What to Know About Posterior Subcapsular Cataracts

A posterior subcapsular cataract develops on the back of the lens of your eye. It causes cloudy vision but is treatable with surgery.

Cataracts are cloudy areas that develop on the transparent lens of one or both of your eyes. A posterior subcapsular cataract develops on the back of your lens, where it borders the capsule that keeps it in place.

Posterior subcapsular cataracts often develop together with other types of cataracts. You may develop symptoms such as diminished visual acuity and seeing a halo when you look at bright lights.

Doctors can usually treat cataracts with surgery to replace your lens with an artificial lens. Most people have improved vision shortly after surgery but some people develop complications that might require a second surgery.

In this article, we examine posterior subcapsular cataracts in more detail, including their symptoms, risk factors, and treatment.

What are the symptoms of posterior subcapsular cataract?

Posterior subcapsular cataracts can cause similar symptoms as other types of cataracts , such as:

• cloudy vision
• blurry vision
• light sensitivity
• double vision
• glare in bright lights
• seeing halos around lights

People with posterior subcapsular cataracts most often complain of glare in bright lights and double vision in one eye. Visual impairment is often more noticeable in bright lights.

What causes posterior subcapsular cataracts?

Your lens is surrounded by a layer of tissue called the lens capsule that holds it in place. Posterior subcapsular cataracts develop on the backside of your lens in the part that borders your capsule.

Cataracts develop when crystallin proteins build up in your lens and cause the loss of transparency.

According to the American Academy of Ophthalmology , a posterior subcapsular cataract often occurs due to aging but also can also develop due to:

• eye trauma
• oral corticosteroids use
• exposure to ionizing radiation
• excessive alcohol consumption
• inflammation

Risk factors can include:

• glaucoma
• diabetes
• atopy , a specific type of allergy
• alcohol consumption
• nearsightedness
• obesity
• retinal dystrophies (degenerative disorders of your retina)
• sunlight exposure
• steroid use
• vitrectomy , removal of some of the gel inside of your eye

Posterior subcapsular cataracts make up about 10% of age-related cataracts. Over 40% of posterior subcapsular cataracts seem to occur together with other types of cataracts.

How do doctors diagnose posterior subcapsular cataracts?

An eye doctor may suspect you have a cataract based on your symptoms. They can make the diagnosis by performing a comprehensive eye exam . During this exam, you’ll receive eye drops to widen your pupils, and you may undergo tests such as:

• a slit lamp exam to look at the structures inside your eye
• retinal exam to assess the tissue at the back of your eyes
• pupil dilation to make it easier to see your lens
• visual acuity test, also called an eye chart exam
• tonometry to measure the pressure in your eye

Posterior subcapsular cataract grading

The World Health Organization (WHO) has developed a simplified grading system for posterior subcapsular cataracts based on the vertical size of the cataract:

Grade	Description
0	Cataract is less than 1 millimeter (mm) high
PSC-1	Cataract is equal to or greater than 1.0 mm high but less than 2.0 mm
PSC-2	Cataract is equal to or greater than 2.0 mm high but less than 3.0 mm
PSC-3	Cataract is greater than 3.0 mm
9	Cataract cannot be graded

Posterior subcapsular cataracts in grade 3 generally need surgical treatment. Your doctor may not recommend surgery for cataracts that aren’t affecting your vision or daily functioning.

What is the treatment for posterior subcapsular cataracts?

Surgery is the main treatment for posterior subcapsular cataracts. Surgery involves removing the lens and replacing it with a synthetic lens.

An eye surgeon may use a small incision or a laser to replace the lens. The recovery time for these procedures is about the same. It usually takes around 2 to 6 weeks to make a full recovery.

The most common complication of cataract surgery is posterior capsular opacification, also called a secondary cataract . It develops when the capsular that covers your lens clouds over.

People who develop a secondary cataract may need a second surgery to remove it.

What’s the outlook for people with posterior subcapsular cataracts?

Like other cataracts, posterior subcapsular cataracts can be debilitating without proper treatment. With surgery, most people can regain high quality vision. People who don’t receive surgery will likely continue to have progressive vision loss.

About 1 in 50 people develop serious complications from cataract surgery. These can include:

• blurry vision
• some loss of vision
• detached retina

Frequently asked questions

How serious is a posterior subcapsular cataract?

Posterior subcapsular cataracts can cause progressive vision loss that can affect your quality of life. Most people who receive surgery have improved vision soon after surgery.

How fast do posterior subcapsular cataracts progress?

The speed at which posterior subcapsular cataracts develop can vary depending on the cause. In a 2019 case study , researchers reported a case of dexamethasone injection causing a cataract that progressed to the mature stage in 3 weeks.

Which type of cataract is most difficult to remove?

Doctors can remove most cataracts by removing your entire lens. However, a Morgagnian cataract has a liquid center and can create some surgical challenges.

Takeaway

Posterior subcapsular cataracts develop on the back part of your lens. They can cause symptoms such as loss of visual acuity and blurry vision.

The main treatment for posterior subcapsular cataracts is surgery to remove the cloudy lens and replace it with an artificial one. Most people who receive surgery have rapidly improved vision. People who don’t receive surgery usually continue to have progressive vision loss.