When a Cataract Comes Back

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

  1. 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.

  2. 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

  3. 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?

  4. Dear Kenni,

    No fear or complications of fluid moving forward through the capsule…all fluid gets to the front of the to the anterior chamber and is drained.

    Do what you want!

    Randy
    Randall V. Wong, M.D.
    Retina Specialist
    Fairfax, VA 22030

    http://www.TotalRetina.com

  5. 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?

  6. Norma,

    Possibly due to Fuchs’, but the timing doesn’t jibe. I’d look for another cause, perhaps the epiretinal membrane?

    Randy
    Randall V. Wong, M.D.
    Retina Specialist
    Fairfax, VA 22030

    http://www.TotalRetina.com

  7. 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.

  8. Carol,

    I have no idea what may have happened, but sounds unusual. I would therefore think you’ll recover.

    Don’t be depressed….doesn’t help anything or anyone.

    Randy
    Randall V. Wong, M.D.
    Retina Specialist
    Fairfax, VA 22030

    http://www.TotalRetina.com

  9. 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.

  10. Maureen,

    Stick close to your doctor. Let him/her know your vision is worse.

    Randy

    Randall V. Wong, M.D.
    Retina Specialist
    Northern Virginia
    Fairfax, VA. 22030

    http://www.vitrectomyforfloaters.com

  11. Esther Mcknight says:

    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?

  12. 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

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