Let’s start with the short answer you may be looking for: yes, refractive surgery and cataract surgery can both be performed. But—like most things in medicine—it’s not quite that simple. The decision to perform both, or to time one around the other, depends on a variety of factors, including your age, your visual goals, the condition of your eyes, and the advice of your ophthalmologist.
In this article, I’m going to walk you through everything you need to know about this subject. Whether you’ve had refractive surgery in the past and are now facing cataract surgery, or you’re weighing your options for vision correction and wondering how these procedures might work together, this is for you.
Understanding Refractive Surgery
Let’s kick things off with a quick refresher on what refractive surgery is all about. Refractive surgery refers to a collection of procedures that are all designed to reduce or eliminate the need for corrective lenses by addressing common vision problems such as short-sightedness (myopia), long-sightedness (hyperopia), astigmatism, and age-related loss of near vision (presbyopia). These conditions usually occur because the shape of the cornea or the length of the eyeball prevents light from focusing correctly on the retina, leading to blurred vision. Refractive surgery works by altering how light enters and focuses within the eye.
Among the most popular refractive procedures are LASIK (Laser-Assisted In Situ Keratomileusis), PRK (Photorefractive Keratectomy), and SMILE (Small Incision Lenticule Extraction). Each of these has its own method for reshaping the cornea to correct the eye’s focusing power. LASIK involves creating a flap in the cornea before reshaping it with a laser, while PRK removes the surface layer of the cornea before laser correction. SMILE, a newer technique, uses a femtosecond laser to create a small disc of tissue which is then removed through a tiny incision. All three aim to give patients clearer vision without dependence on glasses or contact lenses.
The outcomes of refractive surgery can be incredibly rewarding, especially for those with active lifestyles or professions where glasses are inconvenient. Many people find that after surgery, they can drive, read, and even enjoy outdoor activities without needing visual aids. However, it’s important to understand that refractive surgery doesn’t freeze time. It improves the way your eyes focus light now, but it doesn’t stop the natural ageing process of the eye. Over time, you’ll still be susceptible to changes such as presbyopia and, eventually, cataracts.
That brings us neatly to the link between refractive surgery and cataracts. Just because you’ve had your corneas reshaped doesn’t mean you won’t develop a cloudy lens later in life. In fact, this is quite a common trajectory. Patients who underwent refractive surgery in their 20s or 30s often find themselves facing cataracts in their 50s, 60s, or 70s. When that happens, the question arises—how does previous refractive surgery affect future cataract surgery? And more importantly, can both procedures work together to continue providing clear vision throughout a person’s life?
What Is Cataract Surgery?
Cataract surgery is one of the most frequently performed medical procedures around the world, and for good reason—it restores sight. Cataracts form when the natural lens inside the eye becomes cloudy, often due to age-related changes in the proteins that make up the lens. This cloudiness gradually impairs vision, making everyday tasks like reading, driving, or recognising faces more difficult. During cataract surgery, the cloudy lens is carefully removed and replaced with an artificial intraocular lens (IOL), which serves the same focusing function as the natural lens.
What’s particularly fascinating is how far cataract surgery has evolved in recent decades. Originally, it was solely about removing the opaque lens to restore basic vision. But now, the procedure is far more sophisticated. Today’s cataract surgery is a blend of both restorative and refractive goals. Not only does it remove the cataract, but it can also be used to fine-tune your vision by selecting an IOL tailored to your visual needs—whether that’s for distance, near, or a range of both. This gives patients the chance to address both cloudiness and refractive errors in one procedure.
The types of intraocular lenses now available are a major part of this evolution. Standard monofocal lenses provide clear vision at one distance, often requiring glasses for reading or close-up work. However, premium lenses—like multifocal, extended depth of focus, or toric lenses for astigmatism—offer a more customised outcome. For patients who have had refractive surgery in the past, lens selection becomes even more critical, as the previous corneal reshaping must be taken into account when calculating the right lens power.
So when we talk about combining refractive and cataract surgery, we’re no longer just thinking in terms of one before the other. Instead, we’re looking at how the goals of each can complement one another. Cataract surgery has become a kind of second chance at vision correction, especially for those who may have had LASIK or PRK years ago. The trick is to plan the surgery with precision—factoring in the changes from previous procedures, choosing the right lens, and setting clear expectations for the outcome. It’s this integration of methods and goals that has made modern ophthalmology so dynamic and patient-centred.
So, Can You Have Both?
The real question is how and when these procedures should be combined. The answer depends on your personal journey with vision correction. Let’s look at the three most common scenarios.
1. You’ve Already Had Refractive Surgery—Now You Need Cataract Surgery
This is an increasingly common situation. Let’s say you had LASIK in your twenties or thirties, and it gave you years of clear, unaided vision. Now, a couple of decades later, you’ve developed cataracts.
Here’s the good news: yes, you can still have cataract surgery. But—and this is a big but—it requires careful planning.
Why? Because refractive surgery changes the shape of the cornea, which makes it harder to calculate the right power for your new intraocular lens. It doesn’t mean it can’t be done—it just means your ophthalmologist needs to use specific formulas and techniques to ensure the best possible visual outcome.
Often, additional measurements or advanced technology (like corneal topography or intraoperative aberrometry) are used to get the most accurate results. And while perfect vision can’t be guaranteed, many people achieve excellent results—even after previous LASIK or PRK.
2. You’ve Got Cataracts—Should You Have Refractive Surgery First?
This one’s a bit trickier. If cataracts are already present and affecting your vision, then refractive surgery is usually not the way to go. It would be like painting over a scratched lens—you’re not addressing the root of the problem.
In cases where the cataract is mild or still developing, and the person is desperate to ditch their glasses, some might wonder whether refractive surgery can “buy time” before cataract surgery becomes necessary. In truth, most surgeons would advise against this.
Why? Because cataract surgery itself can correct vision—especially with modern premium IOLs like multifocal, trifocal, or toric lenses. So performing refractive surgery when cataract surgery is just around the corner would be inefficient and possibly counterproductive.
Instead, it’s usually better to wait and correct both the cataract and the refractive error in one go with the right IOL.
3. You Want to Address Vision Problems and Don’t Yet Have Cataracts
This is where things get interesting. If you’re in your forties or fifties and struggling with presbyopia (that age-related inability to focus on near objects), and you’re thinking about LASIK or another laser procedure, there’s an alternative to consider: refractive lens exchange (RLE).
RLE is basically cataract surgery done before the cataract forms. The natural lens is removed and replaced with an IOL, just like in cataract surgery. The bonus? You can choose an IOL that corrects presbyopia, distance vision, and astigmatism.
The advantage of RLE is that you’re future-proofing your eyes. You’ll never need cataract surgery later on because you’ve already removed the lens. It’s not for everyone, but in the right hands and the right situation, it’s a powerful option.
What Are the Risks of Having Both?
You might be wondering whether combining or sequencing these procedures comes with added risks. And that’s a very valid concern.
Here are a few things to keep in mind:
- Accuracy of lens power calculation: As mentioned earlier, if you’ve had LASIK or PRK before, it makes calculating your new IOL power more complex. There’s a slightly higher chance of needing glasses after surgery or requiring a “touch-up” procedure.
- Surface healing and dryness: If you’ve had previous refractive surgery, the eye surface may be more prone to dryness. Cataract surgery can sometimes exacerbate this temporarily, leading to fluctuating vision or discomfort.
- Expectations vs reality: Some people who had laser eye surgery earlier in life expect cataract surgery to give them the same wow-factor results. While modern techniques are excellent, it’s important to manage expectations—particularly if the cornea has any irregularities from previous surgery.
- Glare and halos: Multifocal IOLs can sometimes cause glare or halos around lights. If you’ve had previous refractive surgery that altered the corneal surface, these effects might be slightly more pronounced. Your surgeon will weigh this up when recommending the best IOL type for you.
Modern Advances That Make Combined Surgery Easier
We’ve come a long way in the past 20 years. Thanks to technological progress, the challenge of combining refractive and cataract surgery is becoming far more manageable. The tools, techniques, and understanding we now have allow eye surgeons to confidently plan surgeries for patients with complex visual histories. Let’s take a closer look at some of the key advances that are helping make this possible.
Advanced biometric formulas
One of the biggest hurdles in post-refractive cataract surgery has always been accurately predicting the right power for the new intraocular lens. Standard biometric formulas, which work well for eyes that haven’t been surgically altered, often fall short in eyes that have had LASIK or PRK. That’s where advanced biometric formulas like the Barrett True-K and Haigis-L come into play. These formulas take into account the altered corneal curvature and use complex mathematical modelling to estimate the ideal lens power more reliably.
These modern formulas don’t just rely on corneal measurements; they also incorporate data about the eye’s axial length, anterior chamber depth, and even previous refractive surgery outcomes where available. This holistic approach gives a much clearer picture of what the post-surgery vision is likely to be. For patients who’ve already had vision correction surgery and are now dealing with cataracts, this can mean the difference between an underwhelming result and truly sharp, functional vision.
Crucially, the use of these formulas has helped build trust between patients and surgeons. In the past, patients who had LASIK in their youth might have felt uncertain about the quality of their cataract surgery years later. Now, with these sophisticated tools, surgeons can offer more accurate predictions and set better expectations. That transparency goes a long way in helping patients feel confident about the results, especially when they know their previous procedures are being carefully accounted for.
Intraoperative aberrometry
Intraoperative aberrometry has become a real game-changer, particularly in eyes that have had previous laser vision correction. Unlike pre-operative calculations, which rely on static measurements, intraoperative aberrometry gathers real-time data during the actual surgery. This means the surgeon can adjust the choice of lens power on the spot, based on how the eye behaves during the procedure. It’s a bit like fine-tuning your vision while the surgery is still underway.
What makes this technology especially valuable is that it helps address the unpredictability that comes with altered corneal shapes. A patient who had LASIK twenty years ago might have a cornea that behaves differently from a standard one, making it hard to rely on standard pre-surgery measurements alone. Aberrometry bridges that gap by offering live feedback that reflects how light is travelling through the eye in that exact moment. This reduces the risk of surprises after surgery and helps achieve better refractive accuracy.
For patients, the result is a more tailored experience with fewer compromises. While perfect vision without glasses can never be guaranteed, the likelihood of a close-to-target outcome is significantly increased. And in the hands of an experienced surgeon, intraoperative aberrometry provides that extra layer of precision which can make all the difference—especially for those who have already invested in their vision through past refractive surgery and want to maintain high standards moving forward.
Topography-guided PRK
Sometimes, despite a surgeon’s best efforts, the visual outcome after cataract surgery isn’t quite spot on. This can happen in patients with particularly tricky corneas, especially if they’ve had previous refractive procedures. In such cases, topography-guided PRK can be used as a corrective measure. This laser-based enhancement adjusts the surface of the cornea based on a detailed topographic map of its shape, helping to refine any residual refractive error.
Topography-guided PRK is particularly valuable because it’s designed to improve not just the power of vision but also its quality. Traditional enhancements might correct the prescription but leave the patient with visual distortions or irregularities. Topography-guided techniques, on the other hand, are able to smooth out tiny imperfections on the corneal surface, often leading to sharper, clearer vision and less glare or halo effect. This is especially beneficial in eyes that are already complex due to prior surgeries.
It’s worth noting that this isn’t something every patient will need, but having it as an option provides peace of mind. Knowing that there’s a precise, minimally invasive follow-up available if the outcome isn’t perfect can help patients feel more at ease when choosing cataract surgery after refractive treatment. Surgeons can also use this option as part of a staged approach—first removing the cataract, then refining the result as needed with a personalised touch.
Light-adjustable lenses
Light-adjustable lenses (LALs) are one of the most innovative breakthroughs in cataract and refractive surgery. Unlike standard intraocular lenses, these can be fine-tuned after implantation using a special ultraviolet (UV) light. This means that once the eye has healed from surgery, and the patient has had a chance to “test drive” their new vision, adjustments can still be made to tweak the outcome—without needing a second surgery.
What makes these lenses so appealing is the flexibility they offer. Rather than locking in a decision about lens power before surgery, LALs let patients and surgeons work together to assess vision in the real world before making final adjustments. This can be especially helpful for those who previously had refractive surgery, where standard IOL calculations are more prone to error. With a light-adjustable lens, you get a second chance to optimise the vision postoperatively, which is a huge advantage.
The process involves a series of light treatments over the course of several weeks after surgery, gradually adjusting the lens to improve focus. Once the desired vision is achieved, the lens is “locked in” using a final UV exposure. While this technology may not be suitable for every patient, it’s revolutionising the landscape for those who have complicated ocular histories or specific visual goals. It also exemplifies how far ophthalmic technology has come—putting more control in the hands of both patients and their surgeons.
The Role of the Surgeon
A lot rides on the skill and experience of your ophthalmic surgeon. When you’re dealing with a complex case—like a previous LASIK patient needing cataract surgery—the stakes are a little higher.
Make sure your surgeon is well-versed in these kinds of cases. Ask how many similar procedures they’ve done. Ask about the technology they use for IOL calculations in post-refractive surgery eyes. And most importantly, ask about realistic expectations for your vision after surgery.
What If Cataract Surgery Doesn’t Fully Correct Your Vision?
Don’t worry—there are options. If, after cataract surgery, you find that you’re still a bit short-sighted or long-sighted, a couple of solutions are available:
- Laser enhancement: You might be eligible for a quick laser procedure like LASIK or PRK to fine-tune your result.
- Piggyback IOLs: A second lens can sometimes be inserted on top of the first to tweak the prescription.
- Glasses or contacts: While not ideal, some people prefer this route, especially if the refractive error is minor and the risks of further surgery outweigh the benefits.
What About Monovision?
If you’re over 40 and thinking about either surgery, you’ve probably heard the term monovision. This is when one eye is corrected for distance vision and the other for near vision.
Monovision can be achieved with LASIK, with cataract surgery, or even a combination of both. It’s not for everyone, but many people adapt well and find they can function without glasses for most things.
Your surgeon can simulate this setup using contact lenses before surgery to see if your brain can comfortably adapt.
Final Thoughts: Which Path Is Right for You?
There’s no one-size-fits-all answer when it comes to combining refractive and cataract surgery. It all depends on where you are in your vision journey. Here’s a quick recap:
- Had LASIK years ago and now need cataract surgery? You can absolutely have it—just make sure you choose a surgeon experienced in post-refractive cataract cases.
- Considering laser surgery in your 50s but noticing early cataracts? Hold off on LASIK and consider refractive lens exchange or modern cataract surgery with a premium lens.
- Never had surgery but struggling with reading glasses? RLE might offer both freedom from glasses and protection from future cataracts.
No matter your situation, the best approach is always a personalised one. Book a consultation with a skilled ophthalmologist, discuss your visual goals, and don’t be afraid to ask questions. The combination of refractive and cataract surgery is not only possible—it’s increasingly common and highly successful when done with the right preparation. If you’re suffering from cataracts and considering refractive surgery, you can contact us at the London Cataract Centre to arrange a consultation. Our expert surgeons specialise in managing complex cases involving both procedures and are here to guide you through the best options for your vision.