Surgeons should lower expectations for cataract patients who underwent refractive surgery

HONG KONG — Surgeons should temper the expectations of previous refractive surgery patients who require cataract surgery, a surgeon said here.

"Counseling is key to managing post-LASIK cataract patients because outcomes are less predictable. You need to moderate their expectations," Han-Bor Fam, MD, said at the World Ophthalmology Congress. "The more you dampen their expectations, the more happy they will be. You have to tell them that they may require more procedures after the surgery if they want to have spectacle independence."

Dr. Fam said preoperative measurements in LASIK-treated patients who need cataract surgery are complicated and require more caution on the part of the surgeon.

"These patients have high expectations of being spectacle independent and having good vision. After all, this is the underlying reason for them to have LASIK," he said. "Target refraction is not very predictable so ... in my case, I like to dampen the patient's expectations. I usually tell them that they will probably have to rely on glasses, even though if they don't, that is a bonus."

If patients suggest contact lenses, Dr. Fam said he explains their corneal curvature has changed and they may not be able to wear contact lenses or may require special lenses.

He said patients should be aware of the possibility of additional dry eye and glare or halo complications as well as the need for enhancements if they wish to be spectacle independent.

"I will usually explain to the patient that they'll probably need enhancements. That depends on how much tissue they have left and what are the post-cataract surprises," Dr. Fam said. "With all of this, there's a cost factor involved, which I will explain to them as well."