OD News Articles

5th April 2005

LASIK After Cataract Surgery

by Cindy Murrill, OD, MPH Tacoma, Washington

Looking back on the past few decades, it is amazing how things have changed with eye surgery! Many of us recall when cataract patients were left aphakic and had to wear thick spectacles or contact lenses. Next came “experimental” intraocular lenses (IOLs) that were considered so risky we only put them in older patients’ eyes. However, with experience, we have learned to trust IOLs as the best option for nearly all cataract patients.

But now that lens selection has become so precise, doctors and patients expect even better visual outcomes. So surgeons are more frequently performing LASIK after cataract surgery to tune up residual astigmatism.

As lens calculation and IOL selection have become more precise over the years, surgeons have explored several options for treating astigmatism. When benefits outweigh the risk, our surgeons have sometimes offered astigmatic keratotomy (AK) or limbal relaxing incisions (LRI) to cataract patients. But both of these procedures are somewhat imprecise and results have not always met the expectations of patients, referring ODs or surgeons. People with astigmatism may be candidates for toric IOLs, but it’s natural that surgeons who have learned to trust the precision of LASIK are more frequently considering this option for patients following cataract surgery.

When we Offer It

At PCLI, LASIK might be considered after cataract surgery when pre-existing astigmatism has motivated a planned two-stage surgery. If patients are highly motivated to decrease dependence on glasses or contact lenses, but have a lot of corneal cylinder before their cataracts are removed, we offer LASIK as an option once their eyes have healed. We counsel them the same way we do typical refractive surgery patients—carefully reviewing the risks and benefits. If LASIK is desired and treatment is planned post cataract, we offer LASIK as an “enhancement” with a reduced fee. Because this is purely an elective treatment, it is an out-of-pocket expense.

LASIK is not usually considered when cataract patients end up with unplanned refractive errors. Instead, we confirm their dissatisfaction with the results of surgery and present the option, risks, and benefits of an IOL exchange.

Case Study—click to view

Conclusion

Today, patients with cataracts have many options! The more informed they are by you and your staff, the better we can meet their needs. At PCLI we are always available to discuss treatment alternatives to best meet patient expectations, surgical planning and post operative management—so we can continue to delight those you entrust to our care.

Contact Lenses Out Before LASIK

We need your help. Over the past several months an increasing number of patients have come for laser vision correction with corneal stability in question due to contact lens wear. Unfortunately, this has resulted in postponed surgery—and inconvenience to patients.

We rely on your clinical judgment as to when corneas are stable and ready for surgery. The following times are suggested minimums for discontinuation of lens wear prior to your refractive surgery evaluation and the day of surgery:

  • Rigid and gas permeable—3 weeks minimum
  • Soft—7 days minimum

Some conditions may require contacts to be left out even longer:

  • higher refractive error
  • long-term rigid contact lens wear
  • toric contact lens wear
  • contact lens overwear

These patients should be followed in your office until repeatable refractive error measurements and keratometry/topography measurements confirm stability. At that time, your patient’s refractive error information can be provided with your surgery referral.
 

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