Cataract surgery has been highly successful in restoring clear vision in the elderly, but is not without risks. Success depends on good surgical technique, the type of intraocular lens used, other co-morbid eye diseases, and the underlying health of the patient. A high percentage of post-cataract patients develop opacification (cloudiness) of the posterior capsule, in the short-term or long-term; in which case an ophthalmologist may recommend YAG laser to remove part of the posterior capsule behind the manufactured lens. Why opacification occurs is debated, and may occur for different reasons, including the surgery and the manufactured lens in the short-term, and inflammation from chronic infection in the long-term.
Cataract surgery opens the front of the posterior capsule, and YAG laser opens the back of the posterior capsule; thus, the capsule no longer completely separates the front and back of the eye. The degree of risk from a YAG laser surgery is debated among ophthalmologists and thought to be low; however, it is established YAG laser may damage the intraocular lens, makes removal and replacement of the lens difficult, increases the risk of retinal detachment, and may complicate treatment for other eye diseases like glaucoma.
“Clear lens extraction”, which is cataract surgery for refractive purposes, should not be done. No matter the success of cataract surgery in the elderly, performing unnecessary cataract surgery on young patients creates a significant risk of starting a cascade of adverse events, over many decades of life.
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