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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.

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

Recent Cataract Medical Journal Articles...

Related Articles

Managing residual refractive error after cataract surgery.

J Cataract Refract Surg. 2015 Jun 19;

Authors: Sáles CS, Manche EE

We present a review of keratorefractive and intraocular approaches to managing residual astigmatic and spherical refractive error after cataract surgery, including laser in situ keratomileusis (LASIK), photorefractive keratectomy (PRK), arcuate keratotomy, intraocular lens (IOL) exchange, piggyback IOLs, and light-adjustable IOLs. Currently available literature suggests that laser vision correction, whether LASIK or PRK, yields more effective and predictable outcomes than intraocular surgery. Piggyback IOLs with a rounded-edge profile implanted in the sulcus may be superior to IOL exchange, but both options present potential risks that likely outweigh the refractive benefits except in cases with large residual spherical errors. The light-adjustable IOL may provide an ideal treatment to pseudophakic ametropia by obviating the need for secondary invasive procedures after cataract surgery, but it is not widely available nor has it been sufficiently studied.
FINANCIAL DISCLOSURE: Dr. Manche has equity in Calhoun Vision, Inc., Krypton Vision, Refresh Innovations, Inc., Seros Medical, LLC, and Veralas, Inc. He is a consultant to Oculeve, Inc., Best Doctors, and Gerson Lehrman. Dr. Sáles has no financial or proprietary interest in any material or method mentioned.

PMID: 26096522 [PubMed - as supplied by publisher]


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