Over the course of decades, we have found that radial keratotomy (RK) keeps flattening the cornea. Initially these previously myopic patients benefitted from the RK which took away corneal power and thereby addressed the myopia. These patients likely had many great years of emmetropia and good visual acuity. But as the years go on, the RK incisions keep weakening the cornea and the central zone becomes extremely flat. This further loss of dioptric power results in hyperopia for these patients. In the case shown here, the patient has central keratometry values of about 30 diopters, thus necessitating a very high IOL power during cataract surgery. Also remember that these high power IOLs have thicker optics and therefore require large injector tips and wider incisions.