Public or private cataract surgery: what is the difference?Public or private cataract surgery?

What stays the same in both systems?

The aim is the same: remove the cloudy natural lens and replace it with a clear artificial lens, called an intraocular lens or IOL. Public hospitals provide a valuable service, including care for patients with complex eye or medical problems and training for future ophthalmologists.

Being treated privately does not, by itself, guarantee a better result. The condition of your eye, suitable lens selection, surgical care and follow-up all matter. Our cataract surgery guide explains the operation and its risks.

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How long might I wait?

Public access often involves two waits: first for an ophthalmology appointment, then for an operation after assessment and placement on the surgical list. The hospital prioritises patients according to clinical need. Referral requirements and local capacity vary.

In the national AIHW figures, the median public waiting time for cataract extraction was 106 days in 2024–25. This means half of admitted patients waited less and half waited longer, measured from surgical listing. It does not include the earlier wait to see an ophthalmologist. Depending on the hospital and urgency, the total wait can extend beyond a year.

Private surgery is typically available sooner. For some patients, it can be arranged within a few weeks to about three months after assessment. This is an indicative range, not a national average or a guaranteed booking time. Your surgeon’s schedule, hospital availability, medical preparation and preferred date can affect timing.

If vision deteriorates while you wait, ask your optometrist or doctor to update the referral and reassess urgency.

Can I choose who performs my surgery?

As a public patient, you generally cannot choose your surgeon. Your operation may be performed by a consultant ophthalmologist or by an ophthalmologist in specialist training, usually called a registrar. Fellows may also operate: a fellow is undertaking further training and may already be a qualified specialist.

Training surgery is supervised. Royal Australian and New Zealand College of Ophthalmologists (RANZCO) training standards require a clinical tutor for trainee operating sessions. Early trainees have their tutor in theatre; suitably competent advanced trainees may operate with the tutor within the theatre complex, available to attend and take over if needed. The level of supervision depends on the trainee’s experience and the case.

An Australian study of 5,018 cataract operations at Westmead Hospital reported substantial improvement in vision in a service involving consultants, fellows and supervised trainees. 

Private care generally allows you to choose a specialist ophthalmologist.  Many surgeons work in both public and private practice. Ask who will perform your operation and who will manage follow-up; this guide to choosing a cataract surgeon offers further questions.

Is the equipment different?

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Equipment varies between individual public hospitals, private hospitals and day surgeries. Both sectors use ultrasound cataract surgery, or phacoemulsification. Different facilities may use different machines, instruments, imaging and planning systems.

Digital marking systems can help align a toric lens used to correct astigmatism. Femtosecond lasers can perform selected steps of cataract surgery, but access is not universal in either sector. The presence of a newer machine or laser does not establish that every patient will obtain a better result.

Read about the Alcon UNITY VCS cataract surgery system and digital toric lens alignment. These explain particular technologies, rather than a standard equipment list for all public or private facilities.

Will I have the same choice of lens implant?

Public hospitals typically work with a more limited range of approved lens implants. A monofocal lens, which focuses mainly at one distance, is often used. Some services also provide toric lenses for astigmatism or other options for selected patients. Ask your hospital what is available and how your lens will be chosen.

Private care generally provides access to a wider range of IOLs, which can include monofocal, toric, extended depth of focus (EDOF) and multifocal lenses. 

Availability is not an absolute public–private divide: An Australian public-hospital programme has offered multifocal lenses to selected patients. Equally, a monofocal lens can be an excellent choice in either system.

EDOF and multifocal lenses may reduce reliance on glasses for some activities, but have optical trade-offs, including possible glare, halos or reduced contrast. They are not suitable for every eye, and glasses may still be needed. The guide to lens implants available in Australia explains the options. The appropriate lens depends on eye health, measurements and your visual priorities, rather than simply the number of choices.

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What will I need to pay?

Public care: if you are eligible for Medicare and treated as a public patient, the cataract operation and public hospital care are free, without a surgical or hospital gap fee. This does not mean every related expense disappears: privately billed consultations before referral, some medicines, glasses, transport or accommodation can still cost money.

Private care: you may pay for specialist appointments, the surgeon, anaesthetist, hospital or day surgery, and other agreed items. Medicare and eligible hospital insurance contribute, but the amount you pay depends on the fees and your policy. Some arrangements have little or no medical gap; others have appreciable costs.

For eligible admitted private treatment, Medicare generally pays 75% of the Medicare Benefits Schedule (MBS) fee and the insurer pays the remaining 25%. These percentages relate to the scheduled fee, not necessarily the doctor’s actual bill. Fees above it can create a medical gap. Hospital excesses, co-payments and other charges are separate.

Check that your policy specifically covers cataracts. Gold hospital policies include cataracts; some lower-tier Plus policies also include them. Optical extras or an “eye” category alone do not establish cataract surgery cover. Waiting periods, including up to 12 months for a pre-existing condition, may apply when joining or upgrading.

You can also self-fund private treatment without hospital insurance. Obtain written estimates covering the surgeon, anaesthetist and facility, any lens-related charges and each eye. Confirm what is included in reviews and what happens if additional care is needed. Being a private patient in a public hospital can also involve charges; the patient status matters.

Will the environment and follow-up be different?

Public hospitals are often large, busy services with several clinics and teams. This can mean less continuity with one doctor, but also access to broader medical and specialist support. Some public operations take place in dedicated eye units or contracted day surgeries.

Private consultations and surgery often occur in smaller practices or day hospitals. There may be more continuity with your chosen surgeon, although private hospitals can also be large and follow-up may involve other clinicians. Rooms, appointment processes and waiting areas vary; the setting alone does not determine surgical quality.

In either system, confirm who will see you after surgery, whether your optometrist will be involved, and whom to contact if a problem occurs.

What should I ask before deciding?

• What are the expected waits for assessment, the first eye and the second eye?
• Who will operate, and what supervision or specialist support is available?
• Which lenses are suitable for my eyes, and which are actually available?
• Would any proposed technology meaningfully help in my case?
• Who will manage follow-up and urgent concerns?

Public care may be the right choice when affordability is the priority and the expected wait is manageable. Private care may suit someone who values a particular surgeon, earlier scheduling or a lens option that is appropriate but unavailable locally. 

What can my optometrist or GP help with?

Your optometrist or GP can document how cataract affects daily life, assess whether a glasses update may help, and discuss referral options. For a public referral, information about vision, glare, driving, work, falls risk, other eye disease and support needs can help the receiving service assess urgency. Local acceptance criteria vary.

If you change pathways or receive more than one booking, tell the services involved so referrals, tests and follow-up can be coordinated.

What if my vision changes while I am waiting?

Seek urgent eye assessment for sudden loss of vision, new flashes or a sudden increase in floaters, a curtain or shadow in your vision, or a painful red eye. These changes should not simply be attributed to cataract or left until a routine surgical appointment.

For a gradual decline affecting daily life, contact your optometrist, GP or ophthalmology service to review the plan and whether your priority needs updating.