How do you approach cataract surgery in a patient with a history of radial keratotomy (RK) who desires postoperative independence from glasses?  

Carefully. I would say I'm abrupt and dispel the notion they will be spectacle independent at all, given they are not candidates for MTF lenses and, even EDoF lenses, would have issues of aberrations in the visual system caused by the RK incisions. I literally hang the "black drape." That sort of s...

If he is serious about glasses independence, he needs an LAL. Nothing else will give him the 99% odds of being glasses-free in the distance, and usually up close as well.Otherwise, assuming he is even a candidate, the standard disclaimers about refractive surprise with an MF or EMV lens. May need PR...

Agree with all of the above. Note that there is a big difference between a 2 or 4-cut RK and a 12-cut with astigmatic AK cuts. I can also remember a patient that I targeted for mild myopia afterwards and ended up hyperopic. She was bitterly unhappy, and after about nine months, badgered me into exch...

People who have had RK have more unstable corneas; the more cuts, the worse. If the expectations are too high, you need to quash them BEFORE surgery. Complete spectacle independence is a high bar at a baseline.