Brandon Menke, MD, hears one worry often from patients who had LASIK or RK decades ago: they were told cataract surgery might not work well for eyes like theirs. Dr. Menke, a board-certified ophthalmologist who performs laser cataract surgery at Modern Vision Centers in West Des Moines, Iowa, addressed that concern directly in a recent interview on WHO13’s Hello Iowa. His answer draws on both his surgical experience and his own eyes.
Can you have cataract surgery after LASIK or RK?
Yes. Patients with previous LASIK or RK may now achieve sharp, glasses-free vision after cataract surgery, largely because of a newer lens called the Light Adjustable Lens (LAL). Older lens calculations struggled with corneas reshaped by earlier refractive procedures, which made outcomes harder to predict for these patients.
The LAL solves that problem by moving the fine-tuning until after the lens sits inside the eye. “We actually put this blank canvas lens in and then use light in the office to customize and adjust that prescription while the lens is inside your eyes,” Dr. Menke explained on Hello Iowa. Adjusting the prescription after healing removes the guesswork that made post-LASIK eyes difficult to calculate.
Dr. Menke speaks from personal experience here. “I’ve had LASIK in both my eyes,” he shared. “Those patients that historically have not been great cataract surgery patients now are getting 20/20 […] spectacle-free vision.” A surgeon who chose vision correction for himself, like Dr. Menke, brings a patient’s perspective into the exam room along with a clinical one.
Does astigmatism affect cataract surgery results?
Astigmatism directly affects how sharp vision can be after cataract surgery, and the femtosecond laser can correct it during the procedure. Roughly 80% of patients have some corneal astigmatism [Dr. Brandon Menke, WHO13 Hello Iowa interview].
Dr. Menke describes the condition with an analogy any Iowan can picture. The cornea, he said, “instead of being shaped like a basketball, nice and round, most people, about 80% of patients, their cornea is more shaped like a football.” That shape scatters focus, and glasses or contacts only compensate for it temporarily. Correcting the curvature during surgery addresses it at the source, which he noted can be the difference between uncorrected 20/20 vision and needing glasses full-time afterward.
Are you awake during laser cataract surgery?
Patients stay awake during laser cataract surgery at Modern Vision Centers, and the preparation involves no needles and typically no IV. Numbing and dilation happen through eye drops alone.
The experience surprises many patients with how uneventful it feels. “A lot of people come in, they look at a light for 30 or 40 minutes,” Dr. Menke said, describing a visit where both eyes are treated. For anyone who has delayed a consultation out of fear of needles near the eye, that detail changes the picture considerably.
Can you have cataract surgery on both eyes the same day?
Most patients at Modern Vision Centers can have both eyes treated the same day, and the laser is a key reason why. The femtosecond laser softens and segments the cataract before removal, making the surgery gentler on the eye.
Dr. Menke offered a memorable image for what the laser does inside the lens. “If you think of it kind of like an M&M, it’s breaking up the hard chocolate, kind of like putting perforations in paper,” he said. Removing pre-softened pieces rather than scooping out an intact cataract means less trauma, faster healing, and a recovery of a day or two of scratchiness and blur before most patients drive again. A full overview of the procedure and lens options is available on the laser cataract surgery page.
Is it safer to stop wearing glasses after cataract surgery?
Reducing dependence on glasses after cataract surgery carries a genuine medical benefit beyond convenience, particularly for older adults. “Most falls [in] people that […] are over the age of 60 [or] 65 happen because they’re looking down through a bifocal,” Dr. Menke said. Fall prevention is a serious health concern at that age, and eliminating the bifocal removes a common contributor.
Lifestyle benefits follow from the same choice. Dr. Menke described patients who forget their glasses on a trip and face replacing thousands of dollars of eyewear far from home, along with people keeping readers stationed in every room of the house. Correcting vision at the time of cataract surgery may resolve those frustrations for good.
Wondering what your eyes qualify for, whether you’ve had LASIK, RK, or have other vision concerns? Schedule a cataract consultation with Modern Vision Centers in West Des Moines, Iowa. Call 515-674-2020 or visit mvcvision.com.
Full interview transcript: Laser Cataract Surgery interview with Brandon Menke, MD, on WHO13 Hello Iowa
Host: Cataracts are often considered an inevitable part of aging. I talked to Dr Brandon Menke at modern vision centers to learn what laser cataract surgery is and how it differs from traditional cataract surgery.
Dr. Menke: Laser cataract surgery is where we use a femtosecond laser to assist us in cataract surgery, and what that does is kind of going from the front of the eye to more the middle and the back is that the laser, first of all, can correct astigmatism. And astigmatism is where the cornea, the clear part of your eye, instead of being shaped like a basketball, nice and round, most people, about 80% of patients, their cornea is more shaped like a football, and that makes it where optically, visually, your vision is not in focus as much as it could be. So glasses, contacts, things like that, we use to correct astigmatism, but for cataract surgery and more permanent fix, we can again use a laser to correct that. The other thing the laser does is that it can break up the cataract inside of our eyes. And so during cataract surgery, if you think of it kind of like an M and M, it’s breaking up the hard chocolate, kind of like putting perforations in paper. And so when we remove it, instead of kind of scooping it out, we remove the pieces. And so it makes the surgery less traumatic, less invasive, and thus the healing time a lot faster and quicker for patients, also allowing us, typically, to do both eyes the same day for most patients.
Host: So this is different than traditional cataract surgery?
Dr. Menke: Traditional cataract surgery, and not I’ve done 1000s of traditional cataract surgery cases where we use a blade, we do it all by hand. The outcomes, again, are great. However, they’re not quite as precise, and because of exactly what I talked about earlier, that’s because the astigmatism is not being corrected all the way. And so those little changes in curvature and the shape of someone’s cornea can be the difference between 2020 uncorrected vision versus needing glasses all the time for the rest of your life. And so here, what we do is try to correct everything and give your outcome, make the outcome as best as possible, precise and make your vision as sharp as possible by using a laser to correct that astigmatism. Again, as opposed to traditional historical models, where, again, we’re just trying to get out the cataract and throw a lens in.
Host: How long does a laser assisted cataract surgery take?
Dr. Menke: Usually it’s about 15 to 20 minutes per eye, so about 30 to 40 minutes total. Again, we get people in here to just get them dilated with drops. There’s no needles. We don’t give you an IV, typically. So again, a lot of people come in they look at a light for 30 or 40 minutes. If we’re doing both eyes the same day afterwards, you’re typically a little scratchy, little blurry for maybe a day or two, usually a day or two of kind of healing and being a little blurry. But most people able to drive the very next day.
Host: What about lenses? Are there options for those?
Dr. Menke: Similar to the laser, we use the most advanced technologies to give you the best and most in-depth pre-operative testing that we can give you, and we use those tests to help guide along a journey in our discussion, in the in the exam room, on what lenses fit your lifestyle, one of the most common lenses are something called a monofocal lens. And just like it sounds like it’s one focal point, historically, that’s a lens, again, that we’re thrown in to give you good distance vision, not necessarily to correct astigmatism, but just to make things brighter. With a lot of patients, though, that have retina problems, macular degeneration, when we use the laser to help fix the focus, we’re still able to give you the best vision possible with a monofocal lens, a lens that we typically use in about half, if not more, of our patients are lenses called multifocal lenses, which just like it sounds like, are multiple focal points. So those are people that are very nearsighted or slightly nearsighted, or they just want to have the ability to read up close without glasses. Those give you multiple focal points, giving you distance intermediate and near vision. And then the last one that I would say is the most kind of advanced lens that is newer within the last three, four or five years is something called a light adjustable lens, or an l, a, l, and that’s one where we actually put this blank canvas lens in and then use light in the office to customize and adjust that prescription while the lenses is inside your eyes to give you that sharpest distance vision you’re capable of, along with the reading. And that’s good and perfect for patients that have had previous lasik surgery. I’ve had LASIK in both my eyes. My partner did mine, something called rk to alleviate nearsightedness 2030, years ago. So those patients that historically have not been great. Cataract surgery patients now are getting 2020, vision, spectacle free vision that they otherwise weren’t from these light adjustable lenses.
Host: And that’s a big deal to not have glasses
Dr. Menke: Correct. So most falls and people that you know again are over the age of 6065. Happened because they’re looking down through a bifocal. So medically, it’s safer to get out of glasses. There’s a lifestyle where you don’t have to think about them. Don’t have to have them on, you know, have people that have readers in different rooms, or every room in their house for their for the rest of their life. And also, I’ve had a lot of patients where, you know, again, they go on a trip, they forget their glasses, and they’re, you know, out a few $1,000 the way that we do it again, I do. To give you the best vision now you don’t have to worry about that for the rest of your life.
For more information, you can go online to MVCvision.com or call 515-674-2020, they’re located in West Des Moines, and you can see more on social media.