Posterior Subcapsular Cataract (PSC)
Posterior Subcapsular Cataract (PSC)
Central plaque-like opacity causing disproportionate glare and reading difficulty. This patient-education article is prepared by the cataract service at Suraj Eye Institute, Nagpur.
Posterior Subcapsular Cataract (PSC)
Posterior subcapsular cataract (PSC) is a plaque-like opacity lying just in front of the posterior capsule of the lens, directly in the visual axis. Even a small PSC produces symptoms out of proportion to its size. It is the third major pattern of cataract alongside nuclear and cortical, and at Suraj Eye Institute it is one of the most frequent presentations among working-age patients.
Why PSC Causes Severe Symptoms
The opacity sits at the back of the lens, exactly on the visual axis. When the pupil constricts — in bright sunlight, or during reading — the entire light path passes through the opacity, scattering light and dramatically degrading vision. In dim light, when the pupil dilates, vision may be surprisingly good. This contrast is characteristic of PSC.
Typical Symptoms
- Difficulty reading — even with updated glasses
- Severe glare — from sunlight, oncoming headlights and bright indoor lights
- Poor vision against a bright background — looking at a face against a window
- Fluctuating vision — worse in bright conditions, better in dim light
- Haloes around lights at night
- Normal colour appreciation (unlike nuclear cataract)
Who Is at Risk?
- Long-term steroid users — oral, inhaled (asthma, COPD), or even prolonged topical steroids
- Diabetics — PSC develops earlier and progresses faster
- Patients with uveitis
- Previous intraocular surgery (particularly vitrectomy)
- Retinitis pigmentosa and other retinal dystrophies
- Radiation exposure
- Younger patients with no apparent cause — idiopathic PSC
Diagnosis
PSC is diagnosed at the slit lamp after dilating the pupil. The opacity appears as a granular or vacuolated plaque just in front of the posterior capsule. Glare testing or vision measurement under bright conditions helps quantify the functional impact. Visual acuity under standard clinic conditions may underestimate real-world disability.
Treatment — When to Operate
Because symptoms outstrip the appearance of the opacity, PSC is often operated on earlier than other cataract patterns. We decide the timing together with you, based on how it affects your work, driving and reading. See our decision-making page.
Surgery is routine phacoemulsification. PSC can make the posterior capsule more fragile, so our surgeons use dedicated techniques — careful hydrodissection, lower phaco energy, and meticulous cortex removal — to minimise the risk of posterior capsule rupture. An appropriate IOL is implanted at the time of surgery, chosen in consultation with you.
PSC surgery needs specific expertise — capsule stability is less predictable, and pre-op planning with Anterion biometry and macular OCT is important. With 65+ years of combined consultant experience, we manage PSC cases routinely and safely.