Cataract: symptoms, surgery and costs in Switzerland

The lens inside your eye is normally clear and helps to focus incoming light sharply. With a cataract, it gradually becomes cloudy – a bit like looking through a misted-up window. According to the World Health Organization (WHO), cataract is the leading cause of blindness worldwide. However, the WHO notes that surgery with an artificial lens can restore vision.

What happens inside the eye

According to the US National Eye Institute (NEI), the proteins in the lens start to break down and clump together from around the age of 40. Over time, more and more of the lens becomes cloudy. In the United States, the NEI says that more than half of all people aged 80 or over either have a cataract or have already had cataract surgery. A cataract can affect one eye or both, but it cannot spread from one eye to the other.

Typical signs

At first, you often won’t notice a cataract at all. Later on, the NEI lists symptoms including:

• cloudy or blurry vision
• colours that look faded
• poorer vision at night
• lamps, sunlight or oncoming headlights that seem too bright
• halos around lights
• double vision
• frequent changes to your glasses or contact lens prescription

‘Second sight’: when you need your reading glasses less

A surprising sign can come from a nuclear cataract, in which the clouding forms in the centre of the lens. As the American Academy of Ophthalmology (AAO) explains, the core of the lens becomes harder, its refractive index rises and the eye’s focusing power shifts towards short-sightedness. People who are long-sighted and also have age-related presbyopia may therefore temporarily depend less on their glasses – a phenomenon known as ‘second sight’. This is no reason to relax, because the clouding keeps progressing. If you suddenly find yourself reaching for your reading glasses less often in later life, it is worth having your eyes checked.

Important: a cataract usually develops slowly. Suddenly worse vision, new flashes of light, a shower of floaters or a shadow across your field of vision do not fit this pattern. These warning signs are an emergency: get them checked by an eye doctor straight away, at the latest the same day – or go to an emergency department outside practice opening hours. Find out more in our guide to flashes and floaters.

Who is at higher risk

According to the NEI, your risk goes up as you get older. It is also higher if you:

• have diabetes
• smoke or drink too much alcohol
• have a family history of cataracts
• have had an eye injury, eye surgery or radiation treatment to the upper body
• have spent a lot of time in the sun
• take steroids such as cortisone

Sunlight deserves a closer look. According to the WHO, studies support UV-B radiation as a risk factor for one particular type, cortical cataract. The WHO estimates that too much UV radiation may be behind up to 10% of cataracts – cases that could therefore be avoided. UV exposure of the eyes is particularly high when skiing or mountaineering. Our guide to UV protection and sunglasses explains what to look for in a pair of sunglasses.

The NEI also advises protecting your eyes from injury, not smoking and choosing eye-healthy foods. If you are worried about your risk – for example because you take cortisone – the NEI suggests talking to your doctor about it. From the age of 60, the NEI recommends a dilated eye exam every one to two years.

When and how surgery is done

According to the NEI, surgery is the only way to get rid of a cataract – drops or tablets will not clear it. However, surgery is not automatic once a cataract is diagnosed; it is usually recommended when the clouding gets in the way of everyday activities such as reading, driving or watching TV. Until then, the NEI says brighter lighting, anti-glare sunglasses, magnifying lenses and, in the early stages, an updated glasses prescription can help.

The standard technique is called phacoemulsification. A Cochrane review from 2023 describes it like this: through a small incision in the cornea, a circular opening is made in the front of the lens capsule, the cloudy lens is broken up with ultrasound and suctioned out, and an artificial lens is placed in the capsular bag. The eye is numbed, and according to the NEI the procedure is almost painless. The Cochrane authors count it among the eye operations performed most often worldwide, and the NEI reports that around 9 out of 10 people see better afterwards.

If both eyes are affected, the NEI says each eye is operated on separately, usually about a month apart. According to the NEI, you may also need to avoid touching the eye, bending over or lifting heavy things for the first few weeks – follow the specific instructions from your surgical team. Most people are fully healed after eight weeks, and you may need a new glasses prescription afterwards. In Switzerland, cataract surgery is listed in Annex 1a of the Health Care Benefits Ordinance (KLV) among the procedures that basic insurance generally reimburses only as outpatient treatment – a hospital stay is covered only in special circumstances, mostly because of relevant other medical conditions.

Does a laser help?

Some steps – the incisions, opening the capsule and breaking up the lens – can also be performed with a femtosecond laser. The Cochrane review mentioned above analysed 42 randomised trials involving 7,298 eyes. It found probably little or no difference from the conventional method in complications, visual acuity and quality of life; two studies also suggest that the laser may be the less cost-effective option.

Warning signs after surgery

According to the NEI, contact your eye doctor right away if you notice:

• loss of vision
• severe pain that does not go away even with pain medication
• a very red eye
• flashes of light or lots of small dark spots or squiggly lines drifting across your vision

Posterior capsule opacification: when things get cloudy again

The artificial lens sits in the eye’s natural lens capsule. Weeks, months or years after surgery, this capsule can become cloudy or wrinkled and your vision may blur again, as the AAO describes. This is known as posterior capsule opacification, sometimes called a ‘secondary cataract’ – so it is not the artificial lens that clouds over, but the capsule holding it.

It is treated with a YAG laser capsulotomy: the laser makes an opening in the cloudy capsule so that light can pass through again. According to the AAO, this takes about five minutes, the eye may be numbed with drops, and if you have no other eye problems, your sight should improve within about 48 hours. As a rule, it only needs to be done once per eye. Possible risks include raised eye pressure and retinal detachment.

What Swiss basic insurance covers

In Switzerland, cataract surgery is covered by basic health insurance. According to a 2025 report by the Swiss public broadcaster SRF’s health programme ‘Puls’, the standard lens covered by insurers is a spherical monofocal lens. It has a single focal point: you decide beforehand whether you want to see sharply up close or in the distance, and you will usually still need glasses for the other distance.

Basic insurance does not cover extras. ‘Puls’ gives examples: CHF 600 to 2,000 per eye for the femtosecond laser, around CHF 1,200 for a toric lens used for astigmatism, and around CHF 2,300 per multifocal lens, which is designed to give sharp vision at several distances but, according to ‘Puls’, does not suit everyone and takes some getting used to. Our lens exchange page explains how multifocal lenses are used in elective (refractive) lens exchange.

The aspheric lens is a special case. According to ‘Puls’, many eye surgeons now use it as their standard lens and bill it to health insurance; it costs about the same to buy as a spherical lens. Even so, many charge a surcharge for it – usually around CHF 350, sometimes around CHF 500. The Swiss Society of Ophthalmology (SOG) justifies this as a consultation fee, whereas specialists who do not charge extra find it hard to explain. The advice from ‘Puls’: before your first appointment, ask whether an aspheric lens will cost extra, request a price list covering all lenses, and compare offers.

Good to know

Clouding of the lens can be detected during an eye examination with a slit lamp. At My Laser Vision in Wallisellen, examination of the front and back of the eye is part of the basic examinations offered in ophthalmology.