If you had LASIK 10, 20, or even 25 years ago and are now developing cataracts, you may be wondering whether your previous vision correction surgery changes what happens next. Fortunately, having LASIK does not prevent you from having cataract surgery, although it does make certain parts of the surgical planning more complex.
LASIK permanently changes the shape of the cornea to correct your vision. Years later, those changes need to be taken into consideration when your cataract surgeon calculates the power of the intraocular lens (IOL) that will replace your cloudy natural lens. Modern diagnostic technology and specialized IOL formulas have made cataract surgery after LASIK much more predictable, but careful measurements and individualized lens selection remain particularly important.
For patients who originally chose LASIK because they wanted greater freedom from glasses and contact lenses, the lens selected during cataract surgery can also play an important role in maintaining that independence.
Why Is Cataract Surgery Different After LASIK?
LASIK corrects nearsightedness, farsightedness, and astigmatism by reshaping the cornea, while cataract surgery removes the cloudy natural lens inside the eye and replaces it with an artificial intraocular lens. Because the two procedures involve different structures of the eye, previous LASIK does not prevent a patient from undergoing cataract surgery.
The primary difference is in the planning. Since LASIK changes the curvature of the cornea, the measurements traditionally used to calculate IOL power can be more difficult to interpret in an eye that has undergone refractive surgery. Cataract surgeons therefore use specialized measurements and formulas designed for patients with previous LASIK or PRK.
Does Previous LASIK Make Cataract Surgery Less Accurate?
Modern diagnostic technology and specialized post-refractive IOL formulas have significantly improved cataract surgery planning for patients who have undergone LASIK or PRK. Even with these advances, however, predicting the exact postoperative prescription can still be less precise than it is in an eye with an untreated cornea.
This does not mean that patients who have had LASIK cannot achieve excellent vision after cataract surgery. It simply makes careful preoperative measurements, appropriate lens selection, and realistic expectations especially important. Depending on the individual eye, additional technologies may also be used to give the surgeon more information when planning the desired refractive outcome.
Do I Need My Old LASIK Records?
If you still have records from your original LASIK or PRK procedure, it is helpful to bring them to your cataract consultation because previous measurements may provide additional information for surgical planning. However, patients who had LASIK many years ago often no longer have access to those records, and that does not mean cataract surgery cannot be accurately planned.
Modern diagnostic technology and specialized post-refractive IOL formulas allow cataract surgeons to calculate lens power in many patients without their original LASIK records. The most important thing is to make sure your surgeon knows about any previous LASIK, PRK, or other refractive surgery.
What Is the Best Cataract Lens After LASIK?
There is no single cataract lens that is best for every patient who has previously had LASIK. The appropriate lens depends on several factors, including the shape and optical quality of the cornea, your prescription, astigmatism, retinal health, overall eye health, and what you would like your vision to accomplish after surgery.
Some patients prioritize crisp distance vision and are comfortable using reading glasses, while others want to reduce their dependence on glasses across a broader range of distances. A patient who spends much of the day working on a computer may have different visual priorities from someone who frequently drives at night or spends significant time reading.
Depending on your eyes and visual goals, options may include monofocal, toric, multifocal, or extended-depth-of-focus lenses, as well as the Light Adjustable Lens™. Not every patient who has had LASIK is an appropriate candidate for every premium lens technology, which is why a detailed examination of the cornea, retina, and overall health of the eye is necessary before making a recommendation.
Why Is the Light Adjustable Lens an Option After LASIK?
Traditional intraocular lenses require the surgeon to select the lens power before cataract surgery. The Light Adjustable Lens™ (LAL) is different because its optical power can be adjusted after surgery, once the eye has healed and the patient’s actual postoperative vision can be evaluated.
The LAL is made from a photosensitive material that responds to specialized light treatments. After surgery, these treatments can be used to refine the prescription before the final lens power is permanently locked in. This ability to make adjustments after surgery can be particularly useful in eyes that have previously undergone LASIK or PRK, where predicting the final refractive result may be more challenging.
Clinical research involving cataract patients with previous LASIK or PRK has reported strong visual and refractive outcomes with the Light Adjustable Lens. It is not automatically the right choice for every patient with previous refractive surgery, however, and factors such as eye health, corneal quality, lifestyle, and visual goals still need to be considered.
How Can ORA Help During Cataract Surgery After LASIK?
Another technology that may be useful when planning cataract surgery after LASIK or PRK is intraoperative aberrometry, including the ORA System. While most cataract measurements are performed before surgery, ORA provides additional information during the procedure after the cataract has been removed.
Your surgeon can consider this intraoperative measurement alongside the calculations performed before surgery when selecting IOL power and managing astigmatism. Research evaluating ORA in eyes with previous LASIK or PRK has shown encouraging results, although no single measurement method is perfect for every eye. ORA is best understood as another source of information available to the surgeon when developing an individualized surgical plan.
At Peninsula Laser Eye Medical Group, ORA can be incorporated into cataract surgery planning when additional intraoperative refractive information may be valuable.
Can I Still Reduce My Dependence on Glasses After Cataract Surgery?
Many people who chose LASIK years ago did so because they valued being less dependent on glasses and contact lenses, so it is understandable that they want to preserve as much of that freedom as possible when it is time for cataract surgery. Modern lens technology provides considerably more options than traditional cataract surgery once did, and some patients who have previously undergone LASIK may still be candidates for lens technologies designed to reduce their dependence on glasses.
Depending on your eyes and the lens selected, cataract surgery may be planned for clear distance vision, distance and intermediate vision, or a broader range that includes near vision. Astigmatism may also be addressed, and some patients may be candidates for monovision, where one eye is targeted more toward distance and the other toward near.
No lens can guarantee complete freedom from glasses, and each lens technology has its own advantages and trade-offs. The goal is to select an approach that makes sense for your eyes, your daily activities, and what you expect from your vision after surgery.
What If I Had PRK Instead of LASIK?
The same general considerations apply to patients who previously underwent PRK. Both LASIK and PRK reshape the cornea to correct refractive error, so those changes need to be considered when calculating the power of the lens implant and planning the desired postoperative vision.
Patients who have undergone other forms of refractive surgery should also discuss their complete surgical history during their cataract evaluation. Even when a procedure was performed decades ago, that information remains relevant when planning cataract surgery today.
Your LASIK May Be 20 Years Old. Your Cataract Plan Shouldn’t Be.
Many of today’s cataract patients were among the earlier generations to choose LASIK, and the technology available for cataract surgery has changed considerably since then. Previous laser vision correction does not prevent you from having cataract surgery, but it does make individualized measurements, lens selection, and surgical planning particularly important.
At Peninsula Laser Eye Medical Group in Mountain View, Dr. Dan Beers and Dr. Jeffrey Liu have extensive experience in refractive and cataract surgery. Our practice offers advanced cataract technologies and a range of modern lens implants, including the Light Adjustable Lens, allowing us to develop a treatment plan around the individual eye rather than taking the same approach for every patient.
If you had LASIK or PRK in the past and are now noticing cloudy or blurry vision, increasing glare, difficulty driving at night, or other signs of cataracts, request an appointment with Peninsula Laser Eye Medical Group to learn which cataract surgery and lens options may be appropriate for you. Call (650) 961-2585 or request an appointment online to schedule a cataract consultation in Mountain View.