Cataract surgery is possible after LASIK. Many individuals who had LASIK in their younger years are now reaching the age when cataracts commonly develop. Cataract surgery addresses the eye’s natural lens, which becomes cloudy, while LASIK reshapes the cornea, the eye’s outer clear window. While successful outcomes are common, a history of LASIK introduces specific considerations.
Why Previous LASIK Matters
Previous LASIK significantly impacts cataract surgery due to lasting corneal changes. LASIK reshapes the cornea to correct refractive errors, altering how light enters the eye. This permanent alteration of the cornea’s shape and thickness makes cataract surgery planning different.
The main challenge arises in accurately calculating the power of the intraocular lens (IOL) that replaces the cloudy natural lens during cataract surgery. Standard IOL calculation formulas are designed for eyes without prior corneal surgery and assume a consistent ratio between the anterior and posterior corneal surfaces. However, LASIK disrupts this ratio, making traditional measurements and formulas less reliable. If these calculations are inaccurate, there is a higher chance of a “refractive surprise,” meaning the vision outcome might not match the intended goal, potentially requiring glasses after surgery.
Adjustments for Cataract Surgery
Surgeons employ specialized methods and technologies for accurate IOL power calculation to address complexities from prior LASIK. Advanced IOL formulas, such as Barrett True-K, Haigis-L, and Shammas-PL, have been developed specifically for post-refractive surgery eyes. Many surgeons also utilize online calculators, like the American Society of Cataract and Refractive Surgery (ASCRS) post-refractive IOL calculator, which can average results from multiple formulas.
Beyond formulas, advanced diagnostic tools provide detailed information about the cornea. Devices like corneal topography and tomography precisely map the corneal curvature, identifying subtle changes and irregular astigmatism caused by LASIK. Optical biometry, which measures axial length and other eye dimensions, is also refined to improve accuracy. Intraoperative aberrometry, such as the ORA system, provides real-time refractive measurements during surgery after the cataract is removed but before the IOL is implanted. This allows the surgeon to fine-tune the IOL selection or placement based on the eye’s actual state during the procedure, which can be particularly useful in eyes with previous refractive surgery.
Vision Outcomes and Expectations
Patients with a history of LASIK can expect excellent vision after cataract surgery, though realistic expectations are important. While surgical outcomes for post-LASIK patients have significantly improved, there might be a greater likelihood of needing glasses or contact lenses for some activities compared to individuals who have not had prior refractive surgery. Cataract surgery after LASIK has a high success rate. However, achieving vision within ±0.5 diopters of the target refraction may occur in a slightly lower percentage of post-LASIK eyes compared to unoperated eyes.
Residual refractive error, such as a slight need for glasses for distance or reading, can occur. This can be managed with corrective eyewear, or in some cases, enhancement procedures. Options for managing residual error include additional LASIK or photorefractive keratectomy (PRK) touch-ups, which are considered accurate methods for correction. In rare instances, if there is a significant discrepancy, an IOL exchange or a “piggyback” IOL (an additional lens placed on top of the implanted IOL) might be considered.
Preparing for Your Surgery
Thorough preparation is important for individuals with a history of LASIK considering cataract surgery. Discuss your complete eye history, including prior LASIK, with your cataract surgeon. Providing any available pre-LASIK and post-LASIK eye records is highly beneficial for accurate IOL calculations. These records may include old prescriptions, corneal topography maps, or operative reports from your LASIK procedure.
Choosing a surgeon experienced in performing cataract surgery on post-LASIK eyes is a significant step. Such surgeons are familiar with the unique challenges of IOL calculation and employ the advanced techniques and diagnostic tools necessary for optimal outcomes.