Do Cataracts Come Back After Surgery?

Cataract surgery is one of the safest and most widely-performed surgical procedures. By replacing the eye's natural cloudy lens with an artificial optical lens, patients can enjoy crisper, clearer vision.

While cataract surgery is safe and effective, patients may wonder if the changes are permanent — or if cataracts can come back after surgery. Understanding details about cataracts, cataract surgery, and the recovery process can help patients develop a clearer idea of what to expect.

Cataracts are a natural part of the aging process. A cataract occurs when the eye's natural lens begins to cloud. In a healthy eye, the lens bends and refracts light. This allows us to see clearly.

When a patient has a cataract this naturally clear lens becomes cloudy. This cloudy lens prevents light from coming in and makes it difficult to see. As the lens continues to cloud, patients may experience other issues such as blurry vision, trouble reading, or in serious cases, vision loss.

Patients can treat early cataracts with prescription glasses and healthy lifestyle changes. However, as a cataract grows more severe and begins to disrupt day-to-day activity, cataract surgery may be required.

During cataract surgery, a surgeon removes a patient’s cloudy lens and replaces it with an artificial or intraocular lens (IOL). This clear lens allows the patient to enjoy clearer vision.

Many patients suffering from cataracts wonder if surgery is a permanent solution. Cataract surgery is intended to be permanent and has an impressive success rate, around 98%.

During cataract surgery, a surgeon removes a patient’s natural cloudy lens and replaces it with a synthetic lens. This synthetic lens cannot develop cloudy and opaque areas in the same way that a normal lens can. Therefore, it is not possible for a cataract to come back after surgery.

While a cataract cannot come back following surgery, a condition called posterior capsule opacification (or a secondary cataract) can occur in the years following surgery.

Secondary cataracts occur in between 3-50% of cases. They typically arise one to five years after surgery. A secondary cataract is the result of the proliferation of epithelial cells on the posterior capsule - a part of the eye modified during cataract surgery.

The most common symptom of a secondary cataract is the reduction of visual acuity. This decline usually happens months or years after cataract surgery and can affect both near and far vision.

Secondary cataracts can also cause some patients to experience glare in their vision, starbursts, halos around lights, and the reduction of color vision.

If a patient experiences cloudy or blurry vision following cataract surgery, they should talk to their eye doctor.

The symptoms of secondary cataracts are similar to those of regular cataracts. They include:

• Lack of visual acuity: This can occur with both near and far vision.

• Blinding: Often with frontal lights at night.

• Difficulty with color perception: Having trouble making out colors.

• Blurry or opaque vision

Secondary cataracts are usually treated with a procedure called a Posterior capsulotomy (or YAG laser capsulotomy).

During a posterior capsulotomy, an eye doctor uses a laser to create an opening in a cloudy capsule that allows light to pass and helps clear vision. The procedure is quick, painless, and only takes minutes to complete.

The eye doctor will first numb your eyes with drops, then they will use a laser to make a small opening in the back of the capsule.

Vision usually clears up shortly after the procedure but patients will need to wait several days to start performing day-to-day activities again.

Eye doctors may prescribe eye drop medication to use in the days following surgery. People with healthy eyes will normally see improved vision within 24 hours.

A posterior capsulotomy is a safe and effective procedure. However, as with all surgical procedures, certain risks and complications can occur. These include:

• Experiencing floaters in the days that follow the procedure

• Increased pressure in the eye

• Additional swelling and need for steroid drops