I often get the question from my patients at their free comprehensive LASIK exam preoperatively asking, “Can I wear contacts after LASIK?“ This is an interesting question because contact lenses after LASIK?? Why would you do that?! A few LARPers (Live action role play) have asked, “Can you wear colored contacts after LASIK?” This makes more sense as to why you’d want to wear lenses, to change eye color/iris and not to improve vision.

Wearing contacts after LASIK is definitely possible, But is rarely necessary because… You’ve had LASIK! I’m not sure why I get this question about LASIK contact lenses, but I think it’s just a reaction to the unknown and to the trepidation surrounding LASIK. The only reason I can think of for you to wear contacts after LASIK is if you need a touchup- also called an enhancement. An enhancement refers to a second procedure to adjust the result of your LASIK procedure. And if that’s the case: have the enhancement and you won’t need the contact lenses after LASIK!

LASIK Enhancement

There are two basic categories when discussing the need for an enhancement after your LASIK surgery:

• Short term- 3 to 6 months: The LASIK laser is extremely accurate at shaping the cornea to the precise curvature that your eyes need to see clearly without contact lenses or glasses. In a small percentage (less than 2% over all patients regardless of age or starting prescription) of people, there will be a slight residual astigmatism or nearsightedness that can be corrected or adjusted with a procedure called an enhancement. The potential need for an enhancement after LASIK is correlated to your amount of prescription and is somewhat correlated to your age. That is, if you have a very high degree of nearsightedness and/or astigmatism, then the risk of needing an enhancement goes up slightly. If you have a low degree of astigmatism and/or nearsightedness, the risk of enhancement is less. Also those under age 40 have a slightly lower risk of needing an enhancement versus those over 40 years old. In my practice, I have always waited at least three months for the eyes to heal after the LASIK procedure before I assess the need for an enhancement. The enhancement procedure is very easy and extremely accurate.

• Long-term- A year or more: We have found that the vast majority of people never need additional laser after their original LASIK procedure. Approximately 1% per year of the people who have had the LASIK or PRK procedure needed an enhancement over a ten-year period.* That is to say that only one out of 10 over a ten-year period needed a touchup (enhancement).

Other Reasons for Contact Lenses after LASIK

As we age, there are inevitable changes in our eyes. One inevitable change is the loss of flexibility of the natural lens of our eyes that results in presbyopia. Presbyopia occurs in everyone at around age 45. This is still something that we don’t have a superb treatment for. Multifocal contacts after LASIK are generally a poor option. Unfortunately, no one can have perfect distance and near vision in both eyes forever with their natural lens.  Sometimes our nearsighted (blurry distance vision) patients do not understand this and they say,

45 year-old Patient: “Oh, I have no problem seeing up close, I just take my glasses off!”

Doctor: “How is your distance vision?“

45 year-old Patient: “Oh, I can’t see anything at distance!“

Doctor: “So you see, you can’t have it both ways.“

One potential treatment for presbyopia is a multifocal contact lens. LASIK itself cannot fix presbyopia. The options for presbyopia treatment when you are over 45 years old include:

• Refractive Lens Exchange (RLE): We often recommend an RLE, or refractive lens exchange. This means that we remove the natural lens in your eye and replace it with a high tech intraocular multifocal lens. This allows you to focus on distant objects, near objects, and fairly well on middle range objects. RLE makes it so you don’t need glasses for anything! RLE corrects your nearsightedness/farsightedness, astigmatism, and need for reading glasses, and you will never need cataract surgery. If you wait long enough, cataracts are inevitable. The average age to remove cataracts is 71 years old, but some have it much younger or older than that. It often makes sense to have RLE if you are over age 45. My reasoning is that if you have six pairs of glasses and are over age 45, you can fix everything with one procedure and will no longer have the cost of purchasing glasses. Your nearsightedness, astigmatism, and presbyopia are all corrected AND you will not need cataract surgery when you are older. Yes, insurance contributes to the procedure if you are older, but it’s still a fairly small percentage of the overall cost, and by doing it younger, you are simply done with eye surgery and everything is fixed! Why wait until you are old to have perfect vision again!
• Monovision: I have written blog posts on presbyopia in the past and talked about this. Monovision is when we treat one eye for distance vision and one eye for near vision. Most people think they wouldn’t like this, but most folks do adapt quite well to monovision.  You don’t need to move your head to focus, you don’t have trouble with depth perception, and you don’t get nauseated or headaches from monovision. It’s also reversible for most patients. I have had people upset with me when we treat both eyes for distance and they have trouble seeing near objects after LASIK, but I’ve never had people upset with me for doing monovision.  The percentage of people who reverse monovision is probably around 1%.  Presbyopia affects EVERYONE beginning around age 45. If you have good distance vision, you WILL have trouble seeing things up close. This is why we wear bifocals, and this is where multifocal contact lenses after LASIK are potentially an option for anyone over age 45.
• Multifocal Contact Lenses after LASIK: Contacts after LASIK might be appealing to someone who is over age 45 (and therefore cannot have perfect distance and near vision in both eyes with their natural lens) who is able to comfortably wear contact lenses. I’ve had people who adapt well to multifocal contact lenses, but for the most part I have found that my patients would rather just wear reading glasses then deal with the hassles of multifocal contact lenses. Multifocal contact lenses create some decrease in visual acuity and quality of vision at distance and are not superb for near vision either. The point is that you can safely wear contacts after LASIK.

Colored Contact Lenses after LASIK:

Unfortunately, I cannot recommend wearing colored contact lenses, also called “novelty contact lenses” after LASIK, unless they are purchased directly from a reputable contact lens manufacturer that also supplies vision correction contact lenses. Colored contact lenses are often imported from disreputable manufacturers overseas. The sterility of these contact lenses cannot be guaranteed and they may be very irritating to your eyes. Novelty contact lenses are impermeable because they have heavy pigmentation and don’t let oxygen in. This creates an environment for bacteria to thrive and penetrate your cornea. Contact lenses used for refraction (nearsightedness, farsightedness, or astigmatism) from reputable manufacturers are guaranteed sterile and are highly oxygen permeable. Even short term use for Halloween or costume parties (LARP) may cause vision threatening corneal infections.

“Most people don’t realize that there are over 1 million emergency room visits for corneal infections from contacts each year in the United States.”

Another reason people ask, “Can I wear contact lenses after LASIK?“ is that their optometrist tells them that they won’t be able to wear contact lenses after LASIK. I’m not sure exactly why this myth persists, but contact lenses are soft and malleable and can fit on just about any shaped eyes. It is true that our corneas are slightly flatter after LASIK than they were to begin with if you started out nearsighted. If you started out farsighted, then your cornea will be slightly steeper or more curved than it was prior to your LASIK procedure. These changes are fairly small, and a contact lens molds to just about any shaped eye.

Rigid gas permeable lenses (RGP-hard contacts) on the other hand, would need to be custom fit to wear after LASIK. Very few people would need to wear RGP lenses, and most commonly RGP lenses are fitted for someone who has a pathological condition of their cornea such as keratoconus. Keratoconus is a condition where the cornea is weak or thinned and is irregular or bulges so that the vision is distorted. There is a theory that is gaining in acceptance that a significant portion of people with keratoconus, a type of corneal ectasia, are exacerbating the condition by severe eye rubbing. This is a difficult hypothesis to prove because many people rub their eyes and do not get keratoconus, and many don’t rub their eyes and do get keratoconus. My current working hypothesis is that there probably are a significant number of people with keratoconus who get it because of severe eye rubbing, but there are probably other factors involved.  Keratoconus can potentially be helped by wearing RGP lenses to mask the irregularities of the corneal shape, as well as mold the eye to some extent.

Can you wear contacts after LASIK surgery? Sure, but why would you want to? Isn’t that why you had LASIK in the first place? Schedule your free comprehensive LASIK consultation online at: sharpe-vision.com or call us at 425-451-2020. We look forward to helping you get out of glasses, so you do not need to wear contact lenses after LASIK or any other of our procedures at SharpeVision.

SharpeVision: making glasses a thing of the past.

*Internal industry data on 124,000 eyes treated in a period from 2000 to 2010.