Can cataracts come back after surgery?

However, if you start to experience similar symptoms to the ones you experienced with cataracts, we understand it may be concerning - especially if your sight has been clear for some time. Because of this, it's easy to assume that the cataract has returned, or that the original operation wasn't successful. And whilst that worry is completely understandable, the reality for most people is quite different. 

We've put together this guide to help you understand what’s actually happening and what to do if your returning symptoms are getting in the way of daily life.

Why am I experiencing cataract symptoms after surgery?

If your vision becomes misty again later on, the cause is usually posterior capsular opacification (PCO). This is a change affecting the thin membrane that supports the artificial lens, rather than any changes in the lens itself. The symptoms can look and feel like a cataract returning, which is why it’s sometimes called a secondary cataract, but what is actually happening is separate from the original operation.

What is a secondary cataract, and how do they form?

As mentioned above, when cataract surgery is performed, the cloudy natural lens is removed and replaced with a clear artificial one. The artificial lens sits inside a thin membrane called the lens capsule, which is left in place to hold it securely.

In some cases, cells that remain after surgery migrate slowly across the back of this capsule. Over time, that layer becomes less transparent, and light no longer passes through as cleanly. The effect can feel similar to the original cataract, even though the artificial lens itself has not changed at all - and this is commonly referred to as a ‘secondary cataract’. 

Not everyone who has had cataract surgery will develop this. When it does happen, it tends to develop slowly and can appear months or years after surgery.

Symptoms of a secondary cataract

The symptoms are quite similar to those patients experience during the formation of the original cataract. Vision that was clear and stable after surgery can slowly look slightly misty again. It has been described as feeling like there is a thin film over the eye, causing a gradual loss of sharpness.

Similar to cataracts in the natural lens, you may have difficulty with glare in bright sunlight or at night. The harsher appearance of light, or halos around it, makes driving at night safely more difficult. You might also notice that contrast feels reduced in dim lighting, making it harder to pick out details that you could following your first surgery. 

Even if your prescription hasn’t changed, reading can become more difficult. It’s important to note that these changes are entirely separate from the short-term blur that can occur soon after surgery while the eye is healing.  It’s more if your vision was stable for some time - even years after surgery - but has slowly become less clear, posterior capsular opacification is the most common explanation.

Does having a secondary cataract mean I’m at higher risk of other eye problems?

Posterior capsular opacification is a change affecting the capsule behind the artificial lens. It is not a condition of the retina or the optic nerve.

Because it is limited to the lens capsule, it doesn’t directly affect other structures at the back of the eye. Current evidence does not link secondary cataracts to a higher risk of other eye diseases.

However, if you develop new or unusual symptoms, an eye examination can help rule out other causes.

How secondary cataracts are treated

It can be discouraging to learn that you might need a follow-up treatment after a successful cataract surgery, but the solution is a common procedure that is markedly different from the initial surgery. 

If the artificial lens capsule becomes cloudy, the solution is a short laser procedure called a YAG capsulotomy to restore visual clarity. During this quick procedure, the artificial lens stays in place while the laser creates a small opening in the membrane behind it. This allows light to pass through clearly again and clears up any misting or glare from lights. 

YAG capsulotomy is an outpatient procedure and usually takes 5-10 minutes per eye to complete. As with all eye procedures, each patient’s recovery is slightly different. Many patients notice an immediate improvement in vision within a day of treatment, with some people reporting improvement on the same day. There is a chance you might experience temporary floaters immediately after the procedure, but these usually settle over a few days to a few weeks.

Is YAG laser treatment safe?

YAG laser capsulotomy is a low-risk outpatient procedure. It is minimally invasive, requires no stitches, and causes only brief discomfort.  There is no need to reopen the eye or replace the artificial lens that was put in during your original cataract surgery.  As with any medical procedure, there are small risks, and your specialist will check your eye health before recommending treatment. 

Can a secondary cataract come back after YAG laser treatment?

It is uncommon for capsule opacification to return following a YAG capsulotomy. The laser creates a permanent opening that allows light to pass through. In rare cases, cells can grow around the edge of the opening over time, or the opening itself can shrink. In these instances, further laser procedures can be performed to correct this. 

If you’re in any doubt or have concerns following YAG capsulotomy treatment, make an appointment to see a specialist for an assessment. 

When to contact your eye clinic

If you’ve noticed any changes in your vision after it has been stable for a period of time after cataract surgery, it’s important to contact your clinic for an assessment. 

Signs you should contact your clinic include:

• Vision becomes cloudy again after a period of stability.
• Glare or halos around lights are getting worse or much more noticeable.
• Your sight is starting to affect daily activities in the same way your original cataracts did before surgery. 

Seek urgent advice if:

• If you experience a sudden change in vision.
• You’ve noticed new floaters and shadowing.
• You’re experiencing redness that is increasing or pain in the eye.

The clinical team at OCL Vision is used to seeing patients with exactly these concerns. If something doesn't feel right with your vision after surgery, don’t hesitate to make an appointment. 

Next steps

If your vision has changed since surgery, what matters most is understanding what is happening before drawing any conclusions. Cloudy vision months or years after cataract surgery is rarely a sign that something has gone seriously wrong. For most people, there is a straightforward explanation and path forward, with the OCL Vision team on hand to help you get assessed and treated if that’s necessary.

If your symptoms are starting to affect daily life, a follow-up assessment is a sensible next step. A consultation isn’t a commitment to undergoing another treatment; it's the best opportunity to check on what’s going on and what’s the best option for you. 

If you would like to discuss your symptoms with our clinical team, you can book a follow-up assessment at a time that suits you.