Had LASIK? Here’s What You Need to Know Before Cataract Surgery | Neda Nikpoor, MD

Financial Support: Supported by an educational grant from Tarsus Pharmaceuticals, Inc. & Rxsight

Listen On

If you’ve had LASIK—whether 25 years ago or just last decade—and you’re now hearing the words “You have a cataract,” you’re probably wondering:

Does my old LASIK affect cataract surgery?

The short answer: Yes.
The longer answer: Absolutely—and in ways most people don’t realize.

I’m Dr. Rupa Wong, pediatric ophthalmologist and adult strabismus surgeon here in Hawai‘i, and today I sat down with someone who lives and breathes refractive cataract surgery:

Dr. Neda Nikpoor, board-certified cataract and corneal surgeon at Jenkins Eye Care, who performs nearly 1,000 surgeries each year—including an enormous volume of surgeries on patients just like you who had LASIK or PRK decades ago.

She’s trained at Bascom Palmer, completed a global ophthalmology fellowship with the Himalayan Cataract Project, and is considered one of the leading experts in post-LASIK cataract surgery and light adjustable lens technology.

Together, we unpacked everything—from why LASIK eyes behave differently to what you should (and shouldn’t) choose when it comes to lens implants.

Let’s dive in.

Why Your Old LASIK Still Matters Today

Here’s the most confusing thing for many people:

👉 LASIK doesn’t “wear off.”
Your need for reading glasses in your 40s?
That’s presbyopia—not failed LASIK.

But LASIK does permanently change the shape of your cornea. And decades later, when you eventually develop a cataract, that altered corneal shape affects our ability to calculate the perfect lens power for your eye.

Dr. Nikpoor put it simply:

“All of our cataract formulas become less accurate in eyes that have had LASIK.”

Even with the best equipment and modern formulas, fixed-power lenses are only 70% accurate in previously LASIK-treated eyes.

Compare that with non-LASIK eyes, where we typically hit the target ~91% of the time.

This is why results can be more unpredictable—and why choosing the right lens becomes incredibly important.

LASIK vs. PRK: What You Had Still Matters

Many people don’t even remember whether they had LASIK or PRK—and honestly, after 25 years, who would?

Here’s the quick refresher:

LASIK

• A flap is created on the cornea

• The laser reshapes the tissue underneath

• The flap is repositioned

• Vision typically improves overnight

PRK

• No flap is created

• The laser reshapes the surface

• The top layer of corneal cells grows back over several days

• Recovery is slower, but the anatomy stays more “natural”

We can usually tell which one you had by examining your eye or by using advanced corneal imaging.

And yes—both LASIK and PRK affect cataract calculations.

Can You Have LASIK After Cataract Surgery?

Surprisingly, yes.

If you end up with a small amount of residual nearsightedness, farsightedness, or astigmatism after cataract surgery, a touch-up LASIK or PRK can fine-tune your vision.

This is a very normal part of refractive cataract surgery—and something corneal specialists like Dr. Nikpoor perform regularly.

Will Cataract Surgery Undo Your LASIK?

No.

Cataract surgery replaces your cloudy natural lens with an artificial lens.
LASIK reshaped your cornea.

Two completely different parts of the eye.

Your old LASIK doesn’t get “erased”—but it does make choosing the right lens more important.

Choosing a Lens After LASIK: What You Should Know

This is the heart of the conversation—and where Dr. Nikpoor’s expertise shines.

The biggest takeaway?

If you’ve had LASIK, not every cataract lens is a good idea.

Here’s the breakdown.

1. Monofocal Lenses (Standard, Insurance-Covered)

Pros:

• Clear vision at one distance (usually far)

• Covered by insurance

• Good optical quality

Cons:

• You’ll still need glasses (reading or distance depending on your target)

For many patients, this is perfectly fine.

2. Extended Depth-of-Focus (EDOF) Lenses

Pros:

• Broader range of vision

• Usually great distance + intermediate (computer range)

Cons:

• Near vision (phone distance) is still limited

• May cause some glare/halos

For non-LASIK patients, EDOF lenses are an excellent option.
For post-LASIK patients? Sometimes. Depends on the cornea.

3. Multifocal Lenses

This is where things get tricky.

Multifocal lenses split light into rings to give near, intermediate, and distance vision—but those rings can:

• increase glare

• cause halos

• worsen starbursts

• magnify any optical imperfections

Dr. Nikpoor’s advice was clear:

“I will not implant multifocals in any patient who has had LASIK.”

She used to, years ago—before better technology existed.
And while some patients were happy, a significant portion were miserable.

In those cases, the lens often needed to be removed and replaced.

4. The Light Adjustable Lens (LAL): The Game Changer

This is the lens Dr. Nikpoor recommends most strongly for people who had LASIK.

And honestly? I completely understand why.

What makes the Light Adjustable Lens so special?

Instead of picking one fixed lens power before surgery and hoping it’s perfect, the LAL allows you to:

• Heal from surgery

• Measure your new vision

• “Fine-tune” your lens using a special UV light

• Adjust again, up to 3 times

• Then lock it in permanently

It’s like getting custom-designed vision after your eye has healed.

And for post-LASIK patients, where measurements are less predictable, the accuracy is remarkable:

96–98% hit their target vision.

That’s even better than traditional lenses in patients who’ve never had LASIK.

Is the Light Adjustable Lens Good for Dry Eyes?

Yes—and this was such a good pearl from Dr. Nikpoor.

Dry eye can:

• make vision fluctuate

• reduce the accuracy of pre-operative measurements

• worsen glare with multifocal lenses

But the LAL:

• has extremely pure optics

• allows adjustments after the dry eye is treated

• avoids the rings/glare of multifocals

Who Should Not Get a Light Adjustable Lens?

A few groups aren’t ideal candidates:

• Patients whose pupils don’t dilate wide enough

• Those with moderate or advanced macular degeneration

• Patients who cannot reliably participate in adjustments

• Eyes where refractions are impossible to measure accurately

• People with silicone oil in the eye (e.g., prior retinal detachments)

But most post-LASIK patients are excellent candidates.

The Recovery Process: What to Expect

LASIK patients often imagine waking up the next morning with perfect vision again.

Cataract surgery is different.

The timeline looks more like this:

Day 1–3

• Blurriness

• Watery/irritated eye

Week 1–4

• Vision improves steadily

• Dryness can temporarily fluctuate vision

Week 4+

• LAL adjustments begin (if you choose this lens)

• Adjustments happen weekly until you're satisfied

• Two “lock-ins” finalize your vision

And yes—throughout the adjustment period, you wear special UV-blocking glasses to protect the lens from accidental light exposure.

Final Thoughts: Should You Choose a Light Adjustable Lens?

If you had LASIK or PRK, the LAL is often the most precise, customizable way to achieve the vision you want after cataract surgery.

It allows your surgeon to:

• compensate for the unpredictability LASIK leaves behind

• fine-tune your vision after healing

• adjust based on your real-world lifestyle and preferences

Dr. Nikpoor put it best:

“We’re no longer asking patients to make a lifelong decision before surgery. With the LAL, they get to choose after they see how their eyes heal.”

For anyone who values being glasses-independent—or wants the most accurate outcome possible—it’s worth discussing with your surgeon.

Want to Learn More?

This is just the beginning. In upcoming episodes, we’ll explore:
-How screen time and digital habits are shaping our kids’ development
–The connection between vision and overall health
–What you need to know about common eye procedures like LASIK and cataract surgery
–Practical ways to advocate for your child’s visual needs

You can subscribe to my podcast, In Focus, anywhere you listen—or follow along on Instagram for updates and tips.

Watch this episode on Youtube right now!

Thanks for reading—and for doing what you can to protect your child’s vision, one step at a time.

– Dr. Rupa Wong
Pediatric Ophthalmologist | Surgeon | Mom of 3

This episode is brought to you by The Pinnacle Podcast Network! Learn more about Pinnacle at learnatpinnacle.com