What Happens When Patients Who Have Had Laser Vision Correction Develop Cataracts?

More than 25 years have passed since the first modern laser vision correction procedures, commonly referred to as laser eye surgery or laser vision correction. Patients who underwent these procedures during that period are now reaching the age when cataracts begin to develop. This is particularly relevant for those who had myopia (short-sightedness) corrected, as it is well known that patients with myopia tend to develop cataracts at a younger age.

Laser vision correction does not accelerate cataract formation, and the development of cataracts is not related to the procedure itself. Cataract surgery in patients who have previously undergone laser vision correction is performed in essentially the same way as in all other patients. This applies to both LASIK and PRK procedures.

Patients who have had their refractive error corrected with laser surgery would also like to remain independent of glasses after cataract surgery. This may be made possible by so-called presbyopia-correcting intraocular lenses, which include multifocal intraocular lenses (MFIOLs) and lenses with an extended range of vision. Until recently, however, there were several reasons why we generally implanted only monofocal lenses in patients who had previously undergone LASIK or PRK, meaning that they still needed reading glasses after cataract surgery.

The first reason was the reduced accuracy of calculating the appropriate intraocular lens power due to the altered relationship between the anterior and posterior curvature of the cornea following LASIK or PRK. This change does not affect visual acuity, but it can “confuse” standard formulas used to calculate the power of the intraocular lens implanted during cataract surgery. It is well known that multifocal lenses function optimally only when there is little or no residual refractive error.

The second reason is the possibility of corneal irregularities, which could cause light scattering and reduce the quality of the image produced by a multifocal lens, potentially leading to difficulties with night driving.

The Symfony intraocular lens, thanks to its design, has also made it possible for patients who previously underwent laser vision correction to become free of glasses after cataract surgery. Symfony is an extended-depth-of-focus (EDOF) intraocular lens with a monofocal-like design and an extended range of vision, providing better contrast sensitivity and, consequently, better image quality. In addition, because of its extended depth of focus, a small residual refractive error is less likely to cause significant problems with vision.

Newer formulas have also been developed that take into account the altered corneal shape following laser vision correction, making intraocular lens power calculations increasingly accurate. A key prerequisite for implanting a Symfony lens after previous laser surgery is a regular corneal surface. Therefore, it is extremely important that the original laser vision correction procedure be performed with a high degree of precision and quality.

At the end of last year, I operated on a patient who had undergone laser vision correction for high myopia in 2011: -8.00 D in the right eye and -6.50 D in the left eye. At the age of 55, he developed cataracts in both eyes, with his visual acuity declining to approximately 40–50%. Since corneal topography was completely normal, we decided to implant Symfony lenses.

Following surgery, the gentleman achieved excellent vision at distance, near, and intermediate range (computer distance), with minimal light scattering during night driving. He does not need glasses. In the future, we expect to see an increasing number of patients presenting to our clinic with cataracts who have previously undergone laser vision correction. We can also fulfill their wish for good vision without glasses.