How do you adjust postoperative refraction targets for LAL in patients with altered corneal anatomy?

I don't adjust any postoperative refraction targets based on prior refractive surgery or previous EK, but modify the approach to adjustments. In patients with a history of PRK/LASIK, we wait at least 6 weeks to initiate adjustments. In patients with a history of RK, we wait 8+ weeks to start adjustments, and in patients with a previous DMEK, I also like to wait 6 weeks to start adjustments. I do not alter targets during the adjustment process based on previous refractive surgery or previous DMEK.

We do use previous monovision targets (e.g., -1.00 in the non-dominant eye) as a guide for selecting the first target in the LDD process.