> Source: https://www.thenycoptometrist.com/blog/eye-surgery-co-management-nyc (last updated 2026-07-24) # Cataract and Eye Surgery Co-Management: Your Optometrist's Role Before and After Surgery **By Dr. Joanna Latek** · Published 2026-07-21 > When eye surgery is on the table, your optometrist handles the pre-op workup and post-op recovery while the surgeon operates. Here's what co-management actually looks like, and why most patients prefer it. # Cataract and Eye Surgery Co-Management: Your Optometrist's Role Before and After Surgery A cataract diagnosis catches people off guard. The word itself sounds serious, and the recommendation for surgery often arrives in the middle of a routine visit that was supposed to be about updating a glasses prescription. The first question I get is almost always the same: is this urgent? Almost never. The second is: who's doing the surgery, and what's your role? That's the one worth spending time on. For most eye surgery, the answer is co-management. I handle the work before and after. A surgeon — an ophthalmologist — performs the procedure itself. We work as a team, and in my experience, patients do better when they understand the split going in. ## What "co-management" means \(and why it lowers your stress\) Co-management is the standard arrangement for elective and semi-elective eye surgery in the United States. You see me for the pre-operative workup and the post-operative follow-up, and you see the surgeon on the day of the procedure. Your records, imaging, and intraocular lens calculations travel with you to the surgical center, and the surgeon sends you back to me for the one-day check. There are practical reasons this works. Surgeons operate; that's what they're optimized for. Optometrists are the ones who already know your eyes — your prescription history, your dry eye, your retina, your glaucoma risk — and who you'll keep seeing long after the surgery is over. When the surgeon hands you back to me the morning after, I'm not starting from scratch. It also lowers the stress, and I don't think that's a small thing. Surgery centers are efficient, impersonal places. You're one of many patients that day, you meet the surgeon briefly, and the counseling happens fast. When the bulk of your questions get answered in my chair — by someone who's known you for years — the surgical day is less frightening. Most of my patients tell me that's the part they value most. ## Cataracts: choosing your IOL and what we handle A cataract is a clouding of the natural lens inside the eye. Surgery removes the cloudy lens and replaces it with an artificial intraocular lens — an IOL. The surgery itself is one of the most common and successful procedures in medicine: a small incision, ultrasound to break up the old lens, and insertion of the new one. Typical operating time is 15 to 30 minutes per eye, under local anesthesia with light sedation. The decision that actually shapes your experience is which IOL you choose, and that's a conversation I walk patients through in detail. The four broad categories: **Monofocal IOLs.** Single-focus lenses, almost always set for distance. Insurance covers these. You'll almost certainly need reading glasses afterward, and if you have astigmatism, you may still need distance glasses too. This is the default, and for many patients it's the right call. **Toric IOLs.** Monofocal lenses with astigmatism correction built into the lens. If you have significant astigmatism, a toric lens can save you from distance glasses. There's a small risk the lens rotates after surgery and needs a brief second procedure to reposition. Usually an out-of-pocket upgrade. **Multifocal and extended-depth-of-focus IOLs.** These split light across multiple focal points so you can see at distance and near. The appeal is reading-glasses independence. The trade-off is real: more halos and glare around lights at night, slightly reduced contrast, and a longer neuroadaptation period. A 2024 multicenter study following more than 160 patients across five multifocal IOL designs found satisfaction varied meaningfully by lens type and was linked to how advanced the cataract was before surgery — evidence that these lenses are not for everyone. Patients who drive a lot at night, or who are detail-oriented about image quality, often dislike them. I'm honest about this with anyone considering them — the marketing is slicker than the reality. **Accommodating IOLs.** Lenses designed to flex with the eye's focusing muscle. Less common than the others, with a modest near-vision benefit. IOL choice is partly medical and partly personal. I help with the medical part — which lenses are even options for your particular eye — and you decide the personal part based on how you feel about glasses, night driving, and the trade-offs. The choice is not reversible, so we take our time with it. ## The pre-op workup and the day-of handoff Once we've decided on surgery and a lens, the pre-operative workup is a longer visit in my office. I measure the eye in detail: the axial length \(the front-to-back dimension of the eye\) with optical biometry, the curvature of the cornea, sometimes a separate topography, and occasionally an OCT scan of the macula to confirm the retina is healthy. These measurements feed the formulas that calculate IOL power. The lens has to be the right strength, and the math is precise to a fraction of a diopter. I also review your medications. Certain prostate medications — tamsulosin and others in that drug class — can cause a condition called intraoperative floppy iris syndrome, which makes the pupil behave unpredictably during surgery, and the surgeon needs to know about it ahead of time. Blood thinners are usually continued; we coordinate with your primary care doctor. I check for active dry eye and blepharitis, because an inflamed ocular surface can throw off the measurements. Sometimes we delay surgery a couple of weeks to treat the lid margins first and remeasure. On the day of surgery, you go to the ambulatory surgical center. You're there for a few hours total, even though the procedure itself is short. You'll have drops to dilate the eye, light sedation through an IV, and local anesthesia. Most patients feel pressure, not pain. Most surgeons do one eye at a time, with the second eye a week or two later if both need surgery. You go home the same day with a shield over the eye. The surgeon sees you the next morning for a quick check — pressure, incision integrity, lens position — and then hands you back to me for the rest of your care. ## Post-op care: drops, checks, and red flags Post-operative care is mostly about drops and monitoring. A typical regimen is three drops — an antibiotic, a steroid, and a non-steroidal anti-inflammatory — each on a tapering schedule over two to four weeks. I'll see you at one week, at one month, and then we settle back into your routine. The vision in the operated eye clears over days to weeks. For comfort, preservative-free artificial tears are the backbone. The incision can make the eye feel scratchy and dry for weeks, and preservative-free drops avoid the irritation that preserved bottled drops cause when used frequently. A 2025 systematic review and meta-analysis confirmed that dry eye is one of the most common complications after cataract surgery and that it typically peaks in the first month before resolving, which is why I treat the ocular surface proactively rather than waiting for patients to bring it up. Lid hygiene products help if there's any residual blepharitis. I walk each patient through what to use and when, and we adjust based on how the eye looks at each visit. There are symptoms I want to hear about right away. Sudden vision loss, not just blurriness. Pain that's getting worse instead of better over the first days. A spreading redness, or a redness that shows up after the eye had been quiet. New floaters, flashes of light, or a curtain or shadow over your vision — these point to the retina, and a retinal problem after cataract surgery is rare but urgent. Light sensitivity beyond the first day or two. None of these are reasons to panic, but they're reasons to call. Most turn out to be inflammation that a drop adjustment fixes. A few need same-day attention, and catching those early is the whole point of close follow-up. I'd rather you call and have it be nothing than sit on something that turns out to matter. ## Beyond cataracts: pterygium, blepharoplasty, and more Cataracts are the most common reason I co-manage, but not the only one. A pterygium — a fleshy, wedge-shaped growth of conjunctiva that extends onto the cornea, often from years of sun and wind exposure — can be removed surgically if it's irritating the eye, growing toward the visual axis, or causing astigmatism. The surgery is outpatient, and I handle the pre-op checks and post-op recovery, including watching how the graft heals, since that's what determines whether the pterygium comes back. Blepharoplasty — eyelid surgery for drooping upper lids \(ptosis\) or baggy lower lids — is another one. When the upper lid droops enough to cut into the upper part of your visual field, it's not cosmetic; it's functional, and insurance often covers it. I do the visual field testing that documents the obstruction, refer you to an oculoplastic surgeon, and manage the post-op healing. For patients with age-related macular degeneration, I coordinate with retina specialists, and for some, an AREDS2-based nutritional support formula is part of the plan to slow progression. If central vision is already compromised, a low vision exam opens up devices and strategies that make a real difference in daily life. The thread through all of this is the same: the surgeon operates, and I'm the one who knows your eyes before and the one watching them heal after. If you're facing any kind of eye surgery, the time to bring me in is before you've scheduled it. And if it's been a while since your last full exam, that's where it starts — a comprehensive eye exam is how most of these conditions get found in the first place. For those weighing refractive options rather than medically necessary surgery, the laser vision correction consultation covers that path separately. ## Thinking about eye surgery? I see patients at Eye & Health in the East Village. If you've been told you need eye surgery — or you'd like a second set of eyes on a diagnosis — and want co-management that puts your care first, you can book online — usually within the week. _This is not medical advice. Please consult your eyecare professional or schedule an eye appointment today._ --- ### Bibliography Age-Related Eye Disease Study 2 Research Group. "Lutein + Zeaxanthin and Omega-3 Fatty Acids for Age-Related Macular Degeneration: The Age-Related Eye Disease Study 2 (AREDS2) Randomized Clinical Trial." JAMA, vol. 309, no. 19, 2013, pp. 2005-2015. American Academy of Ophthalmology. Cataract in the Adult Eye Preferred Practice Pattern. American Academy of Ophthalmology, 2021. Niazi, Sana, et al. "Association of Patient Satisfaction with Cataract Grading in Five Types of Multifocal IOLs." Advances in Therapy, vol. 41, no. 1, 2024, pp. 231-245. Ta, Hillary, et al. "Dry Eye Post-Cataract Surgery: A Systematic Review and Meta-Analysis." BMC Ophthalmology, vol. 25, no. 1, 2025, Art. 18. Jones, Lyndon, et al. "TFOS DEWS III: Management and Therapy Report." American Journal of Ophthalmology, vol. 279, 2025, pp. 289-386.