Yes. Previous SMILE, SMILE Pro, FemtoLASIK or PRK does not, by itself, prevent a later cataract operation. The important point is that the earlier change to the cornea must be considered during the assessment and calculation of the artificial lens. The useful question is therefore how cataract surgery can be planned reliably for an eye that has already undergone vision correction.

Laser vision correction and cataract surgery treat different parts of the eye. A refractive laser procedure changes the focusing power of the cornea. Cataract surgery removes the cloudy natural lens and replaces it with an intraocular lens, usually shortened to IOL. The previous corneal correction remains in place. A further corneal laser treatment cannot remove clouding inside the natural lens. [1]

A cataract can develop later in life even after successful laser eye surgery. A decline in vision years after treatment does not automatically mean that the laser correction has worn off. The cornea, natural lens, tear film and retina need to be assessed separately. Our article on how long laser eye surgery results last discusses long-term vision more broadly. This guide focuses specifically on a later cataract operation.

Why is artificial lens calculation different after laser treatment?

The power of an artificial lens is not simply copied from your current glasses prescription. Calculations use measurements including eye length and corneal focusing power. The calculation method also needs to estimate the effective position of the implanted lens. Together, these factors help predict where the eye will focus after surgery.

Corneal vision correction changes the optical starting point. Some conventional measurement and calculation methods use assumptions about the relationship between the front and back surfaces of the cornea. After laser treatment, those assumptions may no longer be accurate enough. The type of original correction matters too: an eye treated for short-sightedness has different characteristics from one treated for long-sightedness. A scientific investigation of IOL calculation after SMILE discusses these optical challenges; its theoretical model does not replace clinical surgical outcomes. [2]

Specific calculation approaches are available for previously treated eyes. Examples include versions of Barrett True-K and other methods designed for eyes after refractive surgery. Modern measurements may also include the back surface of the cornea. A clinical study in eyes with previous myopic LASIK compared several current formulas against actual results following cataract surgery. Such comparisons support an informed choice of method; they do not establish one formula as the best option for every eye. [3]

Clinical evidence is also available after SMILE. A study published in 2022 examined eyes that actually underwent cataract surgery following SMILE. A further clinical case series in 2024 assessed ray tracing and methods incorporating total corneal power. These studies provide useful information, but cannot guarantee an individual result. Findings after SMILE should not automatically be extended to every SMILE Pro treatment profile or to previous long-sightedness correction. [4] [5]

What examinations are important before cataract surgery?

The first step is to identify the cause of the change in vision. Not every episode of blurred vision after previous laser treatment is a cataract. A changed prescription, an unstable ocular surface or a retinal condition can produce similar complaints. The findings determine which treatment is appropriate.

Cataract preparation includes assessment of the natural lens, visual acuity, refraction and the health of the rest of the eye. For patients with previous corneal refractive surgery, the European Society of Cataract and Refractive Surgeons recommends corneal topography or tomography. These examinations help assess corneal shape. Lens calculations should use methods appropriate to the patient’s surgical history. [6]

• Vision testing and refraction: How well do you see with the best available correction, and are the measurements consistent?
• Corneal assessment: Are the shape and measurement results sufficiently regular and stable?
• Biometry: What eye length and other measurements are available for calculating the artificial lens?
• Ocular surface: Could dryness or tear-film problems affect measurement quality?
• Retina and optic nerve: Are there findings that may limit the visual outcome or influence lens selection?

An unstable ocular surface may mean that measurements need to be repeated. Clinical research after myopic LASIK or PRK has assessed total keratometry alongside specialised lens formulas. This work illustrates the value of suitable measurement data, while no single device reading replaces an assessment of the whole eye. [7]

In practical terms, an additional measurement appointment does not mean that cataract surgery is impossible. It can be part of careful planning. If you are considering your first laser procedure, our page on the examination before laser eye surgery explains that earlier assessment. It serves a different purpose from preparation for a later cataract operation.

Which artificial lens can be used after SMILE, LASIK or PRK?

Previous laser treatment does not automatically determine which artificial lens you must receive. Alongside the calculated lens power, the optical strategy matters: which distance should each eye focus on, and how should the two eyes work together? Your job, screen use, reading habits and night driving therefore belong in the consultation.

Monofocal lenses have one main focus. If this is set for distance, glasses are often needed for close work. Depending on the model, enhanced monofocal or extended-depth-of-focus lenses can offer a wider useful range. Multifocal or trifocal lenses distribute light between several viewing distances, and potential optical side effects need to be discussed. Toric versions are designed to correct suitable corneal astigmatism. The ESCRS patient information compares these lens concepts. [8]

Describe specific situations rather than simply asking for the “best” lens. Do you drive regularly after dark? Do you spend hours reading small print? Is most of your work at a computer? Would you be comfortable with reading glasses if distance vision were the priority? These details do not replace diagnostics, but help your surgeon understand what a useful result would mean to you.

Previous monovision or Laser Blended Vision should also be discussed explicitly. Cataract surgery involves a new decision about lens power. Your existing balance between the eyes should be documented and considered, rather than assuming that both eyes should automatically receive the same focusing target.

What results and limitations should you expect?

The main aim is to improve the visual function affected by the cloudy lens. The achievable result also depends on the cornea, retina, optic nerve and chosen refractive target. A clear artificial lens cannot compensate for every other eye condition. Some residual prescription can remain despite careful planning.

A clinical investigation of cataract surgery after myopic laser vision correction illustrates why the achieved outcome and intended focusing target should be considered separately. For an individual patient, asking what visual quality and reliance on glasses are realistic is more helpful than adopting a general success rate. [9]

Before surgery, ask how a remaining prescription could be managed if necessary. Glasses may be the appropriate solution. Further corneal laser treatment is an option only in selected circumstances and requires suitable, stable findings. Our guide to laser eye surgery enhancement explains the general principles.

The back of the lens capsule can become cloudy after a cataract operation. This is called posterior capsule opacification, sometimes described as an after-cataract. It is not the removed natural lens growing back, and it does not mean that the earlier corneal laser correction has disappeared. Where appropriate, it can be treated with YAG laser capsulotomy, a procedure different from SMILE or LASIK. [10]

Which records should you keep after laser eye surgery?

A personal copy of your treatment records can help with future surgical planning. The FDA describes a record developed with the American Academy of Ophthalmology for documenting measurements before LASIK, which may be helpful if cataract surgery is needed later. [11]

• The treatment date and precise procedure name for each eye.
• The original prescription, including cylinder power and axis.
• Available corneal measurements from before treatment.
• The surgical report and records of any later enhancement.
• Stable postoperative refraction and follow-up findings.
• Details of monovision, including the distance and near eye, where relevant.

Keep legible PDF copies where possible and identify the right and left eye clearly. A note saying “laser in 2010” is less informative than a record of which procedure was used for which prescription. If details are missing, ask your original provider what documentation is still available.

Missing historical records do not automatically make cataract surgery impossible. Calculation approaches that do not require old data are available. A current examination remains essential in every case. The American Academy of Ophthalmology also recommends keeping information from before and after LASIK for possible future eye surgery. [12]

If you are considering laser eye surgery now, ask about the condition of your natural lens during the consultation. A lens-based approach may be more appropriate when significant lens clouding is already present. PRESBYOND Laser Blended Vision retains the natural lens; it does not stop lens ageing or remove an existing cataract.

Frequently asked questions about cataracts after laser eye surgery