One of your patients, who previously had LASIK, now needs cataract surgery. The excimer laser was approved for myopic treatments more than 20 years ago, and the early adaptors are now in their 60s and 70s, still active, and still wanting a life free of glasses or contact lenses.
Should these patients have the same expectations regarding the outcomes of their surgery 20 years later when undergoing cataract surgery? The answer may be “yes,” but extra planning is necessary.
1. Set expectations
The most crucial step for the referring OD is to set a realistic expectation. The changes in the cornea from laser vision correction alter the calculations in determining intraocular lens (IOL) power, thus affecting the final refractive outcome.
In our center, we stress with staff who interact with this type of cataract patient to avoid overpromising results. In addition, I do not discuss specific outcomes. I will say things like, “You have a greater chance of not being exactly on the target and a greater chance of needing a touch-up photorefractive keratectomy (PRK) procedure.”
In our clinic, the preference for laser vision correction after cataract surgery is PRK. The eye is not pressurized during the creation of a flap, eliminating that process from disrupting the IOL position.
Unfortunately, the recovery time from PRK is slower.
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