The LASIK Tsunami
We are experiencing a new breed of patients presenting with cataracts following refractive surgery. PRK has been available in the United States since the early 1990's and LASIK over 15 years. We now have a growing legion of baby boomers who are developing cataracts, unrelated to their previous excimer laser surgery. It is a given that if we live long enough, we stand a 100% chance of developing cataracts. Many of us experience this decline in vision in our mid fifties or early sixties. In any given day at Brighton Surgery Center I have seen as many as 40% of the patients being post LASIK. Many of these patients have requested a premium IOL upgrade such as the Bausch and Lomb Crystalens to improve their independence from optical aids for both distance and near.
Although the techniques utilized for cataract surgery are unchanged by the altered curvature of the cornea, there are some unique issues that need to be recognized and addressed by the surgeon.
Of paramount importance is the pre-surgical calculation of the Intra Ocular Lens (IOL) power. Standard measuring devices most commonly used in the Ophthalmologist's office misread the central power of the cornea resulting in sometimes very poor uncorrected vision following even meticulous uncomplicated surgery. These pre-operative errors are even present with some of the latest measuring devices such as the IOL Master which utilizes a laser to measure the axial length of the eye. Similarly topographic instruments such as the Humphrey, EyeSys and Tomey are not capable of accurately measuring the central power of the cornea. Miscalculation of IOL power can lead to a need for further surgery in a significant percentage of patients which may include removal and replacement of the IOL.
At Robbins Eye, we have found the Pentacam an invaluable instrument for calculating central corneal curvature. Combined with the Holladay formulas and an in-house nomogram developed over thousands of cases we have been successful in improving outcomes and limited the risk of reoperation.
More on this in a future article
Allan Robbins, MD
LASIK Rochester, Webster, Hornell, NY.
Cataract Surgery Rochester, Webster, Hornell, NY.
Crystalens Rochester, Webster, Hornell, NY.
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