What are secondary cataracts?

It’s probably better we give up on the term “secondary cataracts” since it's inaccurate. Posterior capsular opacification doesn’t have the same ring to it

Joel Hunter, MD
Joel Hunter, MD
Refractive Surgeon, Hunter Vision Updated 11/21/19 10:43 AM

Secondary cataracts are a good example of a medical term that was made up to simplify things, but then accomplished exactly the opposite. The same thing happened with the idea of cataracts being “ripe.” There is no such thing as a secondary cataract happening after successful cataract surgery, just like there is no such thing as ripeness to a cataract.

The reason this matters is because the inevitable misunderstanding caused by these poor explanations will often cause people to worry about problems that don’t exist. It’s kind of the ophthalmologic equivalent of cooties, which were just an attempt to explain why the opposite sex is gross when you’re in kindergarten, but instead created panic over highly-contagious, non-existent disease.

When a cataract is removed, it isn’t a layer of cloudiness being removed. The lens in the eye itself is cloudy, and so the whole lens must be removed for the cloudiness to go away. This would cause a problem when it comes to seeing clearly afterward because lens in the eye has such a high prescription.

Most human lenses have a prescription of around +15 diopters to +20 diopters—now compare that to your strong reading glasses that are +2.50 diopters or so. The only way to have glasses strong enough to make up for the power of the missing lens is to make them as thick as shark aquarium glass.

More on these so-called “secondary cataracts”

Also known as “after-cataracts,” secondary cataracts’ medical term is posterior capsular opacification (PCO). If you’re trying to call it a confusing and incorrect name, it would be called secondary cataracts. Sometimes it takes a couple of months, sometimes a couple of years. Sometimes, it stays transparent for the rest of your life.

These occur when proteins grow at the back of the lens capsule that contains the intraocular lens or IOL. Take note that this type of cataract can be in the form of pearl, fibrous or a combination of both and may multiply around the capsule, move to other areas or differentiate from the lens epithelial cells.

The capsule is transparent, but it is also still natural human tissue. That means it is dynamic. It means it still can change over time. Because of that, it isn’t uncommon for the capsule holding this new, perfectly clear lens to lose a little bit of its transparency. 

Secondary cataracts may develop months or even years after cataract surgery. Truth be told, there’s no sure way to tell when the PCO will develop. But it’s the most common complication after a cataract surgery according to medical researchers, and there are no signs of a decrease in the total number of cases being recorded. In fact, the American Optometric Association (AOA) estimates that almost 50 percent of patients experience this post-operative condition.

A study made by researchers from the Oregon Health and Science University and McMaster University discovered that secondary cataract is more prevalent among children who have undergone early surgery. Among healthy adults, up to 12 percent incidence rate has been recorded by Austrian medical researchers.

Who are at risk of secondary cataracts?

Results of several medical studies found out that those who are prone to secondary cataracts include younger patients, diabetic patients, those with eye inflammation such as uveitis, and those with traumatic cataracts during their childhood.

You may or may not be surprised to find out that a 2002 medical study found out that among the risk factors for secondary cataracts, having your first cataract operation by a less experienced surgeon increases the chances of developing PCO.

Can secondary cataracts be prevented?

There are several ways to prevent the occurrence of secondary cataracts. Researchers from the University of Delaware discovered the lens cells left behind the cataract surgery were the primary causes of PCO occurrence. Researchers from India also recommend exhaustive cortical cleaning to reduce the risk. Japanese ophthalmologists, on the other hand, suggest better IOL design in the form of square edge to improve the surface quality of the IOL. The IOL quality certainly has an impact.

The IOL matters.

The power built into an intra-ocular lens is customized to have the exact right prescription to match what the eye needs. Now, not only is the cloudy lens gone, there is a new clear lens in its place with exactly the right focusing power to make glasses unnecessary altogether. And the perfect place is exactly where the old lens was.

The only way to get a new lens into the exact same spot that the old lens was is to put it inside the capsule that held the old lens. There is a very thin, transparent “skin” around the natural lens inside the eye that holds it in place. Successful cataract surgery is in large part the removal of the old cloudy lens without damaging the capsule that held it. Except for a small, circular opening made in the front of the capsule so that the old lens may be removed, the rest of the capsule must stay damage-free so it may hold the new artificial lens.

But when that capsule—the old transparent membrane that held both your old lens and now the new one—gets cloudy, you can imagine what the symptoms might be. Yes! They match the symptoms of a cataract almost line for line. The only difference is how you fix this problem. 

It involves a laser procedure (called a YAG laser capsulotomy) that takes about 30 seconds in clinic. It’s a laser you can’t see and can’t feel, and it fixes the problem instantly and permanently.

YAG laser capsulotomy for secondary cataracts

You may be wondering now how a YAG laser capsulotomy is going to be administered. Is it painful? Do I need to prepare something before the procedure? Am I going to be sedated? The first thing that I can advise you is that a YAG procedure is exceptionally anticlimactic. It’s going to be an easy ride.

You don’t need to prepare anything. Before coming into the room to have your capsulotomy performed, you can eat and drink as usual. Then once you’re settled, the doctor will numb your eyes with anaesthetic drops. After some time, you'll notice that a special lens will be placed on your eye so that the PCO can be seen clearly by the doctor. Then a laser beam will be applied to form a small opening in the capsule. The capsule has no nerves so there is zero pain.

Once the laser procedure opens the capsule, the cloudy membrane isn’t in the way of your vision anymore. The only surface the light entering your eye must pass through is the clear, artificial lens. That new intra-ocular lens can never get a cataract, so you don’t have to worry about it changing over time. And because it can never get a cataract, it’s probably better we give up on the term “secondary cataracts” since it is inaccurate and misleading. It’s an uphill battle though, because posterior capsular opacification—while very easy to cure—sure doesn’t have the same ring to it.

The procedure is painless (thanks to the eye drops!) and takes less than 5 minutes (depending on your doctor and his expertise).

If you would like to know more about cataract surgery, I suggest you check out the link below to receive all the information that you need:

Get Your Cataract Surgery Guide

Can I afford YAG Laser Capsulotomy?

Now that you’ve come to know about the possibility of finding a remedy for secondary cataracts, it all boils down to the question: Can I afford a YAG Laser Capsulotomy procedure?

For starters, cataract surgery costs may be covered by Medicare, particularly conventional IOL. Any cataract surgery is covered if traditional surgical techniques or laser is used. I say “may be covered” because cataract patients may differ in terms of their cataract case and preference where to get treatment that Medicare can reimburse. Some of the factors you need to consider include your other insurance plans, your eye doctor’s service fees, the type of facility where the procedure will be performed, and additional procedures that your doctor would recommend.

But since it is an outpatient procedure, Part B coverage rules generally apply. According to Medicare’s official site, the removal of recurring cataract in lens capsule using laser (code 66821) covers $204 for patients in ambulatory surgical centers and $394 in hospital outpatient departments. But these values don’t cover physician fees yet as well as other procedures and medicines that may be prescribed. Part D Prescription Drug Plan may be used to shoulder the medications and eye drops as needed.

Still, you may be facing other costs or worse, if you don’t have Medicare or private health insurance.

My advice is not to about the cost of treatment. Rather, it’s important to consider this first: will the benefits of YAG be something that I can find valuable in the long term? They usually are.


Get Your Cataract Surgery Guide


Author:Joel Hunter, MD is an Ophthalmologist, Refractive Surgeon, and the Founder of Hunter Vision, a LASIK Clinic in Orlando, Florida. A recognized and respected specialist in vision correction who has performed a countless number of refractive surgeries, Joel gives lectures across the country and trains fellow doctors in the newest LASIK surgery techniques.

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