What is LASIK and am I a Candidate?
The most commonly performed vision-correcting procedure in the world is laser in-situ keratomileusis (LASIK). LASIK uses laser energy to precisely reshape the surface of the eye to correct visual errors such as myopia (nearsightedness), hyperopia (farsightedness), and astigmatism. In a qualified candidate, modern LASIK procedures are safe and successful in >99% of cases, and can reduce or eliminate your need for glasses and contact lenses. The best LASIK candidates are typically those between age 20-49 with thick corneas, but can you still have LASIK if you're older and already had cataract surgery? While every patient is unique, in most instances the answer is yes.
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What is Cataract Surgery?
Cataract surgery is an outpatient or office-based procedure that replaces the cloudy natural lens (cataract) of the eye with a permanent, artificial lens that restores near-normal vision. When combined with an advanced technology artificial lens (advanced IOL) such as the PanOptix, Vivity, or RxLAL lens, over 90% of cataract surgery patients can reduce or eliminate their need for glasses and contacts after surgery. In the right candidate, modern cataract surgery paired with an advanced IOL frequently results with LASIK-like visual outcomes, but exceptions may occur. Book Cataract Consultation
What is a Refractive Surprise?
While the visual results of cataract surgery are typically excellent, a small percentage of patients will experience something called a refractive surprise. A refractive surprise occurs when the new lens does not deliver the expected uncorrected vision target (your vision without glasses). Your vision may be under or overcorrected, or be left with visually-significant astigmatism. The exact rate of refractive surprise varies by surgeon and will depend on multiple factors such as: the quality and modernity of testing equipment, surgeon experience, and experience of testing staff. However, even with perfect testing and surgery, there is still an element of inexactness due to variable surgical healing that occurs between different individuals.
Can Refractive Surprises be Prevented?
While the rate of visually-significant refractive surprise is already quite low (5-10%), newer technologies have been introduced to attempt to lower this rate to 1-2% or less. Some examples include laser cataract surgery, computer-guided surgery (Alcon Ora and Zeiss Callisto), and the RxSight Light-Adjustable Lens (LAL). While these technologies have reduced the rate of refractive surprise, none of them can eliminate the risk entirely.
How do you treat a Refractive Surprise?
Several strategies have been developed and discussed to address a refractive surprise. Since the majority of refractive surprises are of low magnitude and do not significantly impact vision, most can be left untreated. In mild but visually-significant cases, prescription eyeglasses or contact lenses may be issued to address the blurriness. If this solution is unacceptable to the patient, then surgical intervention may be considered.
What are the Surgical Options for a Refractive Surprise?
If wearing glasses or contact lenses after cataract surgery is not an acceptable option to you and you have been diagnosed with a refractive surprise, then surgical intervention may be considered. For early-recognized cases of large refractive surprises, the surgeon may recommend an early IOL exchange or repositioning procedure, depending on the type of refractive surprise, the current position of your IOL, and how much time has lapsed since your cataract surgery. An IOL exchange involves changing the lens implant for a different IOL model or power (this may be a stronger or weaker IOL, depending on the type of refractive surprise). For smaller degrees of refractive surprise, or in cases where too much time after surgery has elapsed, than a laser vision procedure may be considered.
Can LASIK Correct a Refractive Surprise?
For small-to-moderate refractive surprises, laser vision correction such as LASIK, PRK, or laser LRIs may be performed to successfully correct refractive surprises that have resulted in symptomatic nearsightedness, farsightedness, or astigmatism after cataract surgery. Laser vision correction offers increased precision, faster recovery, and is a lower risk procedure compared to IOL exchange. If you are a candidate for LASIK, it may be the best option to fix a refractive surprise. Ultimately, your surgeon will make a recommendation that is best for you. This recommendation will be based on several factors such as: how large of correction needs to be made, the thickness and clarity of your corneas, and whether you have dry eyes. Some patients are not candidates for surgical correction of refractive surprise, and may need to be fitted with specialized contact lenses or glasses to optimize vision.
What are the Risks of LASIK after Cataract Surgery?
While the overall risks are low, LASIK is a surgical procedure and with that carries risks of infection, inflammation, dry eyes, temporary discomfort after surgery, and the potential need for additional procedures. Your surgeon will explain in detail the specific risks, benefits, and alternatives with you at your consultation so that you can make an informed decision regarding your care.
Is LASIK after Cataract Surgery Covered by Insurance?
The Center for Medicare and Medicaid Services (CMS) has determined that vision correction (seeing without glasses) is a lifestyle choice and not medically necessary. While LASIK is an out-of-pocket investment, you may use FSA/HSA dollars, or qualified candidates may choose 0% financing over 24 months via Alphaeon Credit.
How Much Does LASIK Cost after Cataract Surgery?
If you are already one of our cataract surgery patients with an advanced IOL, there is no additional charge to have LASIK vision enhancement at the Clear Vision Center. If you initially chose a basic single focus IOL, or had cataract surgery by another surgeon in the past we offer LASIK vision enhancement at a rate of $2000 per eye*
* Current pricing applies only to PRK or LASIK vision enhancement after cataracts as of 1/21/23. Please call to confirm pricing.
Ready for the Next Steps?
If you previously had cataract surgery and think you may need LASIK vision enhancement, we recommend calling our office at 248-710-2325 to speak with one of our Patient Care Coordinators. As every situation is unique, we may require receipt of your previous surgery records to optimize your time with us on the date of your consultation