Can Posterior Capsule Fibrosis Increase Myopia After Eye Surgery?

The symptoms of fibrous cell proliferation in the posterior capsule of the lens can lead to an increase in myopia?

Hello Dr.
Wang, I am 45 years old.
Twelve years ago, I underwent laser surgery for myopia.
Originally, I had 1000 degrees of myopia and 400 degrees of astigmatism in both eyes.
After the surgery, I maintained clear vision of 1.0 for ten years, with annual eye exams showing stable results.
However, in 2013, my myopia began to increase dramatically due to nuclear cataracts, which made it difficult for my prescribed glasses to keep up with the rapid progression of myopia.
My doctor submitted a request for surgery costs to be covered by health insurance, and I underwent aspheric multifocal intraocular lens implantation in both eyes in December 2014 and March 2015.
The out-of-pocket cost for each eye was approximately 60,000 TWD.

For six months post-surgery (from March 2015 to September 2015), measurements showed my left eye at 0 degrees and my right eye at 50 degrees.
I needed to wear blue light-blocking glasses for intermediate distances (computer use) to focus better, but both near (smartphone) and far distances were clear.
However, starting in December 2015, measurements indicated my left eye at 150 degrees and my right eye at 175 degrees.
The surgeon suggested monitoring the situation in April 2016, but I felt it was worsening, so I visited a nearby clinic for an examination.
The doctor informed me that this was "secondary cataract," which could be resolved using Nd:YAG laser to treat the membrane fibrosis, and it would not recur.
However, he mentioned that my myopia might have been intentionally left by the surgeon during the initial procedure (which I believe is not the case, as the aspheric multifocal lens is designed to achieve clear distance vision without glasses).
I did not accept the treatment on the spot, wanting to discuss it with my surgeon in April 2016.
Now I have two questions:
1.
Does the fibrotic cell proliferation in the posterior capsule cause an increase in myopia? My current sensation of unclear vision does not feel like blurriness or dimming of light; it resembles the myopia caused by the previous nuclear cataract.
2.
After treatment with Nd:YAG laser, can my myopia return to the post-surgery measurements of 0 degrees in the left eye and 50 degrees in the right eye?
Sincerely, Vincent, February 18, 2016.

Vincent, 40~49 year old female. Ask Date: 2016/02/18

Dr. Wang Zhishun reply Ophthalmology

Hello, 1.
Fibrocellular proliferation occurs in the posterior capsule of the lens (secondary cataract), which may lead to an increase in myopia.
2.
The refractive error after Nd-YAG laser treatment may vary, but vision should improve.

Reply Date: 2016/02/18

More Info

Hello Vincent,
Thank you for your detailed inquiry regarding your eye health and the potential effects of posterior capsule fibrosis (PCF) on myopia after your eye surgeries. I understand that you have experienced significant changes in your vision over the years, and I will address your questions based on the information provided.

1. Can Posterior Capsule Fibrosis Increase Myopia?
Posterior capsule fibrosis, also known as secondary cataract, occurs when the thin membrane (posterior capsule) that holds the intraocular lens (IOL) becomes cloudy due to the proliferation of fibrous cells. This condition can indeed affect your vision and may lead to an increase in myopia. When the capsule becomes opaque, it can interfere with light entering the eye, causing visual disturbances such as blurriness or halos around lights. While PCF itself does not directly cause an increase in myopia, the visual symptoms it produces can mimic or exacerbate myopic conditions. In your case, the sensation of unclear vision you are experiencing may be related to the fibrosis rather than a true increase in myopia.
It is important to differentiate between the symptoms caused by PCF and those stemming from other underlying issues, such as the progression of myopia or other ocular conditions. The rapid increase in your myopia after the initial surgeries could also be influenced by factors such as the development of cataracts or changes in the eye's structure over time.

2. Will Nd-YAG Laser Treatment Restore Myopia to Previous Levels?
The Nd-YAG laser is commonly used to treat posterior capsule opacification by creating an opening in the cloudy capsule, thereby restoring clearer vision. While this treatment can significantly improve visual clarity, it may not necessarily reverse any myopic changes that have occurred due to other factors. After the Nd-YAG laser procedure, many patients experience improved vision, but the degree to which your myopia may return to the previous measurements (0 degrees in the left eye and 50 degrees in the right eye) is uncertain.
The outcome of the Nd-YAG laser treatment largely depends on the extent of the fibrosis and any other underlying conditions affecting your eyes. It is crucial to have a thorough discussion with your ophthalmologist about your specific case, as they can provide insights based on your eye health history and current condition.

In summary, while posterior capsule fibrosis can contribute to visual disturbances that may feel like an increase in myopia, it is essential to evaluate all potential factors affecting your vision. The Nd-YAG laser treatment can improve clarity and potentially alleviate some of the symptoms, but it may not fully restore your previous refractive status. Regular follow-ups with your eye care provider will be vital in managing your condition and ensuring the best possible outcomes for your vision.

If you have any further questions or concerns, please feel free to reach out. Your eye health is important, and understanding the implications of your treatments is crucial for making informed decisions moving forward.

Best regards.

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