I’VE HAD LASIK, CATARACT SURGERY, etc. CAN I STILL BE TREATED?

I will often get email and phone inquiries from prospective patients / eye floater sufferers asking if they may be a candidate for laser treatment of their bothersome vitreous eye floaters. Specifically they have had previous eye treatment / surgeries such as:

  • LASIK
  • CATARACT SURGERY WITH VARIOUS TYPES OF LENS IMPLANTS
  • INTRA-OCULAR CONTACT LENS
  • PRK (Corneal refractive procedure like LASIK)
  • RK (Corneal refractive procedure with incisions in the cornea)
  • RETINA PROBLEMS (Such as laser repair of retinal hole / tear)

The short answer is that I can (and often do ) treat patients with one or more of these previous procedures. Treating them may affect the quality of the laser energy, but treating these patient should not increase the risk to the patient (e.g. changes to the optics of the eye, the intraocular lens, or the retina – even if there has been a history of retina problems.

Here is a more detailed answer to each of these particular issues:

LASIK: Re-shaping the cornea can cause some irregularity of the cornea as well as multiple, concentric, optical zones within the cornea. Depending in part on the amount of the original optical correction, this may affect the amount and quality of the YAG laser energy especially when chasing down floaters in the posterior or periphery of the eye. I can usually compensate by moving the floater into a better position by having the patient manipulate their eye position during treatment, or compensate with more lasers bursts and/or more overall treatment sessions.

IMPLANT LENSES AFTER CATARACT SURGERY: In general I prefer to work through a natural (non-cataract) lens with a large pupil. But I have many patients who have previously had cataract surgery with implants lenses of various types. There are two potential challenges present here: 1). Small apertures, and 2). muli-focal lenses splitting laser energy into two focal points.

1). Small Apertures: A wide open, dilated pupil in a ‘virgin’ eye may open up to 7-9mm in diameter. Most newer implant lenses are now about 5.5mm. It may not sound like much of a difference, but it is when treating in the back of the eye. The laser energy is in the shape of a cone, and I am trying to get this ‘cone’ of energy through the pupil and into the back of the eye. A smaller aperture limits my view through the biomicroscope and decreases the amount of energy, especially when chasing floater in the posterior (toward the back of the eye) or peripherally.

2). Multi-focal Lenses: By their design, many multifocal lenses will take 100% of the light entering the lens and split it into to different focal points. This is how you can conceivably clearly see objects that are both at distance and near (reading/computer).
multifocal-lensThe problem is that this lens will take 100% of the laser energy and split into two focal points. This can diminish the amount of effective energy delivered to the targeted floaters. I can usually compensate for this diminished energy by more shots of the laser and/or more treatment sessions if necessary.

INTRAOCULAR CONTACT LENS (ICL): ICL’s are not that common of a procedure, but I do see one now and then. It is a refractive procedure like cataract surgery in the sense that an artificial lens ins implanted into the eye, but unlike cataract surgery, the eye’s natural crystalline lens is not removed. Although these lenses do affect the optics of the eye, they generally do no affect treatment. I hardly know they are there.

icl

PRK AND RK: These are both refractive procedures that reshape the cornea by different means. The laser energy challenges and considerations are very similar to that with LASIK (above).

RETINAL PROBLEMS PREVIOUSLY TREATED: Many patients present to me with a history of previous retinal treatments such a laser (argon laser retinopexy) treatment for early, small, peripheral holes and tears, or they may have had more invasive surgery to treat a retinal detachment. In either case, there should be no problems or contraindications to treating these patients. Furthermore, the YAG laser should not cause or create any traction on the retina.

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