Secondary Cataracts: Causes, Symptoms, and Treatment

Secondary cataracts are one of the most common side effects from cataract surgery. Light halos and blurry vision are two symptoms, and treatment comes in the form of laser surgery. Using intraocular lenses (IOLs) during the initial cataract surgery can help prevent secondary cataracts.

What Are Secondary Cataracts?

Secondary cataracts occur in up to half of patients who already had their primary cataracts surgically removed. While secondary cataracts do not always develop, the chances of them occurring can range from 3 to 50 percent.

Also called posterior capsular opacification, or PCO, secondary cataracts are one of the most common complications after someone has cataract surgery. With more than half of Americans over the age of 80 experiencing some degree of cataract disease, the number of surgical procedures has dramatically increased. 

One study of 718 people who had cataract surgery showed an incidence rate of secondary cataracts of 10.65 percent, with a mean age of just over 52 years old. The average time between initial cataract surgery and the onset of secondary cataracts was just over two months.

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Symptoms

It can take months or years after the initial procedure for secondary cataracts to develop. There are many signs that secondary cataracts may be starting to develop. They include:

• Halos surrounding lights
• Light glares
• Blurry, foggy or hazy vision
• Difficulty focusing on objects (both far away and nearby)
• Inability to perceive contrasts and colors

As soon as you begin to experience any of these symptoms, notify your eye doctor as soon as possible. Most eye doctors will schedule your first few appointments after an eye procedure approximately six months apart so they can easily notice any of these changes.

Causes

During a cataract procedure, your eye doctor removes the cloudy or hazy lens of your eye and replaces it with an artificial one. A secondary cataract will occur if epithelial cells from the previous lens are still in place.

As time passes, these cells will begin to accumulate, causing the artificial lens to cloud over as well. Just like with the first cataract, your vision will be obstructed and begin to deteriorate. This can sometimes begin to occur within a month or so after the procedure.

For others, the process may take years to affect their vision. Secondary cataracts are extremely common in people who are over 60 and have already had at least one eye surgery.

Treatment

A YAG laser capsulotomy is the only current way to eliminate secondary cataracts. This is an outpatient procedure that takes less than 30 minutes to complete

The laser makes an opening in the clouded lens so light can make its way through to reach the retina. Your eye doctor will use precision accuracy to make a small hole to clear away the secondary cataract. Once the opening is in place, your vision will clear, and the cataract will gradually disappear.

Advances in intraocular lens (IOL) design help with secondary cataract treatment. The development of square-edge IOLs (and other new designs) help prevent the complication, but they have not proved to eliminate it.

Modification of IOL surfaces appears to be a key that is both easy and effective — and one that carries little to no safety risk.

Risk Factors

As with all surgeries, any procedure with the YAG laser also comes with associated risk. Complications include inflammation or increased pressure in the eye itself, which could lead to glaucoma. In some cases, the laser may also cause the retina to detach.

The overall risk of these complications is rare, but they can occur. They are more common for people already diagnosed with glaucoma or uveitis (a form of eye inflammation).

If you have concerns, research the procedure and schedule an appointment with your eye doctor to get all of your questions answered.

The Procedure

During a secondary cataract procedure, your eye doctor places eye drops in your eyes to numb them and prepare them for the laser. Doctors place a special lens on your eye to allow for extreme precision from the laser.

Once your eyes dilate, the lazer will create an opening in the posterior capsule. This will break up the secondary cataract, allowing for improved vision. After the procedure, your doctors will check the pressure within your eye to ensure it is within normal range.

Recovery

During the first few hours after the procedure, you may notice a little blurred vision as effects from eye drops wear off. You may have eye floaters (small bits of debris). If so, notify your ophthalmologist immediately to determine if there are any potential problems that need to be dealt with.

Risks

Every surgery has risks, even when doctors use precise lasers. Talk to your eye doctor about the risk of potential infection or if there are any risks that you may be more prone to. Infection, sensitivity to light, and other potential vision problems are all possible.

Risks are low for many people, but secondary cataracts are more common for people who have already undergone one eye surgery. Discuss your options with your doctor and follow their advice. Your eyesight and a final decision about how to care for it will always be up to you.

Prevention

Taking proper care of your eyes may reduce some degree of risk, but it may not prevent cataracts or secondary cataracts. Secondary cataracts will appear only if the first cataracts were removed or if a doctor performs another eye surgery. Regular visits to the eye doctor will help keep most forms of eye disease under control.

Talk to your eye doctor if you begin to experience any type of vision deterioration. An ophthalmologist can identify the problem and give treatment options to keep your vision as close to 20/20 as possible. Notify your doctors of any changes in your vision so they know what treatments are available.

FAQs

How common is a secondary cataract?

Secondary cataracts are extremely common. Most people who undergo any type of eye surgery have up to a 50 percent chance of having secondary cataracts.

How do they fix secondary cataracts?

An outpatient procedure is performed using a YAG laser to make a small hole in the posterior capsule and clear away the cloudiness.

Do secondary cataracts get worse over time?

Secondary cataracts will get worse over time if they are not treated. Once a secondary cataract is removed, however, it is unlikely that it will come back.

References

1. Secondary Cataracts. (June 2021). Cincinnati Eye Institute.

2. Are You at Risk for a Secondary Cataract? (November 2019). Harvard Health Publishing.

3. Types of Cataract. (August 2019). National Eye Institute.

4. Secondary cataract: an epidemiologic and clinical survey at the Yaounde Gynaeco-obstetric and Pediatric Hospital. (June 2011). Clinical Ophthalmology.

5. Preventing secondary cataract and anterior capsule contraction by modification of intraocular lenses. (March 2008). Expert Review of Medical Devices.

6. What Are Secondary Contacts? University of Central Florida Health.