Optiwave Refractive Analysis may not work well in patients with previous history of radial keratotomy.

Purpose: To report a case of significant hyperopic outcome (both eyes) following Optiwave Refractive Analysis (ORA) intraocular lens (IOL) power recommendation in a cataract patient with history of 8 cut radial keratotomy (RK) in each eye.

Observations: It is hypothesized that increased intraocular pressure (IOP) from phacoemulsification could make the RK cuts swell, and change cornea shape intraoperatively. In this unique scenario, the corneal curvature readings from ORA could be quite different from preoperative readings or from stabilized postoperative corneal measurements. The change in corneal curvature could also affect the anterior chamber depth and axial length readings, skewing multiple parameters on which ORA bases recommendations for IOL power.

Conclusions and importance: ORA has been widely used among cataract surgeons on patients with history of RK, but it's validation, unlike for laser-assisted in-situ keratomileusis (LASIK) and photorefractive keratectomy (PRK), has yet to be established by peer reviewed studies. Surgeons should be cautious when using ORA on RK patients.