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.
If you are ready to choose a doctor to be evaluated for conventional
or custom
wavefront
Lasik,
All-Laser Lasik,
PRK,
LASEK,
Epi-Lasik,
NearVision CK,
RLE, or any
refractive surgery procedure, we highly recommend you consider
a doctor who has been evaluated and certified by the USAEyes
nonprofit organization. Locate a USAEyes Evaluated & Certified
Lasik Laser Eye Surgery Doctor.
If this article did not fully answer your questions, use our
free
Ask Lasik Expert patient forum.
