Are changes in ocular aberrations with age a significant problem for refractive surgery?

We discuss current knowledge about the change of aberrations with aging, cataract surgery, and laser in situ keratomileusis (LASIK) for myopia. Based on this evidence, we speculate about the long-term expectations for postoperative LASIK eyes in terms of aberrations. Standard myopic LASIK surgery produces a significant increase in aberrations, particularly corneal spherical aberration, which changes to positive values. Aberrations increase with age, and in particular, the spherical aberration of the crystalline lens shifts toward positive values. Therefore, no compensatory effect is expected to occur with age after standard myopic LASIK, but rather the unusually high amount of aberrations in postoperative LASIK patients is expected to worsen with age. The amount of aberrations in patients after cataract surgery with implantation of standard intraocular lenses (IOLs) is higher than in normal young subjects. If an ideal customized ablation (not inducing aberrations and reducing naturally existing aberrations) is ever possible, the perfect correction will not last (due to the change of aberrations with age), and aberrations of the crystalline lens corrected on the cornea are likely to reappear after conventional cataract surgery. Potential benefits of customized IOLs for cataract surgery and improved optics in older patients are discussed.