Over 36 years of doing cataract surgery, the most common question I’m asked is “Will my cataract grow back?” Well, the quick answer is no, but understanding that takes more than just a quick answer. Many people tell me about a friend or relative who had cataract surgery and was told sometime later that the cataract had come back, and the eye surgeon now wants to remove the returning cataract with a laser! How can that be, if cataracts don’t grow back?
Your cataract is a living structure in your eye – your natural lens. We call that lens a cataract when it becomes cloudy and no longer provides the quality of vision you need to see clearly. When it’s properly removed with cataract surgery, it’s gone, and doesn’t grow back. We replace the cataract with an artificial lens, the lens implant, to restore the focusing power of the natural lens to your eye. The cataract is held in your eye by a shell called the lens capsule. We remove the cataract from this shell and place the lens implant back into that shell.
Since the natural lens in your eye is made of living tissue, it has cells that grow inside the lens capsule. These cells have long fibers that stretch across the shell like the layers of an onion. So when your eye surgeon removes your cataract he dissolves these cells and fibers, then washes them out of your lens capsule. We often polish the inner surface of your lens capsule just to be certain that all of the fibers and cells have been cleaned off.
Now that lens capsule is very fragile and can be torn if too much polishing is done, or if the cells and fibers are too adherent to the capsule and your surgeon pulls to hard to free them from their attachment. Since that lens capsule is needed to hold your new lens implant in the proper position within your eye, we certainly don’t want to tear it during this process. So rather than risk tearing your lens capsule, it’s common to leave some of these cells or fibers when they cannot be safely removed.
Years ago, when the technology used to remove cataracts was much less precise than what we commonly use today, quite a lot of these cells and fibers were left behind with cataract surgery. In those days, your eye would have inflammation caused by these cells and fibers remaining after surgery, and you would need lots of medication to quiet this down. But eventually your eye would absorb the remaining cells and fibers leaving only some scar tissue behind.
So, we know, quite well, how your eye deals with these remaining cells and fibers, but with modern instruments and skills, it’s rare to have much left after cataract surgery.
Still, over time, even the rare cells remaining after surgery can grow and spread across your lens capsule to produce a scar tissue layer that gets in the way of your clear vision. We call this “capsule fibrosis”. It can develop anywhere from days to years after cataract surgery. But when this scar tissue layer blurs your vision, it seems to be causing the same problems that your cataract caused. That’s why people interpret this return of blurry vision and glare as, “My cataract is coming back!” That’s not what’s happening, but it seems like it could be.
When this capsule fibrosis blurs your vision, your eye surgeon can just erase the scar tissue with a YAG Laser. This takes just a few seconds and restores your clear line of vision almost immediately. That’s why you hear people say, “He removed the returning cataract with a laser!”
Consider how long it took you to read this explanation, and you can understand how some doctors would rather just tell you “Your cataract is coming back. This time we’ll just remove it with a laser!”