Cataract Surgery After LASIK

[00:00:09.320] Now I'd like to talk to you a little bit about what we refer to as [00:00:12.880] post refractive cataract surgery, [00:00:16.040] and some of the challenges that it raises. [00:00:18.880] What I mean by post refractive [00:00:21.080] are those patients who previously, years ago, [00:00:24.280] had either LASIK, or radial keratotomy for their eyes. [00:00:30.240] Now, one of the questions that comes up regularly is, [00:00:33.760] does having had LASIK or radial keratotomy [00:00:37.280] affect the ability of doing the cataract surgery? [00:00:40.440] The answer is a little bit complicated. [00:00:43.320] It doesn't affect the act of the cataract surgery itself, [00:00:47.320] but it can impact the post surgical refractive outcome. [00:00:53.000] What do we mean by refractive outcome? [00:00:55.560] What I mean is, trying to hit the bull's eye [00:00:59.600] in terms of our target goal prescription wise. [00:01:04.200] Let's back up for a moment. [00:01:06.240] Remember, in all cataract surgery, the patient comes in [00:01:10.880] preoperatively, usually a couple of weeks beforehand, for measurements. [00:01:15.160] These measurements are high resolution measurements that test the eye, [00:01:21.840] and these computerized measurements send the data [00:01:25.040] into a computer software system that has mathematical algorithms built in. [00:01:31.080] These algorithms then spit out a projected implant power [00:01:36.160] in an effort to hit the bull's eye, as I call it, [00:01:39.400] try to get as close to our target outcome that we're looking for. [00:01:44.120] Now, understand that with post refractive eyes, [00:01:48.440] the cornea has been reshaped. [00:01:50.800] Both the curvature and the thickness of the cornea are now different, [00:01:55.880] particularly in LASIK. [00:01:57.960] And so when we look at virgin eyes, [00:02:00.760] that is eyes that have never had refractive surgery, [00:02:04.680] in virgin eyes, the national statistics are roughly 92% of patients can achieve [00:02:12.040] driving vision or better without glasses, [00:02:15.240] which is pretty good odds. [00:02:16.480] It's not 100%, but certainly if you were going to Vegas, [00:02:19.640] you would take those odds. [00:02:20.880] A decade ago, in post-LASIK eyes, that number was far, far lower, [00:02:27.920] because the mathematical algorithms used to measure the eye, [00:02:32.160] and calculate the implant power, were not as accurate. [00:02:35.680] Now, fortunately, here we are a decade later, [00:02:38.960] and the statistics have improved significantly, [00:02:43.080] but yet not quite to the level of a virgin eye. [00:02:47.960] How do we overcome this? [00:02:50.520] Well, remember in a previous video [00:02:51.920] I talked about the laser-guided ORA System, remember ORA, [00:02:57.040] and that is where we take high resolution real-time measurements [00:03:02.080] during the cataract surgery, once the cataract has been removed. [00:03:06.840] Based upon these measurements, I then compare [00:03:09.640] what the ORA measurements are telling me to implant [00:03:12.920] as far as implant power, [00:03:14.720] and I compare them to the preoperative measurements. [00:03:18.280] In probably well over half the cases, [00:03:21.320] the ORA measurements give me a little bit different data. [00:03:25.760] I always go by the ORA measurements because although not perfect, [00:03:30.680] again, nothing in life is perfect, [00:03:33.000] but the ORA measurements tend to be more highly accurate, [00:03:36.280] and highly predictable, [00:03:38.040] in terms of achieving our target outcome. [00:03:41.920] Hence, in patients who have had previous LASIK and previous radial keratotomy, [00:03:47.440] it's very important to try and achieve our target outcome [00:03:51.920] to the best degree possible. [00:03:54.640] Hence the reason that we really strongly emphasize ORA. [00:03:58.120] We use ORA quite often even in regular so called virgin eyes, [00:04:03.560] but in post refractive eyes, very important. [00:04:06.640] Now, let me digress a little bit and talk just briefly about radial keratotomy. [00:04:11.200] Some of you may be familiar with it, others may not be. [00:04:14.720] Radial keratotomy was used back in the late '80s, and early '90s [00:04:20.640] to correct near-sightedness, also known as myopia. [00:04:24.960] This is where a diamond blade was used to make [00:04:27.680] radial spoke-like incisions in the cornea. [00:04:32.080] Unfortunately, radial keratotomy had its downsides, [00:04:35.960] and now it's really no longer used. [00:04:39.840] But when we're doing cataract surgery on a patient [00:04:42.720] who's had radial keratotomy, keep in mind, [00:04:45.520] that we are trying to avoid those radial incisions. [00:04:49.760] So we're placing the corneal incision for the cataract surgery [00:04:53.080] in between the radial incisions. [00:04:56.680] I make every effort to be as gentle as possible so that during surgery, [00:05:00.920] we don't disrupt any one of those incisions. [00:05:05.200] If in the case of disrupting it or loosening one of those incisions, [00:05:08.720] it may require putting in a little stitch to close the incision, [00:05:13.320] which is not the end of the world. [00:05:15.520] However, I do my best to try to avoid that scenario. [00:05:19.720] Also in radial keratotomy, the mathematical algorithms, [00:05:23.840] that I referred to earlier, to calculate implant power, [00:05:27.320] are even more variable than in LASIK. [00:05:30.280] It can be sometimes even a greater challenge [00:05:33.320] to hit that bullseye as I talked about earlier. [00:05:37.480] Hence, the reason ORA is very, very important. [00:05:41.560] This is a discussion that I have commonly now with patients, [00:05:45.160] because, as these refractive patients have gotten older, [00:05:49.600] and now 15, 20, 25 years have gone by, [00:05:53.520] many of these post refractive patients have now developed cataracts, [00:05:57.840] and so I would estimate that probably about 15% or so [00:06:02.400] of my current cataract surgery patients, are post refractive. [00:06:07.200] I hope this video helped you in terms of understanding the process. [00:06:11.920] Again, in our practice, it's all about education. [00:06:14.160] We want our patients knowledgeable, educated, [00:06:16.760] so that they can make the appropriate decisions, [00:06:19.960] with our help, of course. [00:06:21.800] Thank you once again and I look forward to seeing you very soon.