From the Guidelines
Refractive surgery can be combined with cataract surgery to address both vision-impairing cataracts and refractive errors simultaneously, as recommended by the most recent guidelines 1. This combined approach, often called refractive cataract surgery, is beneficial for patients who have cataracts and also want to reduce their dependence on glasses or contact lenses. The procedure involves removing the cloudy natural lens and replacing it with an intraocular lens (IOL) specifically selected to correct the patient's refractive error.
Key Considerations
- Options include monofocal IOLs for distance vision, toric IOLs for astigmatism correction, multifocal or accommodative IOLs for both near and distance vision, and extended depth of focus (EDOF) IOLs.
- The standard post-operative medication regimen typically includes antibiotic drops like moxifloxacin 0.5% four times daily for one week, anti-inflammatory drops such as prednisolone acetate 1% four times daily for one week then tapered over three weeks, and lubricating drops as needed.
- Patients should expect a recovery period of about 1-2 weeks, with vision continuing to improve over several weeks.
- This combined approach is beneficial because it addresses multiple vision problems in a single procedure, reducing overall recovery time and potentially providing better visual outcomes than sequential surgeries.
Important Factors to Consider
- Premium IOLs may involve additional out-of-pocket costs not covered by insurance, and not all patients are ideal candidates due to ocular conditions like irregular astigmatism or macular disease.
- The informed consent process should be documented, and the patient should be given an opportunity to have all questions answered before surgery, including the potential risks, benefits, and alternatives to and among the different refractive procedures 1.
- Elements of the discussion include the range of expected refractive outcomes, possible residual refractive error, loss of accommodation, corneal endothelial damage, loss of BCVA, side effects and complications, and changes in visual function not measured by visual acuity testing 1.
From the Research
Relationship Between Refractive Surgery and Cataract Surgery
The relationship between refractive surgery and cataract surgery is complex, with various factors influencing refractive outcomes after cataract surgery. Some key points to consider include:
- Refractive errors can occur after cataract surgery, despite advances in technology and surgical techniques 2, 3, 4.
- Residual refractive errors can be corrected using various enhancement modalities, including corneal-based procedures and lens-based enhancements 2, 3.
- The choice of correction method depends on factors such as the cause of refractive error, type of intraocular lens (IOL) used, ocular comorbidities, and patient preference 2, 3.
- Piggyback IOLs are considered safer and more accurate than IOL exchange for correcting residual refractive errors 2, 3.
- Advances in biometry and microsurgical techniques have improved refractive outcomes after cataract surgery, but residual refractive errors can still occur 5.
Factors Influencing Refractive Outcomes
Several factors can influence refractive outcomes after cataract surgery, including:
- Preoperative and intraoperative pitfalls, such as inaccurate biometric analysis or incorrect IOL power calculation 4, 5.
- Intraocular pressure (IOP) changes, which can affect refractive outcomes, particularly in patients with glaucoma 6.
- Ocular comorbidities, such as astigmatism or presbyopia, which can impact refractive outcomes and require additional correction methods 2, 4.
- Patient expectations and satisfaction, which can be influenced by refractive outcomes and the need for additional corrective procedures 4, 5.
Correction Methods
Various correction methods are available for residual refractive errors after cataract surgery, including: