If you develop a new blurred or cloudy spot in your vision after cataract surgery, it’s likely to be posterior capsule opacification (PCO). PCO is a relatively common complication of cataract surgery that occurs in up to 50% of patients within 2-5 years of surgery. It can easily be treated with a quick outpatient laser eye procedure.
What is posterior capsular opacification?
When you have PCO, it can look like the cataract has reoccurred. The condition is sometimes misleadingly called a secondary cataract, but you cannot develop another cataract once you have had surgery. During a cataract operation, our surgeon removes the cloudy lens from the capsule that contains your lens. They then replace it with an artificial lens called an intraocular lens (IOL). PCO happens when a film of tissue forms in the capsule behind the lens implant, which decreases the clarity of your vision.
We call it posterior capsule opacification (or posterior capsule opacity) because:
- It appears at the back of the lens capsule
- The capsule becomes thickened and opaque (less transparent)
- PCO can develop in both eyes – if you had cataract surgery in both – but it may affect each at a different time.
What are the symptoms of posterior capsular opacification?
In most PCO cases, a hazy membrane forms on the lens capsule, meaning light cannot pass through to the retina as easily. PCO causes symptoms that are like those of the original cataract, including:
- Hazy, cloudy or blurred vision
- Double vision
- Glare or ‘halo’ effect around lights
- Reduced ability to focus
How soon can PCO occur?
If you are wondering how quickly PCO can develop after cataract surgery, the simple answer is – it varies. PCO grows over time, which can be many weeks, months or even some years after your cataract surgery. If you have had a cataract operation recently and have problems with your vision, you should contact our eye specialist as soon as possible. Generally, the younger you are when you have cataract surgery, the greater the chances of developing PCO.
PCO Risk Factors
We see higher rates of PCO in our younger patients. You also may be more at risk of developing PCO if you have one of the following conditions. Conditions that increase your risk of PCO:
- Age <60 years
- Lens type
How do we diagnose PCO?
PCO can occur after cataract surgery or a lens replacement surgery, for example, refractive lens exchange (RLE). If you have had either of these surgeries and experience blurry vision, we recommend booking an appointment for PCO testing. During your initial consultation, we will ask about your symptoms so far and how strong they are. We will then perform a visual assessment and a slit lamp exam. A slit lamp examination involves the ophthalmologist looking into your eye with a lighted microscope. We can get different views of your eye using a range of filters. Before we perform the slit lamp exam, we may use dilating eye drops to widen your pupil. Once we have determined the type and severity of PCO, we can proceed with our treatment plan. The two PCO types are fibrous and pearl (proliferative). We treat both the same way.
What is the treatment for posterior capsule opacification?
PCO causes gradual vision impairment, like an actual cataract. When it begins to affect your daily activities, you may want to seek corrective treatment. You can have a procedure called YAG laser capsulotomy to restore your vision. It is a safe, painless outpatient procedure that takes just a few minutes.
We use a laser to open a small part of the affected lens capsule, allowing light to pass through again. If you have cloudy or blurry vision after cataract surgery, book an appointment to get tested for posterior capsule opacification.
Is PCO treatment effective?
Yes. YAG capsulotomy is a highly-effective procedure that results in immediate vision improvement. It has a success rate of over 95%.
Can PCO return?
It’s rare for PCO to return after a YAG laser capsulotomy. Most patients only need one laser treatment for PCO.
What does PCO look like?
Your vision with PCO will look a lot like your original cataract. It may be similar to looking out of a frosted window.
Does posterior capsule opacification get worse?
Without treatment, posterior capsular opacification worsens over time. We can grade the severity of PCO from 0-3. 0= absent, 1 = very mild, 2 = moderate, 3 = dense white.
Can posterior capsule opacification be avoided?
PCO can occur in up to 50% of patients within 5 years of surgery. However, certain factors have been linked to the delayed formation of PCO. These include the shape and material of the artificial lens implant, the surgical techniques used, and cleaning of the capsular bag.