Lasik no issue for cataract op

Q: I am 33 years old. I was told that if I do Lasik now, I will have problems doing cataract surgery in future when I am older. Is that true?

A: This is not true. Successful cataract surgery is possible for people who have had laser-assisted in-situ keratomileusis (Lasik).

The surgical success rate would be exactly the same as that of an eye that has never had Lasik, as it is technically not any more different or difficult to perform cataract surgery on a post-Lasik eye than it is on a virgin eye.

Lasik is a type of refractive surgery that corrects common vision problems, such as myopia (short-sightedness), astigmatism (when the eye surface is not round but resembles a rugby ball) and presbyopia (long-sightedness).

The corrective surgery enables the person to see clearly without spectacles.

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In 1999, the United States Food and Drug Administration approved Lasik for use in the US and the technique quickly gained popularity with patients.

Today, Lasik is the single most common refractive procedure in the world, with over 40 million procedures performed.

Whether you have had Lasik or not, everyone develops cataracts around the age of 60. This is due to the ageing process of the natural lens inside each of our eyes.

Given that Singapore has one of the highest rates of myopia in the world, many cataract patients here may have had Lasik in the past. These patients would still wish to remain spectacle-free after their cataract surgery.

Some eye surgeons may say that the results of cataract surgery in post-Lasik eyes are unpredictable. They may want old records of your eye measurements before Lasik surgery.

In the past, the calculation formula for lens implant power used during cataract surgery was based on the pre-Lasik spectacle prescription and cornea curvatures.

But advances in calculation formula, cataract surgery techniques and lens implants in the last 10 years have entirely changed the landscape of refractive surgery. Several advanced mathematical formulas have emerged, and these are used for precise calculation of lens implant power in post-Lasik eyes. The modern and more accurate formulas require no prior data at all.

Additionally, they provide greater refractive accuracy.

This allows surgeons to use premium lens implants for total correction of astigmatism and multi-focal implants for presbyopia correction in post-Lasik eyes.

New and innovative mono-focal and multi-focal lens implant designs to correct presbyopia can now improve refractive outcomes without sacrificing visual quality.

For those who have had mono-vision Lasik in their 40s and are used to it, it is advisable for them to maintain mono-vision, by undergoing cataract surgery with mono-vision lens implants.

Mono-vision is where one eye is corrected for seeing far distances while the other eye is corrected for near vision.

But some patients will opt for multi-focal lens implants. It is a misconception that multi-focal lens implants cannot be used in post-Lasik eyes. Highly specialised refractive surgeons who handle both Lasik and cataract surgery are able to achieve accurate results and good outcomes with multi-focal implants.

This has been shown by many published studies worldwide.

Today, patients' vision can be dialled back a few decades in time, even if they have had an earlier Lasik procedure.

Director and consultant ophthalmologist at the Dr Natasha Lim Eye Centre at Mount Elizabeth Novena Hospital

Dr Natasha Lim

A version of this article appeared in the print edition of The Straits Times on November 24, 2015, with the headline 'Lasik no issue for cataract op'. Print Edition | Subscribe