Cataract Surgery after LASIK II: The Solutions

This is the second article in a series addressing cataract surgery after LASIK. The first article discussed how LASIK will affect the assessment of your eye and your postoperative experience. This article tells you what to do if you are planning cataract surgery after LASIK.

There are 5 issues that need to be understood and addressed:

1. indications for surgery are harder to predict

2. glare, halos and loss of contrast can persist after surgery

3. dry eye can affect your postoperative course

4, refractive stability takes longer to achieve

5. your final refractive outcome is less predictable.

Let’s look at each of these issues in more detail.

1. Indications for surgery are harder to predict.

Think carefully about the symptoms that brought you to your eye surgeon for cataract surgery. Are they new? Did you have glare, halos and loss of contrast several years ago, or did they just appear in the last months? The newer these symptoms are, the more likely it is that they are due to your cataract, and the better your prognosis for improvement. This may affect your decision to have surgery. You might be better off leaving things as they are.

2. Glare, halos, and loss of contrast can persist after cataract surgery.

This is related to the first issue. LASIK causes some side effects. Even if they are not that prominent, they will likely have at least a little bit of an effect on your vision after cataract surgery. Manage your expectations.

3. Dry eye can be more severe.

Work with your surgeon to create a plan for managing dry eye, even if you are not aware of dry eye as an issue. Begin at least a week before surgery and continue for at least a month after surgery. This can include eyelid scrubs, eyelid medications, eyedrops, and even pills. Realizing that dry eye can be made temporarily worse by cataract surgery allows you to plan ahead and intervene before it occurs.

4. Refractive stability takes longer to achieve after cataract surgery.

Close your ears when your best friend tells you how perfect her surgery went and how beautiful she saw just a day after surgery. This might happen to you. But it probably won’t. You might find your vision fluctuating from distance to intermediate then back out to distance again over days to weeks. What took your friend a week may take you several months. This may impact how soon you consider cataract surgery in the second eye. Make sure the first eye is where you want it before going on to the second eye.

5. The refractive outcome is less predictable.

This is called “refractive surprise”. Refractive surprise is more common after cataract surgery if you have had LASIK previously. Discuss with your surgeon up front what they do to minimize the chances of refractive surprise. Do they have advanced equipment for measuring the eye? Examples include: The new generation of eye measuring devices is a step up from what was available several years back, and this is particularly important for post-LASIK cataract surgery patients. Intraoperative assessment (ORA) has been shown to improve refractive outcomes. You would pay extra for ORA. Not all surgeons have ORA. You may need to look around your city, or even travel out of your area, to take advantage of this technology.

Find out how your surgeon plans to deal with refractive surprise. Solutions can include glasses and contacts, a touch up of your LASIK, or exchange of your intraocular lens. What is the surgeon’s threshold for recommending a surgical procedure to adjust the result? What will your financial obligations be?

Each of these five issues tends to be more severe if you were highly nearsighted before your LASIK. Go back in your records to find out what your refraction was before LASIK. If your prior prescription for glasses or contact lenses was less than -3.00 Diopters, the issues described above may be less likely to occur and less severe. If your pre LASIK refraction was greater than -6.00 Diopters, the likelihood of the issues above increases, as does their potential severity.

Advanced Technology: Presbyopia correcting lenses may not be appropriate. This is because some of the side effects of presbyopia correcting lenses are similar to the side effects of prior LASIK. This is discussed in more detail in several other blog posts. Toric lenses can still be considered.

In summary, prior LASIK can affect your decision for surgery, your refractive choices, and your postoperative experience.