Vision usually continues to decline, with more glare and difficulty in dim or dazzling light. In very advanced cases the lens can become dense and hard, which can make later surgery more complex.

For the technically minded: Progressive swelling or leakage of lens proteins may trigger phacomorphic angle closure or phacolytic inflammation with secondary ocular hypertension. Dense nuclei require higher phacoemulsification energy, increasing endothelial cell loss and corneal oedema risk.