With age, everyone who lives long enough will develop a cataract. This means that today’s LASIK patients will someday need cataract surgery and the patients who had LASIK two decades ago are nearing cataract age.
The first thing to understand is that surgery must be done differently for these patients. The primary considerations are that the lens power estimation is calculated differently than compared to virgin eyes and that we must be careful not to disturb the corneal LASIK flap.
The error in the lens calculation is usually opposite of the prior LASIK treatment. For example, eyes which have undergone prior myopic LASIK will end up with a hyperopic refractive surprise if we don’t adjust the IOL power appropriately. Patients who had prior hyperopic LASIK will end up more myopic than planned after cataract surgery if we are not careful. For more information on IOL calcs, see our website www.IOLcalc.com
At the time of cataract surgery the LASIK flap edge must be identified and then avoided during creation of the incisions. A simple approach is to let the cornea dry for 30 seconds and then use light touch from a weck-cel sponge to gently press on the cornea. The edge of the flap will present itself and be easily seen. Now when the cataract surgery incisions are made, the LASIK flap edge can be avoided completely.
Figure: Let the cornea dry for 30 seconds, then using a weck-cel sponge, lightly press on the cornea to highlight the LASIK flap edge.
Watch the video showing this technique and the entire cataract surgery: