Can Cataracts Come Back After Surgery?

Cataracts, or an opacification or clouding of the eye’s lens, affect millions of people – it’s one of the most common eye conditions in the world. Cataracts often affect older people, although it’s possible for them to develop in younger patients as well. Today, laser surgery is commonly used to remove cataracts, and it has a high success rate. Traditional cataract surgery using blades is also still commonly used to great effect.

Have you ever wondered whether cataracts can come back after surgery?

The answer isn’t quite as simple as a “yes” or “no.” Cataracts cannot grow back once they’ve been removed. But it is possible for a secondary (or new) cataract to form. So, yes, cataracts can come back after cataract surgery; it’s not the old one growing back, but a new one forming. The medical term for this is posterior capsular opacification, or PCO.

Let’s take a closer look at how cataracts surgery works and how secondary cataracts or PCO happens. Then, we’ll discuss the symptoms of this condition and what can be done about it to help patients see clearly once again.

How Does Cataract Surgery Work?

There are two types of cataract surgery: traditional cataract surgery, which has been used for many years, and the newer laser-assisted cataract surgery.

Traditional Cataract Surgery

This type of cataract surgery involves using a tiny blade to make an incision on the side of the eye’s lens (the cornea) and removing the clouded lens. After that, an artificial lens called an intraocular lens is inserted in place of the natural lens. In some cases, sutures might be needed to close the incision, but more often than not the incision is left alone to heal over time. Most patients are fully healed within a few days or weeks of cataract surgery.

Laser Cataract Surgery

Laser-assisted cataract surgery uses laser technology and 3D imaging to make the incision. An advanced laser called a femtosecond laser creates an opening in the cornea’s front layer, and then the laser breaks

up the clouded lens before it’s sucked out through the incision. Then, an intraocular lens replaces the natural lens in the same manner as traditional cataract surgery.

Both types of cataract surgery are fast, efficient, and very safe. They’re both widely used today, including by top cataract surgeons in Buffalo. In fact, cataract surgery is one of the most common types of surgery performed in the world, with a very high success rate.

Can You Have Cataracts Twice?

As mentioned above, yes, you can have cataracts twice, even after surgery. Secondary cataracts, sometimes called after-cataracts, isn’t particularly common but it is possible.

Secondary cataracts doesn’t develop immediately after your cataract surgery. It will typically take months or, even more commonly, years before developing. And here’s the good news: it’s less common than ever before. For many years, nearly half of all patients who had cataract surgery developed secondary cataracts at some point. Now, thanks to technological improvements particularly in laser surgery, only about four to 12 percent of patients experience secondary cataracts.

PCO is still the most common complication after cataract surgery, but it occurs less frequently than ever before. And research is ongoing into ways to make it even less common.

What is a Secondary Cataract?

Secondary cataracts or posterior capsular opacification (PCO) occurs when the membrane around the lens capsule (not removed during surgery) becomes cloudy and starts to impair vision. New protein cells begin to grow on the back of the lens capsule, which obscures vision just like a cataract does.

There are actually two types of secondary cataracts:

· Pearl PCO: Responsible for the majority of secondary cataracts cases, pearl PCO involves normal differentiation of lens epithelial cells (LECs) in the equatorial lens region.

· Fibrous PCO: Fibrous PCO involves abnormal growth of LECs in the lens.

To put it simply, secondary cataracts is the opacification of the membrane around the lens capsule, which wasn’t removed during cataract surgery. It usually starts to opacify months or years after cataract surgery.

What Makes Secondary Cataracts More Likely?

The development of secondary cataracts is, on the whole, not extremely common. But there are a few conditions and factors that make this condition more likely to occur. One is age; it turns out that younger cataracts patients are more likely to develop secondary cataracts. Other factors include:

· Diabetes – Diabetes and vision problems are closely linked. Patients who have diabetes or had it in the past have a higher incidence of PCO development.

· Uveitis – Uveitis occurs when the uvea, the middle part of the eye, becomes inflamed. This results in itching and redness. Patients with this condition are more likely to develop secondary cataracts.

· Myotonic dystrophy – Related to muscular dystrophy, myotonic dystrophy is an inherited disease that involves prolonged muscle contractions and difficulty relaxing certain muscle groups. Cataracts often develop as a symptom of this condition, and people with myotonic dystrophy often require multiple capsulectomies to restore proper vision.

· Retinitis pigmentosa – People with retinitis pigmentosa have a higher occurrence rate of secondary cataracts. This condition involves the breakdown of cells in the retina, which causes symptoms like loss of peripheral vision and difficulty seeing at night.

· Cataracts caused by trauma – It’s possible for cataracts to be caused by injury or trauma to the head or eye. When this is the case, the chance of secondary cataracts occurring is much higher.

Secondary Cataract Symptoms

What are the main secondary cataract symptoms? How can you tell if you’re developing this condition?

Blurry Vision

Blurry vision after cataract surgery is the most common sign of secondary cataracts. As mentioned, the blurred vision won’t occur immediately after surgery. It will probably happen months or even years afterward.


Patients might notice an increased glare from light sources, such as the sun or car headlights when driving at night. It’s also relatively common for those with secondary cataracts to see halos around these light sources.

Lack of Visual Acuity

A reduction in visual acuity is another common sign of secondary cataracts. This might manifest in difficulty reading text or seeing the television, difficulty driving and seeing road signs, etc. Patients might also notice a reduction in the accurate perception of colors.

Can Secondary Cataracts Be Prevented?

It is not possible to prevent the occurrence of secondary cataracts in every case. However, there are things that can be done to make it less likely. Advances in surgical techniques are one approach; as the technology improves and processes are further refined, ophthalmologists hope to reduce the risk of secondary cataracts developing. Extensive polishing of the epithelial cells during cataract surgery can also help.

New intraocular lens designs (the artificial lenses that replace the clouded cataract lens) show promise for reducing cataract surgery side effects, including secondary cataracts. Square-edged intraocular lenses can reduce the risk of PCO development, and there is also evidence that changes to the surface chemistry of the lens makes PCO development less likely.

Last but not least, drugs that suppress certain cell growth could be used to inhibit the growth of lens cells that end up obscuring vision. The Food and Drug Administration has not approved prescription drugs for this reason yet, so it remains to be seen if medication could play a role in preventing the development of secondary cataracts.

Secondary Cataract Treatment

Secondary cataracts can certainly be a frustrating thing to deal with. After all, cataract surgery was supposed to solve the issue. It’s understandable that patients are frustrated when their vision becomes blurry once again. Luckily, treating secondary cataracts is generally very simple and easy.

Secondary cataract surgery is performed via a procedure called YAG laser capsulotomy, and it’s widely effective in treating secondary cataracts and helping patients to experience restored vision after the development of secondary cataracts.

YAG Laser Capsulotomy

YAG laser capsulotomy is a quick, painless procedure. First, the eye is numbed with special drops. Then, a laser creates a small opening in the clouded part of the lens capsule. This allows light to shine through to the retina, allowing the lost vision to be restored. Most often, the patient can return home immediately with an eyedrop treatment, and will probably be able to return to normal activities – driving, working, etc. – within a day or two.

YAG laser capsulotomy only takes about five minutes, even less than the already quick cataract surgery itself. You’ll probably need to revisit the eye doctor’s office in a week or so for a follow-up appointment to make sure things are progressing well and you’re not experiencing any side effects.

Contact the Ophthalmologists at ECVA if You’re Experiencing Secondary Cataract Symptoms

Are you experiencing blurred vision or other symptoms of secondary cataracts? It’s time to make an appointment with Eye Care & Vision Associates to see the top ophthalmologists in Buffalo, NY. We can help you understand cataract symptoms including secondary cataracts and map out a treatment plan to restore your vision. Contact ECVA, your eye doctor in Buffalo, NY, to get started. We’re here to help! Schedule an appointment at your closest ECVA clinic today.