My practice has a large volume of cataract surgery patients who have had prior radial keratotomy (RK). I often have multiple patients per week who have had prior RK and now are in need of the best cataract surgery for their complex case. We have so many cataract with RK videos here that there is an entire sub-directory on CataractCoach. This video focuses on the challenges of IOL calculations in these tough eyes and the data in this video come from a patient with more than 20 RK cuts in the cornea. There is much to be learned about IOL calculations in these post-RK eyes and the most important lesson is to avoid using the standard IOL calc print-out sheet from your biometer! My best pearls are in this video and we go through the calculations step by step.