Will I Need a LASIK Enhancement?

This is a very common question that people ask, and I have perhaps a unique expert opinion on it because I have been doing laser vision correction for nearly 25 years and have treated over 80,000 eyes.

First, let me describe what a LASIK enhancement or LASIK touchup is. A LASIK enhancement is done when someone anywhere from three months to 20 years after their original LASIK procedure has a slight residual prescription, and we do slight additional laser to eliminate that residual prescription.

I believe there are two basic mechanisms that leave patients needing a LASIK enhancement. The first is when the initial laser treatment does not achieve exactly the result desired. Overall, about 2% of people after their initial LASIK will need a slight adjustment, or LASIK enhancement, to get rid of any residual prescription. This risk can be thought of like a “golf putt.“ The farther you are from cup on the green, the more likely it is that you will miss the goal. It is the same with a higher prescription; the chance of needing a laser touchup is slightly higher than if you have a very low prescription. For instance, a 25 year old with -2 dpt of nearsightedness will have a one in 500 chance of needing additional laser. It is extremely unlikely. Someone with a much higher prescription, such as -6 dpt nearsightedness with -3 dpt of astigmatism may have as high as a 1 in 10 chance of needing additional laser. That’s still nine times out of 10 that we will hit it perfectly, but one time out of 10 that type of patient will need a LASIK enhancement. At SharpeVision, we always wait at least three months to perform an enhancement. The reasoning behind this is that sometimes a patient’s prescription will vary slightly in the first several months. Another confounding variable is that dry eyes can make it appear as though someone will need a slight enhancement, but once the dryness goes away, they do not. This is why we follow our patients very carefully, looking for either residual prescription or dryness as a reason for any blurry vision in the first several months. Almost everyone has some degree of dryness. It does get better, but it can take several months to resolve.

The second major mechanism for needing a LASIK enhancement is if someone’s eyes change over a long period of time. This seems to occur in about 1% of people who’ve had LASIK per year. This is to say that over 10 years, there is probably about a one in 10 chance that you will need additional laser enhancement to continue to see clearly. This is why SharpeVision offers our LASIK4Life plan, so that if you need additional laser in the future, we perform it at no additional charge. It’s $200 per eye, and it allows you to be assured that your clear vision will continue.

One must keep in mind that we have several vision milestones. The different milestones can be described as:

Milestone 01

Ocular Maturity: Age 18 to 45. Our vision prescription is generally stable, and we still have a flexible natural lens in our eyes, so we don’t need reading glasses or bifocals.

Milestone 02

Lens Dysfunction: Age 45 to 60. At this stage, the lens of our eyes becomes less flexible which necessitates either bifocals, reading glasses, RLE, Monovision, or multifocal contact lenses. There is currently no perfect fix for lens dysfunction. The term Presbyopia is often applied to this stage.

Milestone 03

Cataract Development: age 60+ After 60, the lens of our eye is not only inflexible but becomes less clear. The symptoms of a cataract are most commonly noticed when we start having trouble driving at night and see more glare with oncoming headlights. We eventually have difficulty with the activities of daily living. This is called cataract stage. The treatment is to remove the natural lens and replace it with an artificial lens called an Intraocular Lens (IOL). Cataract surgery is performed over 4 million times per year in the United States.

Superimposed upon these stages can be a slight regression of your original LASIK result. If someone was originally nearsighted, they generally will regress toward nearsightedness. The same goes for farsightedness. We’ve found that farsighted patients are more likely to regress versus nearsighted patients. This becomes important in deciding what procedure to recommend for our patients to best solve their vision problems.

For many years I worked for a corporate LASIK provider, and we looked at the large number of patients treated in their Minneapolis center. When compiling outcomes data for over 120,000 eyes treated in Minneapolis over a ten-year period, we found that about 1% per year of these patients were needing an enhancement. We found that the LASIK enhancement numbers varied very little year to year and technology to technology. We did get better at decreasing the initial need for enhancement. That is to say that we tightened our results initially, but it didn’t seem to matter in terms of long-term stability.

So the basic answer to what is the likelihood of needing an enhancement after your initial LASIK is about 10% over 10 years. As we age though, it does not prevent you from needing reading glasses or cataract surgery. Once you hit those milestones, we move to other forms of vision correction procedures; from lasers to intraocular lenses.

How is a LASIK Enhancement Performed?

The LASIK enhancement in my practice is performed as a PRK. If you have had your original procedure more than one year previously, we perform the PRK procedure because it eliminates the risk of something called “epithelial ingrowth.“ If we were to lift the LASIK flap again, do the laser, and put it back, it looks pretty good the next day. However, there is a fairly high risk that the new skin layer will grow under the flap, if it has been lifted a year or more after the original procedure.

To avoid this risk, we at SharpeVision perform a PRK on the surface. We leave the LASIK flap where it is so we don’t break that seal. We remove the skin layer, do the same laser, and then the skin heals over the surface. The difference between PRK and LASIK is basically that: the epithelial skin layer has been removed it must grow back over the ocular surface. This results in more discomfort in the first 48 hours than you would have typically experienced during your LASIK procedure. The skin layer then takes 3 to 5 days to cover the surface. We place a bandage contact lens on the surface to allow the skin layer to heal undisturbed. For PRK, you generally need more time off work because it takes 5 to 7 days to get functional vision back. That is to say that you may have 20/40 or even 20/20 vision, but it’s not as crisp and clear as you would expect. Your vision then gets slightly better for weeks after a PRK procedure. The results with PRK are the same as with LASIK, but it eliminates the risk of epithelial ingrowth.

Hypothetically, there is no limit to the number of enhancements one could need after LASIK surgery. But in my experience, the risk of that scenario occurring is basically zero. So if we treat someone who is 28 years old, then do another treatment (enhancement) when they are 38 years old, that has generally been enough to keep them out of glasses for their entire adult life. There is still however the question of what to do about presbyopia and cataracts. In our 40s and 50s, we start thinking more about RLE (refractive lens exchange), which is where we remove your natural lens and replace it with a multifocal intraocular lens which allows you to see both distance and near clearly. This also prevents you from every needing cataract surgery, because you’ve already had the natural lens of your eye replaced. IOLs never wear out or need maintenance.

LASIK is such a wonderful procedure for young people because they don’t have to worry about presbyopia. I think the best time to have LASIK is in your 20s so that you can enjoy it, don’t have to worry about reading glasses, and save more money long-term because you aren’t buying glasses or contact lenses. Long term LASIK follow up numbers are in the millions already. Personally speaking, I had LASIK 25 years ago for high nearsightedness. My prescription was -8 dpt of nearsightedness with minus one diopters of astigmatism. I have absolutely loved having had LASIK when I was in my early 30s. It’s such an amazing thing to be able to swim, ski, and do all daily activities without having to worry about glasses fogging up or getting lost or contact lenses falling out. For myself, I also had a contact lens related condition called Giant Papillary Conjunctivitis, which prevented me from comfortably wearing contact lenses. Many of our patients also present with an intolerance to contact lenses.

It is such a wonderful thing to have this technology available! I encourage anyone who is suffering with glasses or contact lenses to come to SharpeVision to have their completely free comprehensive exam. At your exam, we will answer all your questions, so you can decide what vision correction option is best for you. Looking forward to seeing you soon!