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Cataracts and Lasik

Concerns and consideration for cataracts and Lasik, Bladeless Lasik, PRK, LASEK, or Epi-Lasik.


Topographical map of a central island after Lasik  
A cataract means the normally clear lens within the eye has become cloudy.  
   

Cataracts are not necessarily a contraindication for refractive surgery, but someone considering corneal refractive surgery such as Lasik, PRK, LASEK, or Epi-Lasik, may want to forego the corneal refractive surgery and rely on the cataract surgery to correct their refractive error.

Cataracts are a natural clouding of the crystalline lens of the eye. Since the eye works much like a camera, a cataract, much like a clouded lens, causes blurring or dimming of vision.

Many cataract patients complain of poor distance vision, especially while driving. Glare can be especially troublesome while driving at night. Cataracts can also be responsible for double vision or altered color vision. Cataracts do not cause pain, tearing, redness or floaters.

Most often cataracts are an inevitable consequence of aging and cannot be prevented. Less common causes of cataracts are trauma, medications, extensive exposure to sunlight, and other eye diseases and heredity.

Prior to the advent of modern cataract surgery, doctors waited until their patients were nearly blind from cataracts prior to recommending surgery. Fortunately, due to the advancements in cataract surgery, a patient may have a cataract lens removed before it reaches such an advanced stage. The principal indication for cataract surgery is based on a discussion between patient and doctor on how the cataract is interfering with the patient’s vision and affecting their lifestyle.

Cataract surgery is usually performed on an outpatient basis. Sedation is often given to alleviate anxiety and pain. Anesthetic is also used to minimize discomfort. A tiny incision is made at the edge of the cornea and the cloudy cataract is removed. A clear plastic or silicone intraocular lens (IOL) replaces the removed lens. The IOL will have a refractive power to correct most refractive error. In many cases, a suture is not required.

The IOL can correct myopia (nearsighted, shortsighted) and hyperopia (farsighted, longsighted), but rarely is astigmatism able to be corrected with cataract surgery. A cornea-based surgery like Lasik, PRK, LASEK, or Epi-Lasik may be used to treat astigmatism after cataract surgery. Also, if the IOL is not precisely the correct refractive power and the patient has residual refractive error, a cornea-based surgery may be used to correct this residual error. If the replacement IOL leaves a significant amount of refractive error, a P-IOL may be implanted to resolve the remaining myopia or hyperopia, however it is probably more common for a helper "piggy-back" IOL to be implanted.

Cataracts after refractive surgery may present a unique challenge because calculations to determine the correct power of the replacement IOL can be more difficult. If cataract removal is necessary, it may be helpful to select a doctor who has both cataract surgery and Lasik experience, or a doctor who has extensive experience performing cataract surgery after refractive surgery. It is possible for the refractive surgeon to take all measurements necessary for the calculation of the IOL before refractive surgery and keeping them for use when cataracts form. Even with the normal changes the eye will experience over time, having the measurements from before refractive surgery will provide excellent baseline from which all future calculations can be determined or compared. It may be wise for the patient to request a copy of these measurements for safe keeping.

There is a common misconception that primary cataract surgery is performed with a laser. Actually the latest technique will use ultrasound and topical anesthesia drops which allows for rapid recovery. However, lasers are used in a portion of patients who several months to years following cataract surgery develop a clouding behind the implant known commonly as a "secondary cataract."

An important additional consideration is what is commonly called "Second Sight" that occurs in the early stages of cataract development.  See Second Sight Details.

Looking For Best Lasik Surgeon?

If you are ready to choose a doctor to be evaluated for conventional or custom wavefront Lasik, Bladeless Lasik, PRK, or any refractive surgery procedure, we recommend you consider a doctor who has been evaluated and certified by the USAEyes nonprofit organization. Locate a USAEyes Evaluated & Certified Lasik Doctor.

Personalized Answers

If this article did not fully answer your questions, use our free Ask Lasik Expert patient forum.


Recent Cataract Medical Journal Articles...

Safety of Besifloxacin Ophthalmic Suspension 0.6% in Cataract and LASIK Surgery Patients.

Cornea. 2014 Mar 14;

Authors: Majmudar PA, Clinch TE

Abstract
PURPOSE:: The aim of the study was to evaluate the safety of besifloxacin ophthalmic suspension 0.6% as antibacterial prophylaxis in the surgical setting.
METHODS:: Two prospective safety surveillance studies were conducted-one in the cataract surgery setting and the other in the laser-assisted in situ keratomileusis (LASIK) surgery setting. Cases from patients aged 18 years and above were eligible for inclusion. In both surveillance studies, data were collected from consecutive cases of routine primary cataract surgery and LASIK surgery, respectively, in which besifloxacin ophthalmic suspension 0.6% or moxifloxacin ophthalmic solution 0.5% was used as the topical perioperative prophylactic antibacterial medication as part of the clinician's routine standard of care. The primary safety endpoint was the incidence of treatment-emergent adverse events (TEAEs).
RESULTS:: The cataract surgery surveillance study included 485 cases/eyes (besifloxacin, n = 333; moxifloxacin, n = 152), whereas the LASIK surveillance study included 456 cases/eyes (besifloxacin, n = 344; moxifloxacin, n = 112). In the cataract study, only 1 TEAE was reported in a besifloxacin case (mild hypersensitivity/allergic reaction considered possibly related to besifloxacin). No TEAEs were reported in the LASIK study. In both studies, surgical outcomes were similar with both treatments. The frequency of preoperative and/or postoperative dosing was generally lower for besifloxacin than that for moxifloxacin.
CONCLUSIONS:: In prospective safety surveillance studies of patients undergoing cataract extraction or LASIK, TEAEs associated with prophylactic use of besifloxacin ophthalmic suspension 0.6% were rare, and surgical outcomes with besifloxacin were similar to those with moxifloxacin ophthalmic solution 0.5%.This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License, where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially.

PMID: 24637269 [PubMed - as supplied by publisher]

 


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