November 30, 2021 | Cataracts

Do Cataracts Grow Back After Cataract Surgery?

By Barrett Eubanks, M.D.

Do Cataracts Grow Back After Cataract Surgery?

In the years leading up to cataract surgery, vision can get quite blurry. Cataracts cause a slow and progressive decline of vision. But what happens after cataracts are treated. Do you have to worry about this same process happening all over again? Fortunately no!

It is impossible for cataracts to grow back after cataract surgery. Cataract surgery permanently takes care of cataracts. It is possible, however, to develop something known as "after-cataracts" which can blur vision. These aren't true cataracts and are also fortunately something easily treated as well

What exactly is a cataract

Within everyone's eye is a natural lens. This lens take part in allowing our eye to focus light and see. When we are born, this lens is crystal clear. But gradually over time, this lens starts to become a little more cloudy. As this lens gets cloudy, light has a harder time passing through the lens. Vision becomes blurry. At this point, this lens has become a cataract. (also check out Your Comprehensive Handbook To Learn What Are Cataracts)

There are a few known causes of cataracts. Medical conditions such as diabetes can cause cataracts. Being on long-term steroids can also do the same thing. Trauma to the eye can certainly cause the lens to be cloudy.

There are also a few weak associations with cataracts. Chronic exposure to UV light can increase the risk of cataracts. Having a family history of early cataracts also makes you more likely to get cataracts at a younger age.

But often cataracts just happen with no regard. If you live long enough, you will get cataracts. But fortunately, only once.

Cataract surgery completely eliminates cataracts

We are only born with one lens. This lens is formed during development. Once this lens becomes a cataract, we have cataract surgery to remove this cataract (and thus the lens). This lens is only formed during development, it can't form later in life. Once this lens is gone, it's gone for good.

Now if you remember from the last section, the lens takes part in the focusing ability of our eye. When we remove the lens / cataract, we need to replace this focusing power to give us clear vision. Thus, once the cataract is removed, a new artificial lens is placed within the eye where the cataract used to be.

However, prior to the surgery, the cataract isn't free floating within the eye. The cataract is actually suspended within the eye within a tiny bag called the capsule. And after cataract surgery, we want the artificial lens to be suspended in the same fashion. This keeps the new artificial lens in focus and prevents it from moving around. Thus, this capsule is preserved during cataract surgery to serve as the support for the new artificial lens.

Capsule of eye
Capsule of eye; 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

The capsule can become cloudy after surgery

Through a special process called phacoemulsification, the cataract is broken up and vacuumed out of the eye through a tiny vacuum.

Despite the cataract being broken up and removed with the tiny vacuum, microscopic cells of the cataract can remain after the surgery. These microscopic cataract cells can adhere to the capsule, migrate to the back of the capsule (within the center of our vision) and start growing. This causes the back of the capsule (called the posterior side) to become cloudy. The official medical term for this is posterior capsular opacification (or PCO for short). But this commonly gets referred to colloquialy as an "after-cataract."

Cloudiness of the capsule will cause the vision to become more blurry. It will also cause more scattering of light, especially at night time. It can cause night driving to become more difficult.

If after a few months or a few years out from cataract surgery, you notice your once perfect vision starting to decline, you may have developed this after-cataract opacification. It can cause a gradual decline in your vision and make it almost seem like the cataract has returned. But the cataract didn't grow back.

Posterior capsular opacifications are actually relatively common. Approximately 5-10% of everyone who goes through cataract surgery will end up getting this cloudiness of their capsule. There really isn't anything you can do to influence this. After the surgery is completed and the new artificial lens is in place it just a matter of seeing what happens. Over the years, however, improvements in cataract surgery and artificial lens design have helped improve and lower this rate.

Maybe in the future we can eliminate it, but at least right now there is a very easy way to get rid of this cloudiness and restore your vision.

After-cataracts have an easy treatment

The cloudiness on the capsule doesn't actually affect your new artificial lens, the lens itself remains very clear, just the capsule gets cloudy.

After the procedure, once the new artificial lens is in place, the back of the capsule becomes unnecessary. The capsule doesn't contribute to improving vision. The only thing the capsule does is hold the artificial lens in place; and the edges of the capsule are able to perform that role just fine. The cloudy posterior capsule just gets in the way.

Because this cloudy part to the capsule is unnecessary, the treatment for an after-cataract involves creating a small hole through this cloudy part. With nothing to obstruct vision in this hole, vision becomes completely restored.

The treatment to create this hole in the capsule (called a capsulotomy) is a really easy procedure to have done. It is performed in the office with a type of laser called YAG (leading to the full procedure name of YAG capsulotomy). This laser procedure is painless and really only takes about one minute to be performed. Prior to the procedure your eyes are dilated in order to allow a complete view of the artificial lens and capsule. The recovery is mostly just waiting for the dilation to go away (which typically takes about 4-6 hours) with no other restrictions like you had after cataract surgery.

Also see Exactly What To Expect With The Recovery After YAG Surgery

Once this hole is created to remove this cloudiness, you are done. This after-cataract can't grow back into your vision (the microscopic lens cells can only grow on the capsule, they can't grow on the artificial lens). There is no other way for that eye to get a "cataract" again.


Cataracts will not grow back after cataract surgery. During cataract surgery, the cataract is removed and replaced with an artificial lens. This cataract comes from our natural lens which only forms during development prior to birth. You CAN have cloudiness on the capsule which can sometimes be referred to as an "after-cataract". If this occurs, this can be easily treated with a YAG capsulotomy to restore your perfect post-cataract vision.

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