Two years out from cataract surgery and you may consider yourself to be in the clear. But wait, things have gotten worse! What's causing your vision to become more blurry?
There is one common thing that can cause your vision to become blurry years out from cataract surgery: the capsule holding the new artificial lens can become cloudy. This cloudiness causes your vision to become blurry.
That's the most common reason related to cataract surgery, but because eyes are eyes, there are also other important medical issues completely unrelated to cataract surgery to be aware about.
So let's look at those different causes and what can be done about it.
Cloudy Capsule
Before cataract surgery, the cataract was suspended in the eye by a bag - called the capsule. This capsule serves as a great spot for the new artificial lens to sit. And thus it is preserved during cataract surgery.
Capsule surrounding lens; image by File:Three Internal chambers of the Eye.png: Artwork by Holly Fischer derivative work: Pixelsquid, CC BY 3.0, via Wikimedia Commons / modified from original
To get to the cataract, a circular hole is made in the front of the capsule. And the cataract is removed from that front hole. This leaves the back of the capsule intact.
But the back of this capsule can get cloudy over time. Microscopic cataract particles can remain behind after cataract surgery, travel to the back of the capsule and start growing. This creates a cloudy capsule - also known as posterior capsular opacification
Instead of being clear, the capsule has developed some cloudiness; image by Rakesh Ahuja, MD, CC BY-SA 2.5, via Wikimedia Commons
This causes vision to become not only more blurry but also creates extra glare and starbursts in vision.
But here's the kicker. This can happen anytime from months to YEARS out from cataract surgery! And is quite common. In fact, about 12% of all cataract patients will develop a cloudy capsule by three years out from cataract surgery. The younger you are at the time of cataract surgery, the more likely you will develop a cloudy capsule.
Because this cloudy capsule can develop over time after cataract surgery, it sometimes is referred to as an “after-cataract".
While there are other rare causes that can be related to the cataract surgery such as retinal detachment (check out The 3 Must Know Late Complications Of Cataract Surgery), having a cloudy capsule is by far the most common.
How it's treated
This issue would be terrible if there weren't a good treatment for it. Fortunately there is. And this procedure is so simple and straightforward that it is done in the office setting as well with minimal recovery.
Lasers are used for many things in ophthalmology (and different lasers are capable of doing different things). And treating cloudy capsules is one of the most common uses of a laser in ophthalmology.
The particular laser type is a nd:YAG (often shortened to just ‘YAG’), giving the name YAG capsulotomy. It's literally using the laser to disrupt and create a hole in the capsule for you to look through.
It only takes a minute or two and overall is very effective at eliminating the cloudiness and restoring vision.
Non-Cataract Surgery Related Causes
If you don't have a cloudy capsule and you have blurry vision, chances are that something else is going on with the health of your eyes completely unrelated to cataract surgery. Unfortunately, cataract surgery can't prevent eye disease.
Dry eye
One very common way vision can become blurry is through an increase in dry eye.
On the surface of the eye is a tear film. This tear film prevents the eye from drying out.
The short story about dry eye is that the tear film can no longer protect the eye anymore. The tear film may be too thin or it may evaporate off the eye too quickly.
When the tear film dries out, it goes from being smooth (and allowing for good vision), to becoming irregular (and blurring vision). This can cause fluctuation of vision. You may find right after blinking things can sharpen up for a second or two (as blinking makes the tear film smooth again), before things go right back to being blurry.
There are many reasons why dry eye can develop. Many medications can cause dry eye. As we get older, the risk for dry eye increases. Changes in health, activity, sleep, diet also play a large part. Therefore, it isn't unusual to develop dry eye seemingly “out of the blue" two years after cataract surgery.
Using preservative free artificial tears regularly is the best first step to treating dry eye.
But dry eye isn't the only thing to pay attention to.
Macular degeneration
The biggest cause of a permanent decline in vision after cataract surgery is macular degeneration.
In the back of our eye is our retina. The retina works as the photoreceptor for our eye. It takes the light that we see and converts that information into signals the brain can understand. The very center and most important part of our retina is called the macula. This area allows us to see all the fine details of what we are looking at.
In macular degeneration, this area of the retina becomes sick. Blood vessels start growing in this area and leaking causing distortion and blurred vision. Untreated, this causes permanent vision loss.
The risk for macular degeneration increases as we get older. And so two years out after cataract surgery (or anytime after), macular degeneration can lead to blurred vision. Unrelated to cataract surgery.
It's important to catch and treat macular degeneration as early as possible. This means visiting eye doctors routinely for dilated eye exams. Early macular degeneration can be monitored with something known as an amsler grid. This can help identify subtle distortions in your vision. Special vitamins can also help prevent the macular degeneration from getting worse.
Vitamins proven to help prevent macular degeneration from getting worse; Image courtesy of Amazon.com
Glaucoma
This is the second biggest cause of permanent decline in vision after cataract surgery.
Information from the retina gets transmitted to the brain through a nerve inside the eye called the optic nerve. With glaucoma, high eye pressures cause damage to that nerve over time. This causes permanent loss of vision if not treated.
But the tricky thing with glaucoma is that it can be harder to detect on your own. Glaucoma affects our peripheral vision first. Unless you routinely check your peripheral vision, you may not even notice that you are losing it. And unless your eye pressure is extremely high, the eye won't feel any different either.
So the key to diagnosing and treating glaucoma is having routine visits with your eye doctor to screen for any issues.
Summary
The biggest cause of blurred vision years out from cataract surgery is due to the development of a cloudy capsule. It's a very frequent problem, but fortunately has a very simple solution. Outside of cataract surgery, vision can still deteriorate from other causes such as dry eye, macular degeneration and glaucoma. All of which require routine visits to screen for and treat.
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