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Cataract Surgery after LASIK


If you had LASIK in the past and are now planning cataract surgery, it is important to understand how this prior eye surgery may affect your experience.


How LASIK works: LASIK for nearsightedness works by flattening the anterior surface of the central cornea, making this portion of your cornea less nearsighted. LASIK probably freed you from wearing thick glasses or contact lenses for years, if not decades. 

Side Effects of LASIK: 

LASIK has important potential side effects, including glare, dry eye, an loss of contrast sensitivity.  These may become more obvious as you get older.


Glare: Glare occurs because the central cornea is flattened by LASIK, but the peripheral cornea is not treated. This means that after LASIK the peripheral cornea remains nearsighted, even though the central cornea is not. When your pupil is dilated in dim light, this outer, nearsighted part of the cornea will scatter light inside of the eye, causing glare.  The glare caused by LASIK will not be made better with cataract surgery. Because of this, at least some symptoms of glare may persist even after cataract surgery. It is hard to tell before cataract surgery how much glare is caused by your cataract and how much is caused by your prior LASIK. 


Dry Eye: Dry eye occurs for two reasons. First, LASIK cuts the nerves that tell the eye to create tears. Second, the flattening of the anterior cornea causes the tear film to break up faster.

How LASIK may affect you after cataract surgery:

Refractive accuracy and stability:  One of the most important issues in surgical planning for cataract surgery is choosing the correct artificial lens to put into the eye to achieve your desired refractive outcome. The flattening of the cornea after LASIK makes this calculation more difficult. Therefore, if you have had LASIK, the refractive outcome after cataract surgery is harder to predict. You may need glasses to achieve your best vision. Also, the cornea after LASIK is thinner and therefore may take longer to stabilize after cataract surgery. Because of this, your refraction may continue to change for the first several months after your surgery.


In summary, if you have had LASIK, cataract surgery will most likely improve your vision. However, you may have some persistent symptoms of dry eye and glare. Also, your refractive outcome is less predictable and takes longer to stabilize.  Refractive surprise (the eye doesn't focus where you want it to) is much more common after cataract surgery in post-LASIK patients.  Before your cataract surgery, confirm with your surgeon that you have a plan in place for dealing with refractive surprise if it occurs. 

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