After cataract surgery, many patients still need glasses or contacts. LASIK is better at touching up residual nearsightedness, farsightedness, and astigmatism than lens exchange surgery or piggyback IOL placement.
Cataract surgery involves taking the cloudy lens out of the eye and replacing it with a plastic implant. Ideally, a patient’s prescription is put into the implant so that, after cataract surgery, the patient can see well without glasses or contact lenses. However, in as high as 10% of cases, it is not possible to perfectly achieve the ideal result with cataract surgery due to inherent inaccuracies in calculating the power of the implant that is placed in the eye. The vision in many of these eyes can be fine-tuned after cataract surgery with LASIK laser eye surgery — or with further lens based surgery including exchanging the implant for a new implant with an updated prescription or simply adding a second implant on top of the first implant, which is called a “piggyback” IOL. A recent study showed that LASIK was the most accurate way to “touch up” cataract surgery.
In this study, 65 eyes of 54 patients were studied which had not achieved accurate correction after cataract surgery and still needed glasses or contacts. 17 of these eyes were treated by an exchange surgery in which the previous lens implant (IOL) was removed and a new intraocular lens was put in its place (“IOL exchange”). 20 eyes had a second implant placed on top of the existing implant (“piggyback IOL”). 28 eyes had LASIK. The results of these three approaches to touching up cataract surgery were compared.
The two lens based approaches had similar results. IOL exchange and piggyback IOL surgery produced similar correction of nearsightedness, farsightedness, and astigmatism (“refractive error”). The eyes that had LASIK to touch up the cataract surgery result, however, had better overall correction. In terms of visual results, 62.5% of eyes in the IOL lens implant exchange group were within 1 diopter of the intended result, compared to 82% in the piggyback IOL group and and impressive 100% in the LASIK group.
The results of this somewhat small study confirm my own experience. Not only is LASIK more accurate than either intraocular lens exchange or piggyback techniques, but it is inherently safer as well as LASIK does not physically enter inside the eye while both of the lens based techniques do, of course, enter into the interior of the eye. Staying on the outter coats of the eye allows LASIK to have a better safety profile. The exception, both in this study, and in my experience, is very extremely large degrees of refractive error. For these patients, a lens based technique will be necessary since the amount of correction can be outside the effective range of LASIK.
Also, for many patients after cataract surgery, I also consider PRK, also known as “flapless LASIK” to be an excellent option to fine tune vision after cataract surgery.
See Also
Resolving Refractive Error After Cataract Surgery: IOL Exchange, Piggy Back Lens, or LASIK
This study from Spain shows that LASIK is more accurate than IOL exchange or piggyback lens placement to fine tune cataract surgery.
Minimizing Surprise After Cataract Surgery
American Academy of Ophthalmology discussion of fine-tuning cataract surgery results.
Predicting the Necessity of LASIK Enhancement After Cataract Surgery in Patients with Multifocal IOL Implantation
A study to look at factors that may predict the need for LASIK touch up after cataract surgery.
Photorefractive Keratectomy for Residual Myopia after Cataract Surgery
PRK can improve results after cataract surgery.
Cataract Surgery Complications
All About Vision discussion of cataract surgery complications, including the need for LASIK to fine tune results after cataract surgery.
Fine-Tuning Premium IOLs
Discussion of techniques, including LASIK, to touch up outcomes after cataract surgery.