular thickness, and no one who received it developed cystoid macular edema. An injection of bevacizumab into the eye had no significant effect in that trial [19].
For eyes that already have DME, a retina specialist may give an anti-VEGF injection or a steroid implant around the time of surgery. A review of studies found a dexamethasone implant reduced swelling at 3 months more than anti-VEGF, with similar vision gains. Steroids can raise eye pressure, so pressure is checked [3]. Our guide to injections, laser and surgery explains these options.
A standard monofocal lens is the usual choice, with glasses for some tasks. A toric lens, which corrects astigmatism, is generally fine. Multifocal lenses can lower contrast. Severe diabetic retinopathy is considered a relative reason to avoid them, because the macula may already be affected or need treatment later [3].
Ask how the proposed lens fits your retina now and in the future. A more expensive lens cannot make up for damage in the macula.
No single A1C number decides cataract surgery, as of October 2026. A 2025 study of 190,393 US veterans found preoperative A1C did not predict infection after surgery. A 2025 multicenter study found no rise in infection or serious medical events at any A1C level. Your teams still confirm you are medically stable [8,7].
This does not make blood sugar unimportant. Higher A1C was linked to DME coming back after surgery and to faster retinopathy progression [14,17]. Your surgical center may also check your sugar on the day.
Get clear written instructions about food, drink, insulin and other diabetes medicines before surgery. Ask who to call if your sugar is very high or low that morning. Do not assume instructions from a past operation still apply.
Your eye often feels better within 1 or 2 days, and most people are fully healed by about 8 weeks. About 9 in 10 people see better after cataract surgery. With retinopathy, expect extra retina checks, because studies track new macular swelling over the first few months after surgery [1,5,4].
You may need to avoid touching your eye, bending over or heavy lifting for a few weeks. You may also need new glasses once the eye has healed [1]. Ask when you can drive, exercise and return to work.
If vision is less clear than hoped, ask for the reason. Possible causes include macular swelling, poor blood flow in the macula, a new glasses prescription, or dry eye. Clouding behind the new lens (a "secondary cataract") can also blur vision and is treated with laser [1,3]. If some vision loss is permanent, low-vision rehabilitation can help with reading and daily tasks.
Netra Restoration Therapy (NRT) is Netra Eye Institute's integrative program based on acupuncture and Oriental medicine, offered alongside care from eye doctors. NRT does not treat cataracts or diabetic retinopathy, does not prevent macular edema after surgery, and cannot replace drops, injections, laser or surgery.
NRT has not been tested in controlled trials for people having cataract surgery with diabetic retinopathy. Never delay or change your surgery, drops or retinal treatment because of NRT. If you are curious about it, talk with your surgeon or retina specialist first. You can read what NRT involves and what is known about its effectiveness.
Cataract surgery is one of the most common and safe operations in the United States, and diabetes does not rule it out. The main added risks with diabetes are macular swelling after surgery and faster retinopathy changes in some eyes. Checking and treating the retina first, then close follow-up, helps lower these risks [1,5,3].
Yes, when possible. Center-involving DME is usually treated and brought under control before a planned operation. If the cataract is blocking care or daily life, surgery may go ahead with treatment continued around it [3,14].
Yes, but active new vessels are usually treated first, often with laser, to lower the risk of worsening after surgery. If the cataract blocks the laser, the retina specialist may plan laser soon after surgery or combine cataract removal with retinal surgery [3].
Possibly. If you were having injections for DME, they usually continue on a plan agreed between your surgeon and retina specialist. Some eyes without center swelling before surgery develop it afterward, which is why follow-up OCT scans matter [4,3].
No. Cataract surgery replaces the cloudy lens but does not treat the retina. It can give your retina specialist a clearer view for exams, scans and laser, which helps ongoing care [3].
Most people feel better within 1 to 2 days and are fully healed by about 8 weeks. With diabetic retinopathy, the retina is watched for longer, because studies track new macular swelling over the first 3 to 4 months [1,5,4].
Usually not. Multifocal lenses can lower contrast, which matters more when the macula is already affected, and severe retinopathy is a relative reason to avoid them. A monofocal lens is the usual choice, and a toric lens for astigmatism is generally acceptable [3].
Sources checked October 31, 2026.
This article provides general education and does not replace an individual eye examination, diagnosis or treatment plan. If you have sudden vision loss, severe eye pain, a very red eye, new flashes or floaters, or a curtain over your vision before or after cataract surgery, contact your eye surgeon or go to an emergency room right away.
