Can you get LASIK twice?

Can you get LASIK twice? The short answer? Yes.

When my patients ask me: “Can you get LASIK more than once?” or “How many times can you get LASIK?” My reply is, “Yes, but you won’t likely need to have LASIK a second time.”

When I worked at a large corporate LASIK provider between 1999 and 2012, I asked myself “Can LASIK be done more than once?“ And I found the answer over many years to be “yes.” I have not seen someone with healthy eyes need LASIK a second time and not be able to get it. It is true that LASIK does remove tissue, and we have a limited amount, but it is exceedingly rare to need more than we have.

One of the advantages to “All-laser LASIK” is that the femtosecond laser creates a flap that is thinner and more consistent and reproducible than the old technology bladed keratome did 15-20 years ago. It allows more tissue to be sculpted by the laser from underneath the LASIK flap, which increases the safety of the procedure and allows higher prescription LASIK to be performed. With the advent of ICL (implantable contact lenses), no tissue is removed at all, so this is not even an issue. So far in my practice that I began in 2012, we have not needed to do an enhancement on anyone who had the ICL procedure, but I expect that some day someone may need an ICL enhancement.

First of all, it’s unlikely that you will need a second treatment in the first place. While I was working at a large corporate LASIK provider, I was the medical director in a major market and did the vast majority of the enhancements/re-treatments. When we looked at our data, this is what we found:

• Approximately 125,000 eyes were treated between the year 2000 and 2010.
• The data were retrospective, but it’s a very large number which should account for patients lost to follow up or not entered in the data when we ask the question “can you have Lasik more than once?”
• The highest percentage of enhancements was in first year at about 3% in 2000 and 2% by 2010 (the lasers have continually improved in accuracy).
• After the first year, the rate of needing a touchup averaged slightly under 1% per year over a ten-year period.
• We can confidently say that roughly 90% of people will still have excellent uncorrected vision at the end of 10 years after their Lasik, although some of these patients may have been lost to follow up.
• The remaining 10% are those that needed an enhancement/touch up at some point along the way.
• If that trend continued, one would expect roughly 20% of people to have needed an enhancement/touchup after 20 years, but this data is not available.
• Typically, the adjustments were very small amounts and over 99% of people had 20/40 uncorrected vision or better after the first treatment.

So, can you have Lasik twice? Definitely yes. For my patients, I always factor in enough tissue to make sure the answer is yes to the question “Can Lasik be done more than once?”

How many times can you have LASIK?

This question is a bit more difficult to answer solely because in my experience it has not needed to be answered. In healthy eyes, I have rarely (probably fewer than 20 times) needed to do a second enhancement, let alone a third. In my recollection those that needed a second enhancement were most likely to be someone with a high (over -6) initial glasses prescription. They needed an enhancement in the early post-op period. Then they needed a second enhancement years later.

The question: “Can you have Lasik surgery twice?” The answer: clearly yes, but the question: “Will I need another enhancement?“ Is more difficult. I don’t know, nor have I seen any data to answer if someone who has had LASIK twice (initial procedure and an enhancement) is more likely than someone else to need a second enhancement. My guess is that someone who has needed an enhancement is perhaps more likely to need a second enhancement, but this data would be difficult to acquire, and I’m not aware of any practice that keeps this data.

LASIK enhancements

I always say there are two mechanisms for someone needing an enhancement. The first one is that the laser just did not get them exactly perfect after the initial laser. This occurs in my hands about 1% of the time, where we need to do a slight touch up for any residual astigmatism or nearsightedness. I describe this as “the laser missed the mark.“ The second type of mechanism that may require an enhancement is when the laser hits the mark perfectly, and the patient enjoys excellent vision.  Many years later the eyes shift slightly causing a slight astigmatism and/or nearsightedness that we can touch up later. This is the part where it seems to be about 1% per year risk of needing more laser. I rounded up slightly (the actual numbers were slightly under 1%) because there may be some people who either moved away, needed an enhancement but weren’t bothered enough to undergo an enhancement, had an enhancement elsewhere, or went back to thin glasses. We have no way of determining exactly what that percentage is in my corporate retrospective data.

Typically, when someone needs an enhancement, their vision is still 20/40 or better, which is good enough to pass a driver’s license test but a little blurry, and may make someone squint to see faces at a distance. It’s not as good as it could be but typically 90 to 95% better than the patient was before they have LASIK

As for my own eyes, (I was -8, extremely nearsighted, with one diopter of astigmatism roughly in both eyes) I had Lasik in 1998 and still have near-perfect distance vision. As I am over age 45, I use reading glasses to help me see up close but do not need glasses for most anything else. This is typical.

The reality is that we won’t likely see people with much need for multiple enhancements, because of our lifespan and vision milestones as described below. If someone gets LASIK at age 25, then needs an enhancement at age 39, the next major changes would likely be those that happen to everyone regardless of their need for glasses or LASIK. We all (with current technology) will develop presbyopia and cataracts.

Our eyes do have certain milestones. The main ones are:

1. Ocular maturity: about age 18 to 22 when our glasses prescription stabilizes.
2. Presbyopia: this occurs about 45 years old where the flexibility in the lens of our eye decreases to the point where we need glasses for something: either distance vision, near vision, or both.
3. Lens dysfunction/cataract: this occurs about age 60 and up when the lens of our eye becomes less clear to the point that we need cataract surgery. Modern cataract surgery can allow us to see both distance vision and near vision without glasses and only needs to be done once.

As you know, our bodies are made of cells and organic material. Our eyes are no different, and like the rest of our body, our eyes age. The question for most of my patients is: “Can I get out of glasses and stay out of glasses my entire life?” With modern technology the answer is: “Almost entirely.” Hopefully in the next few years there will be better treatments for presbyopia (the need for bifocals or reading glasses). There are already superb treatments for cataracts. And obviously LASIK, PRK, ICL are all excellent treatments for nearsightedness that allow young adults to stay out of glasses until they develop presbyopia. We live in a wonderful world full of new technologies and more and better technologies continue to evolve. Would you like to make glasses a thing of the past? Then book your free comprehensive evaluation right on our website and get out of glasses now!

-Dr. Matthew Sharpe