WASHINGTON — Sedation-free cataract surgery appeared safe and feasible in a large consecutive case series.

Across 855 treated eyes, complication rates remained low, with good tolerance of the sedation-free procedure, Ervin Fang, MD, of Southern California Permanente Medical Group in Los Angeles, and colleagues reported at the American Society of Cataract and Refractive Surgery (ASCRS) 2026 Annual Meeting.

“Surgical control was maintained, and the key takeaway is simple: Eliminating systemic anesthesia did not compromise safety,” Fang said.

That doesn’t come as a surprise, said Richard Tipperman, MD, a cataract specialist at Wills Eye Hospital in Philadelphia. “There’s no nerve fiber” in the lens of the eye, he told Medscape Medical News. “You don’t need anesthesia to cut your hair or cut your nails. The anesthesia that you need for cataract surgery really is less for pain control and more for the worry and anxiety that people have.”

As with intravitreal anti-VEGF injections that are administered without sedation, giving a nonsedating anxiolytic can be used to manage that concern, Fang said. Continuous narration during cataract surgery, reassurance cues, and predictable steps can help as well, he said.

The retrospective study involved a consecutive series of 302 bilateral and 251 unilateral cataract surgeries performed at two ambulatory surgical centers by a single surgeon in the Kaiser Permanente healthcare system. These procedures were done with topical lidocaine drops and intracameral preservative-free lidocaine with epinephrine. None of the patients received systemic, oral, or intravenous (IV) sedation, and there was no anesthesiologist involvement or IV access.

The mean age in the cohort was 72 years, and 58.4% of patients were female. “This is not a low-risk population,” Fang said. “Notably, bilateral patients were slightly older, suggesting this approach is even feasible in an older advanced age group.”

Safety outcomes showed no endophthalmitis, toxic anterior segment syndrome, or aphakia, although one patient developed an anterior chamber intraocular lens. No postoperative falls occurred, and all patients had a normal recovery, the researchers reported.

The series included two vitrectomies, which can prolong the procedure. But such cases are not an obstacle to sedation-free cataract surgery, according to Tipperman. “In a pinch, you can always just start an IV,” he said.

Sedation-Free Advantages

One difference without sedation was shorter procedures, with an average of 19.8 minutes compared with the usual 21.5 minutes with anesthesia. “Two minutes may seem small,” Fang said, “but at scale across thousands of cases, this translates into meaningful gain in throughput, staffing efficiency, and access to care.”

For the clinic, eliminating sedation also allows immediate bilateral cataract surgery, simplifies workflow, leads to fewer cancellations, reduces sedation-related risks, and maintains better blood pressure and glucose levels, Fang said.

However, he noted that Kaiser can provide sedation-free cataract surgery where others might struggle “because they align incentives,” such as no fee-for-service anesthesia billing pressure, standardized pathways, and workflow control.

For patients, sedation-free cataract surgery can be a plus logistically. Many patients in the case series ambulated immediately after surgery, and some drove themselves home. Aside from being able to eat before the procedure, Tipperman said “to be able to drive yourself home, it’s huge. Logistically, it makes things much better.”

But not everyone should be treated sedation-free, Fang said. A good candidate is a patient with low anxiety and good hearing and cognition.

Fang predicted that sedation-free cataract surgery will find more traction in high-volume refractive-style cataract centers and value-based systems with bundled payments or capitated care.

“Sedation-free cataract surgery absolutely can gain traction in the US, but it will likely remain selective rather than dominant unless several structural, cultural, and economic barriers shift,” he told Medscape Medical News. He likened that to how LASIK reshaped expectations but did not eliminate alternatives.

Reframing patient expectations would be critical. “The majority of patients who come in for cataract surgery say, ‘I want to be completely asleep. I want to be knocked out completely,’” Tipperman said.

Fang disclosed having no relevant financial conflicts of interest. Tipperman disclosed consulting for Alcon Laboratories and BVI Medical. 

Crystal Phend is an award-winning medical journalist with decades of experience reporting on clinical research and healthcare developments across specialties. When not walking the halls at a medical conference, she can be found at a keyboard in upstate New York.