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Hello and thank you for your question.
It sounds as though your brother has experienced significant regression in his refractive error (need for glasses) after the RK.
In eyes that have had previous corneal refractive surgery performed on them, a thorough evaluation must be performed to determine whether or not LASIK is appropriate for the patient, given their previously altered corneas. In the right setting, a patient with severe myopia and severe astigmatism may indeed be helped by laser refractive surgery such as LASIK, even after RK, but the circumstances have to be right. A good LASIK surgeon will evaluate all of his measurements and take into account his exam to arrive at what is the safest and most beneficial option to help your brother's refractive situation. If you feel like this surgeon does not have your brother's best interests at heart, or you feel uncomfortable with his/her recommendation, it would be wise to seek a second opinion.
As far as the retinal diagnoses, peripheral retinal degeneration and macular degeneration, the retinal degeneration is consistent with a long eye (these eyes that are long are very nearsighted and typically have thin retinas). This can put him at risk for retinal breaks/holes/tears with intraocular surgery, but many people still have surgery with this condition and do just fine. The macular degeneration diagnosis is a bit puzzling because it is quite usually a diagnosis made an elderly person. That being said, however, there are forms of retinal disorders that may mimic macular degeneration that can be seen in younger individuals, and this may be the case with him. However, LASIK will do nothing to help any retinal condition.
As far as his posterior subcapsular cataract, the only thing that can improve this condition is cataract surgery, which can be very beneficial to his vision if the cataract is indeed causing him significant vision problems.
Does this help address your concerns?
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Thank you. So to recap and make sure I understand you correctly
- the thinning of the retina is part of the very high myopia - with LASIK the eye will be reshaped and while the retina won't recover, it likely won't be as 'stretched' in the future and at risk of detachment? what happens if the retina is torn after LASIK?
- there is a separate surgery needed to fix the cataract? should it be performed before or after LASIK?
A thinning retina can be a form of peripheral retinal degeneration, but it may not be a thin retina unless the ophthalmologist said it was. It is just a common presentation with someone who is so myopic.
The cornea is what is reshaped in LASIK and so given that this is not intraocular surgery (surgery on the inside parts of the eye) the risk that LASIK causes problems with a thin retina are less than say cataract or retinal surgery, but not zero.
There is a separate surgery needed to remove the cataract (a cloudy lens). In that separate surgery the cataractous lens is removed and an artificial lens is inserted in its place. The retina can tear with any ocular surgery, but I would suspect cataract surgery (given that it is an intraocular surgery) would be a more likely cause of a retinal tear/hole/break or detachment than LASIK, as it is not an intraocular surgery, but there are still significant forces placed on the eye in LASIK as well, so that risk is there with it, too.
Generally, it is best to do cataract surgery prior to LASIK because the refractive status of the eye (thickness and curvature of the cornea, specifically) is intact and can be counted on to give reliable measurements for artificial lens calculations in cataract surgery if the cataract surgery is done first. While it is not impossible to do cataract surgery after LASIK, the reliability of measurements and predictions of post-operative refractive errors become less reliable if the LASIK is done before the cataract surgery.
Does all that make sense?