When people undergo cataract surgery, they reasonably expect that the cloudy vision they’ve been experiencing will go away permanently. If cloudiness returns, it can be disconcerting. Can cataracts grow back? According to optometrist Dr. Michael Nelson, the answer is no. Post-cataract surgery cloudiness is most likely posterior capsular opacification (PCO). Learn more about what PCO is, why it happens, and what can be done about it.*

A common occurrence

PCO is “the most common complication after cataract surgery,” Nelson says. “And when I say ‘complication,’ I don’t mean it as a bad thing; it’s just something that can occur in a lot of patients after cataract surgery.” In fact, he adds, PCO affects about 20-50% of people who undergo cataract surgery, usually a few months to a few years after the procedure.

At the same time, he says, “Cataracts can’t actually come back.” 

So, what’s going on?

Understanding cataract surgery

The first thing to understand, Nelson explains, is what happens during a surgery to remove cataracts. 

The front of the eye is made up of:

• The cornea, which is the front boundary of the eye,
• The iris, the colored part of the eye located behind the cornea, and
• The lens (where cataracts develop), which is located behind the iris

The lens sits in a small, clear “bag” called the capsule which holds the lens in place. During cataract surgery, the doctor:

• Makes a small incision in the cornea
• Dilates the pupil to access the lens
• Cuts a hole in the capsule to access the cataract
• Inserts a tool to break up the cataract-affected lens into tiny pieces
• Vacuums the pieces out of the eye
• Inserts a synthetic lens into the capsule

How does PCO develop?

PCO develops, says Nelson, when there are leftover pieces of lens epithelial cells, which are the parent cells of those that create the lens, which grows throughout our lifetime.

When the doctor vacuums out the pieces of cut-up lens during cataract surgery, some tiny pieces of lens epithelial cells can remain behind, caught in “cracks and crevices” of the capsule.

Since lens epithelial cells continue to grow, the pieces left behind will often grow along the back of the capsule holding the new synthetic lens, eventually making your vision appear cloudy and opaque again. 

The cataract hasn’t grown back, and there’s nothing wrong with the new lens, but the symptoms of what’s often called ‘secondary cataracts’ or ‘postcapsular haze’–blurry vision, glare–are very similar to those caused by the original problem.

What can be done about PCO?

Fortunately, it’s fairly easy to correct PCO, Nelson says. In what is typically a 10- to 15-minute procedure that can be done in-office, the doctor can use a device called a YAG laser to cut a hole in the back of the capsule to clear your vision. This is called a capsulotomy, and it rarely requires repetition.

*Good Optometry Morning [Dr. Michael Nelson]. (2020, July 18). The Most Common Complication After Cataract Surgery: What Is Posterior Capsular Opacification [Video File]. https://www.youtube.com/watch?v=WgVpCh0uIek 

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