Cataract After LASIK

If you developed early cataracts after LASIK, are facing cataract surgery after LASIK, or experienced a poor outcome from cataract surgery after LASIK, you are invited to join the discussion on Facebook.

Most eye surgeries, including LASIK, carry risk of cataracts. Anecdotal reports of cataracts shortly after LASIK, even in relatively young patients, suggest a cause and effect relationship. Moreover, steriod drops routinely prescribed after LASIK may hasten the onset of cataracts.

Patients with signs of cataracts before LASIK should not have LASIK because vision may be corrected with the intraocular lens used for cataract surgery. Ironically, after LASIK the altered corneal surface causes inaccurate measurement of the intraocular lens power for cataract surgery. This means that patients who have LASIK surgery and later develop cataracts may be right back in glasses after cataract surgery – or worse, subjected to the inherent risks of multiple surgeries.

What should you do if you have had LASIK? Print this form (K-card) and have it completed by your LASIK surgeon, and then place it with your important records for safekeeping. Do not delay, as medical records may be destroyed after five years in some states. Read more about the importance of the K-card below.

Facing cataract surgery after LASIK? Request your LASIK medical records from the surgeon (alternatively, you can print this form (K-card), and have it completed by your LASIK surgeon) and take them with you to the cataract surgeon.

WARNING: Do not fall for the marketing hype surrounding “multi-focal”, “accomodating”, or “premium” intraocular lenses. Patients who have previously undergone RK or laser eye surgery may not be happy with their vision with these so-called “premium lenses”. The cataract surgeon may try to UPSELL you a premium lens to put more money in his pocket, but you may be happier with a conventional cataract lens.

Studies show that LASIK leads to much earlier cataract surgery:

1st Study finds that having Lasik leads to cataract surgery up to 15 years sooner

Iijima et al. Demographics of patients having cataract surgery after laser in situ keratomileusis. J Cataract Refract Surg. 2015 Feb;41(2):334-8.

Excerpts from the full text:

“In the present study patient age at the time of cataract surgery in post-LASIK eyes was approximately 10 years younger than in axial length (AL)-matched eyes and approximately 15 years younger than in the whole population…

“In all previous studies and in the current study, the mean age at the time of cataract surgery in post-LASIK eyes was 50 to 63 years. It was necessary to perform cataract surgery earlier than we had expected in post-LASIK eyes; it is still difficult to accurately determine IOL power in such eyes…

“In conclusion, in this study, patient age at the time of cataract surgery in the post-LASIK cataract group was approximately 10 years younger than in the AL-matched group, and approximately 15 years younger than in the whole population.”

2nd Study finds Lasik leads to cataract extraction a decade sooner than normal

Yesilirmak et al. The Effect of LASIK on Timing of Cataract Surgery. J Refract Surg. 2016 May 1;32(5):306-10.

Abstract

PURPOSE: To compare the age at the time of cataract surgery in patients who have undergone microkeratome-assisted LASIK versus individuals matched for axial length, cataract grade, and visual acuity with no history of refractive surgery.

METHODS: Retrospective chart review of patients who underwent cataract extraction between September 2013 and March 2015 at the Bascom Palmer Eye Institute. Patients had a history of either microkeratome-assisted LASIK or no prior ocular surgery. Corrected distance visual acuity (CDVA) before and after cataract extraction, uncorrected distance visual acuity (UDVA) before cataract extraction, gender, axial length, and cataract grade were assessed, along with age at the time of LASIK, age at the time of cataract extraction, and the time lapse between LASIK and cataract extraction.

RESULTS: Fifty eyes of 38 patients were included in the LASIK group and 155 eyes of 136 patients were included in the control group. There was no significant difference between these groups with respect to gender (P = .87), CDVA before cataract extraction (P = .11), UDVA before cataract extraction (P = .09), axial length (P = .67), and cataract grade (P = .46). Mean age at the time of cataract extraction for patients in the LASIK group and control group were 64 7 and 73 8 years, respectively (P < .005). Negative correlations were found between age at time of cataract extraction and axial length in the LASIK and control groups (r = -0.18, P = .20 vs r = -0.36, P =. 01, respectively).

CONCLUSIONS: Microkeratome-assisted LASIK seems to be correlated with earlier cataract extraction. Patients with a history of microkeratome-assisted LASIK under-went cataract surgery a decade sooner than patients with similar demographic and ocular characteristics. [J Refract Surg. 2016;32(5):306-310.].

3rd Study finds Lasik patients have cataract surgery eleven years earlier, and have worse outcomes

Manning et al. Cataract surgery outcomes in corneal refractive surgery eyes: Study from the European Registry of Quality Outcomes for Cataract and Refractive Surgery. J Cataract Refract Surg. 2015 Nov;41(11):2358-65.

Abstract

PURPOSE: To analyze visual outcomes after cataract surgery in patients with previous corneal refractive surgery.

SETTING: Cataract surgery clinics in 18 European countries and Australia.

DESIGN: Database study.

METHODS: Cases of cataract extraction with corneal refractive surgery eyes (corneal refractive cases) were identified from all cataract extractions reported to the European Registry of Quality Outcomes for Cataract and Refractive Surgery database over a 5-year period. Preoperative and postoperative measurements and trends over time were analyzed.

RESULTS: Of 807,220 cataract extractions, 1229 (0.15%) were corneal refractive cases. There was a significant increase, over time, in the number of corneal refractive cases (P < .001). Corneal refractive patients were younger than patients without corneal refractive surgery (nonrefractive patients) (62.9 years versus 74.0 years; P < .001) but had similar mean preoperative and postoperative corrected-distance visual acuity (CDVA) (preoperative logMAR 0.44[6/16] for both [P = .286]; postoperative logMAR 0.06[6/7] for both [P = .245]). Postoperative CDVA was worse than preoperative CDVA in 35 (4%) corneal refractive and 8,999 (1.5%) nonrefractive patients (P < .001). In all, 74 (8.5%) of 873 corneal refractive versus 16,566 (2.8%) /584,496 nonrefractive patients, having cataract surgery, had preoperative CDVA of logMAR 0.0[6/6] or better (P < .001). Nineteen (54.3%) of 35 corneal refractive case patients who had worse postoperative CDVA had preoperative CDVA of logMAR 0.0(6/6) or better.

CONCLUSION: Cataract surgery has been reported with increasing frequency in corneal refractive surgery patients, since 2008. These patients had preoperative CDVA similar to those of patients without previous corneal refractive surgery but were younger and were at higher risk of worse postoperative CDVA, especially if they had preoperative CDVA of logMAR 0.0(6/6) or better.

4th Study finds mean age of RK, PRK, and LASIK patients undergoing cataract surgery 5 years younger than normal

Moshirfar et al. Age of cataract extraction in post-refractive surgery patients. J Cataract Refract Surg. 2014 May;40(5):841-2.

Quote from the full text:

“The mean age and standard deviation at cataract extraction was 65.07 years +/- 8.32 (SD) for postrefractive patients and 69.97 +/- 11.54 years for control patients… In conclusion, the mean age of cataract extraction in patients who have had refractive surgery is younger than in patients with no previous refractive surgery.”

5th Study finds that LASIK patients had cataract surgery 7-years earlier than people who avoid LASIK.

From the full text: “patients with a history of LASIK underwent cataract surgery 7 years earlier on average. There was a strong association between LASIK and early cataract surgery at age 55 or younger. These results replicate previous studies by Yesilirmak et al. that reported cataract surgery 9 years earlier in the LASIK group and by Iijima et al that demonstrate a 10-year earlier cataract surgery in patients with LASIK…”

Ortiz-Morales G, Ramos-Davila EM, Elizondo-Fernández B, Arreola-Martinez J, Garcia JN, Valdez-Garcia JE. LASIK is associated with early cataract surgery in healthy patients. Int Ophthalmol. 2024 Mar 3;44(1):125.

Purpose: To evaluate the association between LASIK and early cataract phacoemulsification surgery (PE).

Methods: A matched case-control study was conducted. Cases were otherwise healthy adults with a history of LASIK. Groups were paired according to corrected-distance visual acuity (CDVA), axial length, and cataract grade.

Results: A total of 213 patients were included. 85 patients were classified as post-LASIK group and 128 as controls. The mean age at the time of LASIK was 42.32 9.24 years. The mean CDVA before PE was 0.29 0.19 Log MAR in post-LASIK group and 0.34 0.22 Log MAR in controls (p = 0.07). The mean axial length was 23.99 1.78 mm in post-LASIK group and 23.62 0.98 mm in controls (p = 0.085). The mean nuclear cataract grading was 1.36 in post-LASIK group and 1.47 in controls (p = 0.34). The mean age at the time of PE was 60.18 7.46 years in post-LASIK group and 67.35 9.28 in controls (p < 0.0005). The difference between the mean age of LASIK and the mean age of PE was 17.85 5.72 years. There was a positive association between the post-LASIK group and the age of PE = 55 years (OR: 4.917, 95% CI: 2.21-10.90, p < 0.001).

Conclusion: LASIK may be associated with early PE. Patients with LASIK had a 7-year earlier PE compared to a matched control group.

6th Study finds that LASIK patients have cataract surgery more than 16 years earlier than normal

Yehia S. Mostafa, et al. Studying the Effect of LASIK on the Cataract Extraction Timing: A Retrospective Study. Med. J. Cairo Univ., Vol. 91, No. 1, March: 221-223, 2023

ABSTRACT

Background: With the aging of the people who had LASIK, the number of patients requiring cataract surgery after LASIK has been increasing.

Aim of Study: To study the effect of having LASIK on the timing of cataract extraction.

Setting: Eye Care Center, time period from June 2014 to June 2022.

Patients and Methods: The data of the population of this retrospective observational study was collected from files of a private ophthalmology hospital. The patients were divided into two groups of matched axial length and sex, Group A: Eyes with a history of LASIK before having cataract extraction. Group B: Eyes with no history of LASIK before having cataract extraction. In each group the average, median, max-imum and minimum age were calculated. We excluded any patient with history of any systemic or local disease associated with early cataract such as diabetes mellites or previous surgeries apart from LASIK in the first group.

Results: The study showed a statistically significant difference of 16.77 years in the average age between group A compared to group B with the lower age being evident in group A. As in group A, the average was 50.19±8.5 years, while in group B, the average age was 66.96±9.4 years (p<.001).

Conclusion: The study showed that patients with history of LASIK tend to seek cataract extraction earlier than patients who didn’t have history of LASIK with more than 16 years difference.

If you developed early cataracts after LASIK, or if you experienced a bad outcome from cataract surgery due to prior LASIK surgery, you should file a MedWatch report with the FDA online. Alternatively, you may call FDA at 1-800-FDA-1088 to report by telephone, download the paper form and either fax it to 1-800-FDA-0178 or mail it to the address shown at the bottom of page 3, or download the MedWatcher Mobile App for reporting LASIK problems to the FDA using a smart phone or tablet.