Posterior capsule opacification (PCO, secondary cataract, after cataract) is a nagging postsurgical complication following extracapsular cataract surgery (ECCE) and intraocular lens (IOL) implantation. PCO should be eliminated since it has deleterious sequelae and Neodynium: Yttrium Aluminium Garnet (Nd: YAG) laser treatment often is an unnecessary financial burden on the health care system. PCO following cataract surgery could be a major problem, since patient follow-up is difficult and the Nd:YAG laser is not always available. Advances in surgical techniques, IOL designs/biomaterials have been instrumental in bringing about a gradual and unnoticed decrease in the incidence of PCO. We strongly believe that the overall incidence of PCO and hence the incidence of Nd:YAG laser posterior capsulotomy is now rapidly decreasing - from 50% in the 1980s and early 1990s to less than 10% currently. Superior tools, surgical procedures, skills and appropriate IOL designs have all helped to significantly reduce this complication. In this article, we review the aetio pathogenesis, experimental and clinical studies and propose surgical and implant-related factors for PCO prevention. Careful application and utilisation of these factors by surgeons could lead to a significant reduction is secondary cataract, the second most common cause of visual loss worldwide.