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Post Refractive Education

For patients who have undergone prior LASIK or radial keratotomy (RK), cataract surgery requires special consideration due to changes in the shape and stability of the cornea. These alterations increase the risk of a "refractive surprise," meaning the final vision after surgery may be different than intended. While advanced techniques help your surgeon aim for the best possible outcome, your final refractive outcome may be less predictable.

Why previous LASIK or RK affects cataract surgery

The intraocular lens (IOL) implant that replaces your clouded natural lens is selected based on precise measurements of your eye. A standard cataract surgery aims for a specific refractive outcome, but prior corneal surgery makes this calculation more difficult due to altered corneal curvature, difficult/inaccurate pre op mesurements, and lens position predictability. Depending on your unique corneal shape, some types of IOLs, such as multifocal lenses, may not be recommended.

For all patients with prior refractive surgery:

Postoperative variability: It is normal for vision to fluctuate in the weeks and months after surgery. This is especially true for RK patients and should not prompt premature concern.
Long-term outcome: Even with the best available technology, the final result may not be as precise as what is typically achieved in eyes without prior surgery. You should have realistic expectations and be prepared to possibly need glasses or contact lenses for the best vision.

What your surgeon will do to minimize variability:

Your surgeon will use several techniques to improve the accuracy of your outcome.
Advanced measurements: Sophisticated instruments such as topography, tomography, and advanced intraoperative measuring technology (ORA) are used to map the corneal surface and provide more accurate data for IOL calculations before and during the procedure.
Multiple formulas

Management of a refractive surprise

If your vision is not as intended after your eye has stabilized, several options are available
Eyeglasses or contact lenses: These are the most common and simplest solutions for residual refractive error.
Corneal laser enhancement: Procedures like LASIK or PRK may be able to be performed months after cataract surgery to fine-tune your vision.
IOL exchange or piggyback IOL: In some cases, a new IOL can be exchanged or an additional lens can be implanted. This is considered a more complex surgical procedure.
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