When a Cataract Comes Back

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When a Cataract Comes Back

Almost every cataract implant gets cloudy with time. The symptoms of blurry vision return, but the vision can be restored using a laser procedure.

While not a retinal problem, cataracts can “return” and can mimic the symptoms of the original cataract; blurred vision, glare and distortion.  This can usually be remedied by a simple painless laser procedure called a YAG capsulotomy.

Cataract Surgery with Implant

Like grey hair, everyone gets cataracts.  With time, the natural lens of the eye clouds with time.  This clouding decreases vision.  The lens is similar to an “M&M” piece of candy both in size and shape.  An M&M is a core of milk chocolate surrounded by a candy coated shell.

Cataracts Cause Decreased Vision

Cataract

When cataract surgery is performed, the cataract surgeon cuts a hole in the outside candy coating.  The “chocolate”  (core of the lens) is then sucked out leaving the empty candy coated shell.  In the real eye, this shell is actually a clear tissue very similar to plastic wrap used to cover food.  This shell is called the “capsular bag.”

Once the cloudy natural lens material is removed, a clear plastic implant is used to replace the natural lens.  Vision is restored.

Plastic Wrap Gets Dirty

With time, from weeks to years, this clear plastic wrap-like material can get cloudy.  The original symptoms of blurry vision and glare return.  Decreased vision from “posterior capsule opacification” occurs in almost every cataract patient.

Using a “laser” to Restore Vision

A YAG laser is a type of laser that uses its energy to cut.  By focusing the laser beam on the back portion of the candy coating shell, just behind the implant, a small hole is created.  This removes the cloudy/hazy tissue out of the line of sight and vision is restored.

YAG Laser Used for Posterior Capsulotomy

Laser Cut Hole in Posterior Portion of Shell (Capsule)

Does the Implant Fall

Properly performed, a YAG capsulotomy will not cause the implant to move.  While it has happened (and to me!), it is unusual as the implant is usually scarred in place.

In theory, there may be a slight increased risk of a retinal tear that could lead to a retinal detachment.

What Does This Mean?

Many of my patients have had cataract surgery.  It is a relief when we find the cause of the decreased vision is only due to PCO (posterior capsule opacification) and not due to diabetic retinopathy or macular degeneration.

Many people erroneously believe (and perpetuated by some docs) that cataracts “come back.”  They don’t.

This is also why many people believe cataract surgery is performed with laser.  It isn’t, but now you know why, and how, the rumor started.

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Comments
  • Fruzsi June 1, 2010 at 12:45 pm

    As usual, I find this very informative. Can you clarify if it is typical for PCO to occur only once per implant, or is it something that tends to recur? Given that I’m on the younger end of the age range for cataract patients, I’m curious to know if I should expect repeated YAG capsulotomy procedures once I get around to having cataract surgery. Thanks.

    • Randall V. Wong, M.D. June 1, 2010 at 2:44 pm

      Good question. The normally clear tissue becomes cloudy. The laser creates a hole in this tissue and does not recur. It is a one time problem.

      Thanks. Hope this answered your question.

      r

  • mlarson January 10, 2011 at 2:15 pm

    I have developed a cataract in my left eye. Here’s the clinker; I have had torn retinas in both eyes, macular holes in both eyes, two buckles (one had to be removed due to infection) and cataract surgery in both eyes. I have had a total of 8 eye surgeries (or was it 9?).
    The current cataract is due to the scare tissue from the previous surgeries. I’m only 60 years old – my first surgery was in 2004.

    Can you explain this to me and what can be done?

    • Randall V. Wong, M.D. January 10, 2011 at 7:23 pm

      Dear Mlarson,

      I am to assume that the current “cataract” is in fact clouding of the implant? You mentioned that you had cataract surgery to both eyes. A YAG laser is probably indicated now…compared to the other surgeries…a piece of cake!

      All the best. You seem to have beaten all the odds!

      Thanks for sharing.

      Randy

  • Claudio Frias February 27, 2011 at 12:29 am

    Hello: I had cataracts surgery on Jan 17/11 (right eye) and on Jan 25/11 (left eye). My IOL’s are 9.5D AcrySoft IQ (right eye) and 12.5D + 2.25 Cyl AcrySoft Toric (left eye), both are monofocal lenses. I have no concerns with the right eye, but one week after surgery of the left eye I started having blurry vision in this eye; when I look at a light at night (i.e. oncoming cars) I see like a ball if light around it and radial beams of light in all directions. I saw the doctor the day after and he said there were cells forming behind the capsule. He performed Yag Laser capsulotomy three weeks later (Yesterday, Feb 25/11). I thought that the improvement is almost immediate but tonight, one and ½ days later I still don’t notice any improvement, only the light beams pattern changed. The eye pressure went up a bit. I am on Maxidex and Lumigan. He gave me a prescription for glasses that will give me 20/20 vision.
    How long will it take until I see improvement after the Yag laser procedure ? Thank you in advance – Claudio. Feb 26/11.

    • Randall V. Wong, M.D. February 27, 2011 at 8:22 am

      Dear Claudio,

      If the symptoms are indeed due to the capsule or cells forming on the capsule, I’d expect rapid changes after the procedure.

      Get the new specs and see if this changes anything. Make sure to follow up with your doc.

      Randy

  • C Thompson March 5, 2011 at 7:00 pm

    My wife is up for YAG capsulotomy, about 5 years out from cataract surgery. Once the posterior membrane is perforated, what would keep the aqueous fluid from leaking? Also, is there risk that the effect of the YAG laser would change the rear face of the implant lens? Thank you

    • Randall V. Wong, M.D. March 10, 2011 at 11:58 am

      Dear C,
      The aqueous fluid normally goes “around” the lens as it migrates from the vitreous cavity to the anterior chamber. There is also no true redirection of fluid as the posterior membrane is pretty adherent to the adjacent implant. Also, standard of care used to be (before implants) to simply remove the entire lens including the capsule.

      The rear face of the implant can get “dinged” if the laser is not focused properly. Even so, there is usually little impact on the vision (in my experience.).

      Randy

  • Claudio Frias March 10, 2011 at 10:04 pm

    Dear Dr. Wong. Regarding my question of Feb 27/11 (Halos after caratacs surgery).
    My Dr, checked my vision and found that the capsulotomy of the left eye went well, the Toric lens is in the correct axis and the eye pressure is normal. He said there is a huge clowdy mass inside the eye, similar to a floater but it doesn’t move; he doesn’t know how it got there. To remove it would mean another surgery but I see “too well” to justify it.
    He prescribed me Pilocarpine which I have been using it for 4 days. The halos go away almost completely after 45 minutes of applying the drop and this helps me to read and to work at the computer. However, I see darker at night with this eye although I don’t notice difference in light intensity during the day. I got my new prescription glasses and I am surprised how well I see, but I am still very sensitive to light and I have to wear a sun shield outdoors. I have a follow-up appointment in six months.
    Thank you for your help.
    Sincerely,
    Claudio.

    • Randall V. Wong, M.D. March 15, 2011 at 11:29 am

      Dear Claudio,

      If this is in the vitreous, have it checked by a retina specialist for his/her opinion.

      r

  • Jason December 22, 2011 at 2:10 pm

    Dear Dr. Wong,

    I had YAG laser treatment earlier today and my vision is back to normal, it is miraculous! However, I wondered if I will have to have the YAG laser ever again in my life? and if there is a chance another secondary membrane could emerge a few years down the line?

    Thanks for you help in advance, and can I thank you for this very informative page. It has been very reassuring for me over the last few weeks!

    Jason

    • Randall V. Wong, M.D. December 30, 2011 at 7:51 am

      Dear Jason,

      Technically the “membrane” can not return. The laser created a hole in the normally clear tissue that holds the implant. The clear tissue because cloudy and blurred your vision. This does not grow back.

      On rare occasion some cells may proliferate (grow) around the edges of the newly created hole and mimic the membrane returning. These “Elschnig Pearls” can be treated with the laser.

      Randy

  • Matt January 4, 2012 at 1:59 pm

    Had Yag yesterday for ACP and PCO Anterior 100% better! (no more streaks-halos!!) Vision is still blurry 24 hrs post op.. How long can it take to become as clear as it will be?

    • Randall V. Wong, M.D. January 9, 2012 at 11:20 am

      Matt,

      Awesome news! I’d expect pretty quick results within a week or so…but everyone varies.

      r

  • Susan Manola May 24, 2012 at 1:13 am

    I have had both cataracts done in February of this year, and, during a pre-LASIK consult (to correct left-over astigmatism) was found to be in need of a YAG procedure. Will I still be able to have the astigmatic correction? I’ve had previous LASIK.

    • Randall V. Wong, M.D. May 30, 2012 at 10:20 am

      Dear Susan,

      I don’t perform LASIK or other refractive procedures, but I believe the YAG (a procedure performed to the tissue holding your implant) and astigmatism to be completely unrelated…you should be fine to correct the astigmatism (a problem of the curvature of the cornea).

      Randy

  • jasmer singh grewal July 6, 2012 at 6:59 pm

    Dear Dr Wong –I had cataract surgery of left eye on 23 April 2012 come out good but then I had right eye surgery for cataract, on 28 May2012 I have cloudy and hazy vision, after 3 weeks I had yag laser on21 june 2012 and again on july 4 I had second yag lase but I still see cloudy vision after 3 days gone by. I have floaters too. I have another appointment on july 18, please advice for any treatment as still I donot notice improvement,still vision is hazy and cloudy.

    • Randall V. Wong, M.D. July 10, 2012 at 6:44 am

      Dear Jasmer,

      Most likely your symptoms are due to the recent YAG. If you feel your vision is worse, please tell your doctor.

      Randy

  • wee-Victor July 17, 2012 at 7:55 am

    Dear Dr Wong

    I had cataract done on my left eye 2 months ago and during the recent followup, the doctor said he saw a weakness (thinning) in my retina and advise me to do a laser to ensure that there will not be a tear later on. This is only a precaution and also to protect my good eye. This is because my other eye previously had retinal detachment and my vision in this eye is never back to normal and he wants to ensure that my left eye will not get retinal detachment. Pls advise me on what best to do.

    Thank you so much in advance for your feedback.

    Rgds
    Victor

    • Randall V. Wong, M.D. July 19, 2012 at 1:33 pm

      Victor,

      I believe your doctor is advising you well. If you’ve already had a retinal detachment in one eye and there is weakness/thinning (is this lattice degeneration?) in the other eye, laser should reduce the chance of retinal detachment.

      Randy

  • margarita bailey July 27, 2012 at 2:38 pm

    Dear Dr. Wong:

    I had cataract surgery first in the left eye and then right, Nov. and Dec. 2011. I had YAG on the right eye in January and all was well. In the last couple of months, I have had a “smudge” (for example, I am always trying to clean my reading glasses) in the middle of my right eye’s field of vision..particularly noticeable when reading. I have been back to my surgeon, well known and respected, who referred me to a retina specialist although she did not think I have a serious issue. The retina specialist (from Bascomb Palmer), also assured me nothing is wrong but dry eye and to use whatever refresh type drops 4 to 5 times a day…I have been for two weeks now and see no difference. It feels as if I still have a cataract on that eye. Any suggestions? Thank you, Margarita

    • Randall V. Wong, M.D. July 31, 2012 at 11:34 am

      Dear Margarita,

      I can only recommend you follow the advice you’ve been given. Dry eye can be difficult to manage. 2 weeks is not necessarily too long. Make sure you speak to your doctor about these specific concerns.

      Randy

  • Henry G. July 31, 2012 at 9:05 am

    HI. I had a Cataract Surgery back in 1995. About a month Ago I had YAG laser surgery. before the surgery my vision was 20/40 three weeks later it’s still 20/70 or 20/80. My eye was swollen for over 2 weeks and my pressure shot up over 50/55 that day of the surgery and later that night. Thurs the Retina Doctor looked at it and said I now need Vitrectomy Surgery. I’m getting a second opinion. My question is it normal for the vision to get this bad after YAG surgery. And the added headaches that I never used to have.

    • Randall V. Wong, M.D. July 31, 2012 at 11:31 am

      Dear Henry G,

      Your particular situation sounds complicated. I would take the advice you’ve been given as I am unable to examine you myself. The headaches could be from the high eye pressure which should be addressed quickly.

      Randy

  • Henry G. July 31, 2012 at 1:40 pm

    My eye pressure is around 22-24 last time and the headache have lessen. the vision haven’t improved. I’m getting A second opinion this week. Don’t want to have holes poke in the eye If I don’t have too. But the First evaluation came back as the film from the YAG surgery instead of dropping to the bottom of the eye float back in front of the pupil/retina and is blocking the light/vision. But it still don’t explain the increased level of eye pressure to me. if I don’t treat it eventually it will lead to or probably lead to glaucoma. I’m reciting off of memory and didn’t write anything down. Though it would just clear up in a few weeks. but now being a little worried I’m googling and asking question. I also Though they said part of the lens have floated in front of the eye/pupil?

    • Randall V. Wong, M.D. August 13, 2012 at 2:05 pm

      Dear Henry G.,

      Give us an update.

      Sometimes inflammation can occur from a YAG. Also, it is possible that lens fragments get stirred up from the YAG… causing the pressure to increase.

      Hope the second opinion went well.

      r

  • JulieW August 16, 2012 at 7:01 pm

    Who performs the YAG laser treatment and is it done in the OR ?
    Thanks

    • Randall V. Wong, M.D. August 16, 2012 at 8:44 pm

      Dear JulieW,

      A physician, usually a general ophthalmologist, performs the YAG laser. It is not performed in the OR, but in the office.

      Randy

  • Shirley deLong January 25, 2013 at 6:00 pm

    After Cataract Surgery in August, 2012, within a few weeks, a ‘SMUDGE-LIKE’ appeared in this left eye. doctor did the Laser surgery, but it didn’t correct the problem. Doctor has told me I have good eyes with no detachments, no retenal problems of any kind. (I have no problems with right eye). Vision 20/20…only use reading glasses. What can be done to correct this ‘SMUDGE?’ It’s like the lens has a fingerprint over it?
    Thanks for much.

    • Randall V. Wong, M.D. February 2, 2013 at 4:25 am

      Dear Shirley deLong,

      I really can’t tell what’s causing the smudge….because I can’t examine you. It could be so many things.

      Randy

  • Jeff February 20, 2013 at 11:21 pm

    Thanks. A very helpful description.

  • Maria February 28, 2013 at 4:23 pm

    Hi, Dr.

    I am so worried.
    when I was 7, I got hit by a stone in the eye. They said I would be blind.
    But after 2 weeks of some ointment and daily dressing my R eye could see again. Ever since I remember, I could never stand glare.
    At ageg 23 I was told I had traumatic cataract on my R eye. I did not start wearing reading glasses until age 45.
    I noticed a quick progression in my vision. I decided to have cataract surgery four weeks ago with high hopes.
    From day one I noticed my R eye was better than my L. I was so happy.
    On end of second week I noticed a hazy film over my vision although I could read without my glasses. On post op check up at week 3, I was booked to have YAG procedure tomorrow. Everyday my “secondary cataract is getting worse. Now my R eye can hardly read, I am so worried. I keep being told it is not uncommon. I want to hear an expert opinion who does not know me, please.
    Please inform me. What went wrong. my reaction happened too soon. Please tell me what is my prognosis?
    Am I gonna be blind? Is it because of my initial trauma?
    I was only told this usually happens to 20% of patients 2-3 years down the line. I read the issue about “if this is a trauma related cataract, I should expect worse outcomes”?

    thank you for your response.

    Maria

  • Maria March 13, 2013 at 1:01 pm

    Thank you very much for your response, I feel so much better.
    This is day 4 after YAG. There is still a hazy film that fades or dakens but I can read with this eye much better than my L. I got floaters too but the white flashes diappeared totally. Sometimes I feel the fluid in my eye moving in front of my vision which is happening less now.
    But after reading your answer, it is so comforting, I will just take your word for it. I will not worry anymore.
    Thank you very very much for taking the time.

  • ward April 15, 2013 at 10:34 am

    I had cataract surgery 3 months afo. My vision is very cloudy in the surgical eye. Do you think PCO surgery is indicated? My vision test have been good, but my vision is very blurry, and at time has a tendency to flicker and sometimes gets much worse affecting my balance.

    Help!!

    • Randall V. Wong, M.D. April 23, 2013 at 9:19 am

      Dear ward,

      The only way to tell is get examined and have your doc look specifically at the clarity of the implant. The same symptoms could be caused by a variety of issues, not just PCO.

      r

  • Sarah wood April 23, 2013 at 8:58 am

    Hi I wondered if you could help me I had yag laser yesterday I am 37 years old and am concerned that I feel no improvement as yet my vision still appears cloudy am I being impatient ? I would be grateful if you could get back to me
    Thanks sara

    • Randall V. Wong, M.D. April 23, 2013 at 9:22 am

      Sarah,

      It often takes several days for the vision to improve. If the vision becomes worse, make sure to call your doc.

      r

  • Sarah wood April 23, 2013 at 9:58 am

    Thank you for your quick response I really do appreciate this, I feel it is no worse but also no better! But as i say it is only just coming up to 24 hours after my procedure , My eye aches a bit too. Is all this just normal then it was just that I expected for my vision to be clear this morning.
    Thanks sara

    • Randall V. Wong, M.D. April 23, 2013 at 10:17 am

      Sarah,

      Not usually painful, but I prescribe an anti-inflammatory.

      Hang in there.

      r

  • Sarah wood April 23, 2013 at 1:04 pm

    Thanks for responding i will do 🙂
    Sarah

  • Sarah wood April 26, 2013 at 3:37 pm

    Had to go back to the hospital to be checked over my eye is no clearer the doctor said they could clean it up with more laser but I also have scaring at the back of my eye ( from the cataract surgery I think) so now waiting t go for a scan of my eye hope it gets sorted soon its worrying me and my vision at night is dreadful. Fingers crossed il be sorted soon. Hope they can do something
    Sara

  • Amy May 1, 2013 at 10:57 pm

    Dr. Wong,
    After about 5 years of cloudy vision with severe glare during the day and starbursts and halos making driving at night impossible, I had cataract surgery with a toric lens for a posterior subcapsular cataract on my left eye on April 24th, 2013. After they removed the patch the next day, I could already tell there was still come cloudiness. It is a different glare and cloudiness than it was before the surgery but bothersome. My doctor said we would do the YAG laser in about three months after complete healing but I am concerned, especially after reading the above comments, that maybe I have a different problem. You stated that cloudiness “could be caused by a variety of issues, not just PCO” — what are some of these other issues? Should he be able to tell for sure what the problem is before trying the YAG?
    FYI, I was very myopic (-8.25) and also have a small posterior subcapular cataract in the right eye but it is not as debilitating as the right eye was(and still is). Thank you

  • Amy May 1, 2013 at 10:59 pm

    Sorry, my last line should have read: FYI, I was very myopic (-8.25) and also have a small posterior subcapular cataract in the right eye but it is not as debilitating as the LEFT eye was(and still is).

  • Mary June 9, 2013 at 8:42 am

    I had Tecnis mulifocal done in both eyes re: farsightedness (+7) and everything went well. The surgeon stated I would need the YAG in about 3 mos re: ‘fibrosis’. I was elated with the implant results, corrected to 20/25 and 20/30! and not experiencing any problems, yet I agreed to the YAG. The first eye was done 5/8 and the vision got worse. I will not bore you with details about trying to get through to the surgeons office to get back in but suffice to say, many superb doctors have fools working in their offices. At any rate, they eye checked out fine, no problems, macula ok, etc. I was given Prolensa and asked to return in two weeks which I did. My eye continues hazy, I lost mid near vision which I had before the YAG. The surgeon either does not believe me or has no answers except everything looks good.. He put me in touch with the Tecnis rep who listened kindly but is first a sales person. After 3 bottles of Prolensa, Blink eyedrops, and Blink and Clear – nothing is helping. At least your website validates that people DO experience non-published complications of YAG. I go not blame the surgeon, but feel these issues should be reported to the FDA as potential complications of YAG. . I am likely stuck with the problem and will need glasses for some things WHICH I DID NOT NEED BEFORE THE YAG. Other sites say how wonderful YAG is and that there are no potential issues except floaters. THIS IS NOT TRUE! Thanks for allowing this post, if you do. Your site makes me feel I am not alone or nuts.

    • Randall V. Wong, M.D. June 12, 2013 at 10:06 am

      Dear Mary,

      While I can not cite any references, my experience with hyperopic patients (farsighted like you) has been frustrating. Over the years I’ve had several patients who didn’t respond well to typical procedures….such as cataract surgery, YAG or repair of macular hole (I guess I’ve had 3!).

      Vision, like you, worsened. No explanation. No recollection of significant improvement.

      I’d also search for other causes…perhaps the decreased vision was not due to the fibrosis?

      Just my thoughts.

      r

  • Kenni August 23, 2013 at 12:21 pm

    Hi Dr. I just had a Yag procedure done here the other day as I thought it was the cause of my cloudy vision on my left eye. I had some opacification after a cataract surgery done a little over a year ago but I see now that my vision is just as cloudy after the procedure. Therefore i have regrets, and im in a little distress as to what this cloudiness (fog) can be. Ive had 4 macula-on detachment surgeries. The first one was major and the last 3 was minor repairwork. I understand i now have a very watery vitreous after 2 of the surgeries were vitrectomies.

    I live an active lifestyle and i also do extreme sports and now im actually afraid of my vitreous leaking through the hole in the capsule, and that I have to take it easy. Is this at all possible or should I just do what i want?

  • norma mclaughlin September 5, 2013 at 9:38 pm

    Hi Dr. Wong,

    I had a monofocal lens implant (Nanoflex) right eye. Had wonderful 20/20 vision for at least 3 mos. After Yag, vision now about 20/30, but I can see clearly when I put my chin to my chest and look up —- strange! I do have bilateral posterior vitreous separation and in the right eye lasered horseshoe tear, mild epiretinal membrane, and a hard druse on the fovea. Just saw on a report that I also have very mild Fuch’s Corneal Dystrohy. Could this have caused vision to be 20/30 after Yag & not go back to 20/20 pre Yag?

  • Carol November 2, 2013 at 9:12 pm

    I have cataract surgery 2 years ago, went from 20/500 to 20/25 and 20/30. Then gradually developed deteriorating vision because of PCO to 20/50 and 20/60. Had YAG laser capsulotomy to both eyes one week ago. Successful in right eye to 20/20 but worse in left eye to 20/70. Doctor very experienced, has no idea what happened. Did a thorough examination and several tests in the office and cannot give me an explanation of what went wrong. He initially put me on Acular anti-inflammatory drops three times a day. Told me to stop the Acular. Do you think there is a chance the vision in my left eye will clear at this point? I am very depressed about this. Thanks for your reply.

  • Maureen March 15, 2014 at 6:04 am

    i expecyed my vision to get better after laser treatment to remove cloudiness from back of cataract, but now after about 3 days, it is worse. will this get better since maybe not healed yet. also, i am very worried that cigarette smoke entered this eye with burning feeling from smoke going under my glasses. will tear drops help in addition to medicated drops. very scared and worried because my vision is worse now than before. wish i never agreed to this procedure, since i had 20/30 vision after cataract surgery.

  • Esther Mcknight July 31, 2014 at 10:53 am

    I have secondary cataract in my right eye . . .
    My vision was fine for two years after sugary, now its so blurred it’s very difficult to see anything out of it. First they said it could be cleared up with laser, after a second examination they said laser wouldn’t be effective, because the cloudy film was fused on the front and back of the lens, making it too thick.
    Have you ever seen this happen in any of your patients before, if so are there other options than laser?

    • Randall V. Wong, M.D. August 12, 2014 at 10:16 am

      Esther,

      To answer your question – yes. I’ve seen 1-2 times (that’s all) where the haziness was on the front of the lens and was too thick for Yg laser. I have tried to mechanically clean the implant by operating.

      Randy

  • steve burgess August 24, 2014 at 3:00 pm

    I am 42 years of age and had cataract and yag laser surgery two weeks ago.The capsule is still hanging around the pupil area causing me to see starbursts and its like looking through wax paper.I had a victricomy 12 years ago and have saline solution in my eye so floaters are always gone with in a day.my question is why is the capsule still around and will it leave soon because its giving me headaches and hard to see through it?

    • Randall V. Wong, M.D. August 25, 2014 at 12:46 pm

      Steve,

      After only two weeks, I believe anything can happen – quite possible the capsule can move over to the side.

      Fingers crossed!

      Randy

  • steve burgess September 4, 2014 at 6:44 pm

    How long should I wait before I call the docs office and set up an appointment to laser the capsule piece that’s obstructing my vision?Its going on the 4th week now.

    thanks steve

    • Randall V. Wong, M.D. October 3, 2014 at 9:55 pm

      Dear steve,

      In my opinion, get it done if your vision is affected. Many surgeons will probably wait at least 6 weeks before considering a YAG but this is surgeon dependent.

      Randy

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