Reviewed By: Paul M. Griffey M.D.
Cataracts typically develop over the course of several years, and this is part of the normal aging of the eye. According to the National Eye Institute, at around age 40, the proteins in the eye start to break down and stick together. This causes cloudiness of the eye’s natural lens. People with cataracts often describe their visual changes as blurry and hazy. Cataracts can make it challenging to read, see vivid colors, or drive a car, especially at night. Because most cataracts develop slowly, they don’t initially interfere with one’s eyesight but over time, cataracts will cause vision to become blurry.
Can cataract surgery be redone? The original cataract removal is not normally repeated on the same eye because the cloudy natural lens has already been permanently removed. However, that does not mean patients have no treatment options if their vision becomes blurry again. Depending on the cause, an ophthalmologist may recommend a YAG laser procedure, an updated glasses prescription, treatment for another eye condition, or, in uncommon cases, repositioning or replacing the artificial lens.
During cataract surgery, the cloudy natural lens is removed and replaced with an artificial intraocular lens, or IOL. Cataract surgery is one of the most commonly performed procedures across all medical specialties, with an estimated 3.7 million procedures performed annually in the United States, 7 million in Europe, and 20 million worldwide.
Table of Contents
Can Cataract Surgery Be Done Twice on the Same Eye?
Cataract surgery is generally performed only once on the same eye because the natural lens is removed during the first operation. Without the natural lens, a true cataract cannot develop in that eye again.
A patient may still need another type of procedure later. For example, YAG laser capsulotomy can treat clouding behind the IOL, while an IOL may occasionally need to be repositioned or replaced. Although patients sometimes refer to these treatments as a second cataract surgery, they do not repeat the original cataract-removal procedure.
How Many Times Can You Have Cataract Surgery?
The original cataract-removal procedure is normally performed once per eye. Someone with cataracts in both eyes may have surgery on each eye, usually at separate appointments, but each natural lens is removed only once.
Other procedures may be performed on the same eye when medically necessary, including:
- YAG laser treatment for PCO
- IOL repositioning or exchange
- Treatment for a retinal, corneal, or glaucoma-related condition
- Glasses, contact lenses, or another treatment for residual refractive error
The appropriate option depends on what is causing the patient’s symptoms.
What is Posterior Capsule Opacification?
Posterior capsule opacification, or PCO, is clouding of the thin membrane that supports the artificial lens after cataract surgery.
During surgery, the ophthalmologist removes the cloudy contents of the natural lens but usually leaves the clear lens capsule in place to support the IOL. Over time, remaining lens cells may grow across the back of that capsule, scattering light and making vision look cloudy.
PCO may cause:
- Blurry or hazy vision
- Increased glare
- Halos around lights
- Reduced contrast
- Difficulty reading
- Trouble seeing clearly at night
PCO is sometimes called a secondary cataract, but it is not a new cataract. The artificial lens generally remains clear; the cloudiness develops in the capsule behind it.
Can a Secondary Cataract Be Treated?
Yes. A secondary cataract, or PCO, is usually treated with a procedure called YAG laser capsulotomy.
During the procedure, the ophthalmologist uses a laser to create a small opening in the cloudy capsule. The opening allows light to pass through the eye more clearly again.
YAG laser capsulotomy:
- Does not remove or replace the IOL
- Does not require a surgical incision
- Is typically performed in an outpatient setting
- Usually takes only a few minutes
- Often allows patients to resume normal activities quickly
The procedure has a strong safety record, but no treatment is completely risk-free. Possible complications include a temporary rise in eye pressure, inflammation, retinal swelling, retinal tear or detachment, and damage to the IOL. Serious complications are uncommon, and an ophthalmologist will assess the eye before recommending treatment.
How Long After Cataract Surgery Can PCO Develop?
PCO can develop weeks, months, or years after cataract surgery, although it frequently becomes noticeable within two to five years.
A systematic review reported posterior capsule opacification rates of approximately 11.8% at one year, 20.7% at three years, and 28.4% at five years after cataract surgery. Reported rates vary depending on patient characteristics, surgical techniques, follow-up periods, and intraocular lens design and material.
Therefore, blurred vision two years or even five years after cataract surgery could be caused by PCO. However, other eye conditions can produce similar symptoms, so a comprehensive examination is important.
Can an IOL Be Replaced?
Yes, an intraocular lens can be replaced, but an IOL exchange is uncommon and is generally recommended only when there is a clear medical or visual reason.
Most IOLs remain stable and clear for the rest of the patient’s life. An exchange may be considered if the implant moves out of position, becomes cloudy, has an unsuitable power, or causes visual symptoms that do not improve with less invasive care.
Can a Cataract Lens Be Replaced More Than Once?
A cataract lens can technically be replaced more than once, but multiple IOL exchanges are unusual.
Each additional procedure may be more complex because scar tissue can develop around the implant, and the capsule or other structures supporting the IOL may become less flexible. An ophthalmologist will carefully compare the likely benefit with the potential surgical risks before recommending another exchange.
How Long Do Cataract Lenses Last?
Cataract lenses are designed to remain in the eye permanently and usually last for the rest of the patient’s life.
An IOL does not have an expiration date and does not need routine replacement. It also cannot develop a true cataract because it is made from a clear synthetic material rather than the eye’s natural lens.
However, vision can still change years after surgery because of:
- PCO
- Changes in the cornea
- Retinal conditions
- Glaucoma
- Diabetes-related eye disease
- A change in refractive error
- Movement or deterioration of the structures supporting the IOL
The artificial lens may remain clear even when another part of the eye causes blurry vision.
Can an Intraocular Lens Be Removed and Replaced?
Most intraocular lenses can be removed and replaced when an ophthalmologist determines that an exchange is medically appropriate.
Common reasons for considering removal include:
- IOL dislocation or significant movement
- An incorrect or unsuitable lens power
- Clouding or damage to the implant
- Persistent glare, halos, or other visual disturbances related to the lens
- A problem with the tissues supporting the implant
IOL exchange is rare. Research examining exchanges after cataract surgery has found that lens dislocation is among the most frequent reasons for the procedure.
What is an IOL Exchange?
An IOL exchange is a surgical procedure in which the existing artificial lens is removed and another lens is implanted.
It is not the same as repeating cataract surgery because the natural lens has already been removed. The procedure focuses only on the artificial implant and the surrounding structures. An IOL exchange can be more technically complex than the original surgery, particularly when significant scar tissue has developed or a previous YAG capsulotomy has opened the posterior capsule. For that reason, the decision should be based on a detailed evaluation of the patient’s symptoms, eye health, and likely benefit.
Can the YAG Laser Procedure Be Done More Than Once?
Yes, YAG laser capsulotomy can be performed more than once, but most patients need only one treatment.
The opening created by the laser usually remains clear. A second procedure may occasionally be needed when:
- The original opening was too small
- Part of the cloudy capsule still obstructs vision
- New cells grow near or across the opening
- The visual axis becomes cloudy again
Recurrent clouding after YAG treatment is rare in adults, although published reports confirm that repeat laser treatment can restore vision when re-opacification occurs. Before repeating the procedure, the ophthalmologist must confirm that the capsule is responsible for the patient’s symptoms. Performing unnecessary additional laser treatment may expose the eye to risks without improving vision.
What If Cataract Surgery Fails or Does Not Improve Vision?
A less-than-expected visual result does not always mean cataract surgery has failed. Blurriness may result from normal healing, an uncorrected prescription, PCO, or another eye condition that cataract removal cannot correct.
Cataract surgery has a high success rate. The National Eye Institute reports that approximately nine out of 10 patients see better after surgery, while a JAMA patient-education review reported a success rate of about 98%. Exact success rates vary because studies may define success differently and because pre-existing eye disease can limit the final result.
Can Cataract Surgery Fail?
Cataract surgery can occasionally produce complications or a visual result that does not meet the patient’s expectations, but serious problems are uncommon.
Possible reasons vision may remain blurry include:
- Residual nearsightedness, farsightedness, or astigmatism
- Corneal swelling or dry eye
- PCO
- Retinal swelling
- Macular degeneration
- Diabetic retinopathy
- Glaucoma-related damage
- IOL movement or an unsuitable lens power
- Infection or retinal detachment
Some of these concerns are temporary or treatable. Others may be related to a condition that existed before surgery and limited the eye’s ability to see clearly.
If Cataract Surgery Fails, Can It Be Redone?
The cataract removal itself is not normally redone, but the condition responsible for the poor visual result may be treatable.
Depending on the diagnosis, treatment may involve:
- Prescription glasses or contact lenses
- Anti-inflammatory or pressure-lowering medication
- YAG laser capsulotomy
- Treatment for a retinal or corneal condition
- IOL repositioning
- IOL exchange
An ophthalmologist must first determine why vision did not improve before recommending another intervention.
Can Cataracts Come Back After Surgery?
No. A true cataract cannot come back after the eye’s natural lens has been removed.
A cataract develops only in the natural lens. Once that lens has been replaced by an IOL, it cannot grow back or form a second cataract. PCO can make vision cloudy again, which is why it is often mistakenly called an after-cataract or secondary cataract. However, the cloudiness is located in the capsule behind the implant, not inside the artificial lens.
Read more about whether cataracts can come back after surgery.
Risk Factors and How to Slow Cataract Progression
Cataracts cannot always be prevented, but protecting the eyes and managing overall health may help reduce certain risk factors or slow their progression.
Age and family history cannot be changed. However, the National Eye Institute recommends addressing modifiable factors associated with cataract development.
Steps that may support long-term eye health include:
- Avoid smoking. Smoking is associated with an increased risk of cataract development and other eye conditions.
- Manage diabetes. Consistently elevated blood sugar can increase the risk of developing cataracts at an earlier age.
- Control blood pressure. Following a healthcare professional’s treatment recommendations supports both general and eye health.
- Maintain a healthy weight. A balanced diet and regular physical activity can help manage conditions associated with cataract risk.
- Protect the eyes from ultraviolet light. Wear sunglasses that block UVA and UVB rays and consider a wide-brimmed hat when outdoors.
- Schedule routine eye examinations. Regular examinations can identify cataracts and other eye conditions before they significantly interfere with daily activities.
These measures cannot reverse an existing cataract. Surgery remains the only way to remove a cataract once it begins significantly affecting vision.
Why Do Some People Experience Blurry Vision Again After Surgery?
Blurry vision after cataract surgery can occur for several reasons and does not necessarily mean the cataract has returned. Mild blurriness during early recovery may be related to inflammation, corneal swelling, dry eye, or the eye adjusting to its new lens.
When vision becomes hazy months or years later, possible causes include:
- Posterior capsule opacification
- A change in glasses prescription
- Retinal swelling
- Age-related macular degeneration
- Diabetic eye disease
- Glaucoma
- Corneal conditions
- Movement or clouding of the IOL
Learn more about whether blurry vision after cataract surgery is normal.
What to Do If Your Vision Is Still Blurry After Surgery
If your vision hasn’t improved or has worsened after cataract surgery, don’t assume you need another operation. Talk to your ophthalmologist. It could be a simple case of PCO, easily treated with a laser, or another eye condition that needs addressing.
Seek prompt medical care for symptoms such as:
- Sudden or significant vision loss
- Increasing eye pain
- Increasing redness
- New flashes of light
- A sudden increase in floaters
- A curtain or shadow across the field of vision
- Nausea or vomiting accompanied by eye pain
Cataract surgery is a common, safe, and effective procedure that millions of Americans undergo each year. As with all surgery, complications can occur, but they are rare.
Contact your doctor for an appointment if you have concerns about your recent cataract surgery, or would like a consultation for surgery. For more information on cataract surgery or to make an appointment with Griffey Eye Care, call 757-776-0416.
FAQs
Is Cataract Surgery a Permanent Fix?
Cataract removal is permanent because the cloudy natural lens does not grow back. However, surgery cannot prevent every future eye condition or guarantee that glasses will never be needed.
Do Premium (Multifocal/Toric) IOLs Have Higher Exchange Rates?
Premium IOLs can sometimes require additional treatment, but complete lens exchange is uncommon. Multifocal IOLs may be replaced if glare, halos, blurred vision, or difficulty adjusting to the lens continues. One large study reported an exchange rate of only 0.63%.
Toric IOLs are usually repositioned rather than replaced if they rotate out of alignment.
Can Your Vision Change Years After Cataract Surgery?
Yes. Vision can change years after cataract surgery even when the artificial lens remains clear and properly positioned. Possible causes include PCO, refractive changes, glaucoma, macular degeneration, diabetic eye disease, or corneal conditions.
Does Everyone Need YAG Laser Treatment After Cataract Surgery?
No. YAG laser treatment is only needed when posterior capsule opacification develops and begins affecting vision. Many patients never experience significant capsule clouding after cataract surgery.
