Had LASIK or PRK Years Ago? What It Means for Your Cataract Surgery

This article is for educational purposes only and is not medical advice. Please see the full disclaimer at the end.

Many people who had laser vision correction in their thirties and forties are now developing cataracts. If you are one of them, the good news is that your earlier surgery does not make cataract surgery riskier. It does make one step harder: choosing the power of the new lens implant. When that step is done the routine way, patients can end up farsighted and back in glasses.

The short version

• You can have cataract surgery after LASIK or PRK. The operation itself is no more difficult.
• Laser vision correction changes the cornea in a way that throws off standard lens calculations, usually leaving the eye farsighted.
• Formulas made for post-LASIK eyes, your old records and modern scans correct for most of this.
• Before surgery, ask your surgeon which method they will use for your eye.

Why the usual measurements go wrong

To choose a lens implant, a surgeon needs to know how strongly your cornea focuses light. No instrument measures that directly. Standard instruments read the curve of the front of the cornea and estimate the rest, assuming the front and back surfaces have the same relationship found in eyes that have never had surgery.

LASIK and PRK flatten the front surface and leave the back surface alone, so that assumption no longer holds. The instrument underestimates the cornea's power, the standard formula responds by choosing a lens that is too strong, and the eye ends up farsighted, often in someone who paid years ago to stop wearing glasses.

The more correction you had, the bigger the possible error. Someone who was mildly nearsighted may land close enough to be happy. Someone who was very nearsighted can be off by one to two diopters, which is the difference between seeing well and needing glasses again.

How careful surgeons correct for it

No single method is perfect, so good practice is to use several and compare the answers:

1. Formulas built for post-LASIK eyes. Examples include the Barrett True-K, the Haigis-L and the ASCRS post-refractive calculator. Using a routine cataract formula on a post-LASIK eye is the most common cause of a disappointing result.
2. Your pre-LASIK records. Your old glasses prescription and the amount of correction that was treated let the surgeon reconstruct your original cornea. If you can find these records, bring them.
3. Scans of both corneal surfaces. Modern tomography measures the back of the cornea instead of assuming it.
4. Measurements during surgery. Intraoperative aberrometry measures the eye after the cataract is removed, as one more cross-check.

Even with all of these, eyes that have had laser vision correction are less predictable than eyes that have not. You deserve to hear that before surgery, not after.

Choosing a lens implant after LASIK

The power of the lens is one decision. The type of lens is the other, and it matters just as much.

• Diffractive full-range lenses (PanOptix, TECNIS Odyssey, enVista Envy) split light between several focal points. They do best on a smooth, regular cornea. After a larger laser correction, the cornea often has more optical irregularity than it once did, and adding a diffractive lens can increase glare and halos.
• Extended-depth-of-focus lenses (Vivity, TECNIS PureSee) are usually the better match. They give distance and intermediate vision, depend less on perfect corneal optics, and are more forgiving if the final power is slightly off.
• A standard monofocal lens with reading glasses is still a very good option, and for an irregular cornea it is sometimes the best one.
• The RxSight Light Adjustable Lens is fine-tuned with brief light treatments a few weeks after surgery, which removes most of the guesswork from post-LASIK calculations. Dr. Feiz performs these treatments in our Walnut Creek office. Read more in our post on Light Adjustable Lenses.

Five questions to ask your surgeon

1. "What formula will you use for my eye?" Listen for a post-refractive formula by name, not just general reassurance.
2. "Would my pre-LASIK records help?" A surgeon who asks for them is taking the problem seriously.
3. "How predictable is the result in my case?" An honest answer is a range, not a promise.
4. "What if the result is off target?" Options include a laser touch-up once the eye settles, exchanging the lens, or glasses. Knowing the backup plan ahead of time removes most of the worry.
5. "Will a premium lens really help my eye?" Sometimes it will not, and that is worth knowing before you pay for one.

What does not change

Your earlier LASIK does not change the cataract operation itself. The small incision, the removal of the cloudy lens, the healing and the recovery are the same as for anyone else. The LASIK flap is not lifted or disturbed. The challenge is a measurement problem, not a surgical one, and it is a well-understood problem for surgeons who handle it routinely.

Dr. Feiz completed a fellowship in cornea and laser refractive surgery and performs both laser vision correction and cataract surgery. Lens calculations for eyes that have had LASIK or PRK are a regular part of his practice, which is why other East Bay eye doctors refer these patients to him.

Common questions

Can I have cataract surgery if I had LASIK?
Yes. The surgery is no harder. The lens power calculation is, and it needs post-refractive formulas rather than the standard ones.

Will cataract surgery damage my LASIK flap?
No. Cataract surgery uses a separate small incision. The flap is not lifted or disturbed.

What if I cannot find my old LASIK records?
They help, but they are not essential. Modern measurements can still produce a good result without them.

Am I more likely to need glasses afterward?
Somewhat, yes. Eyes that have had laser vision correction are less predictable, even when everything is done well. Your surgeon should explain this beforehand, along with the plan if the result lands off target.

Should I choose a multifocal lens?
Often not. Extended-depth-of-focus lenses such as Vivity or TECNIS PureSee usually suit these eyes better, because they are less sensitive to corneal irregularity and more forgiving of a small miss.

Questions?

If you had LASIK or PRK and are starting to notice cataract symptoms, Dr. Feiz can review your measurements and lens options with you. Call Eye Care of East Bay at (925) 705-7299 or contact us online to request a cataract evaluation.

Medical Disclaimer

This article provides general educational information only. It is not medical advice, diagnosis or treatment, and reading it does not create a doctor-patient relationship with Eye Care of East Bay or any of its physicians. Every eye is different, and the right choice for you depends on a full eye examination.

Do not delay seeking professional care, or make decisions about surgery or medications, based on what you read here. Talk with a qualified eye care professional about your own situation. If you have sudden vision loss or another emergency, call 911 or seek immediate medical care.