Well, is LASIK Permanent?
I don’t think I’ve been asked the question “is lasik surgery permanent” as much in recent years. I think the reason why, may be due to more people knowing someone who had LASIK many years ago, and the person is still doing well and is happy they had lasik. I know that’s true for me. I had LASIK in 1998 and other than the normal reading glasses in my late 40s, I have great vision.
We all want to know what to expect after LASIK, and part of that is the answer to the question of how long does Lasik surgery last. Since I have been doing LASIK almost since it was first approved in 1995, I have a great historical perspective on it and have some data to back it up.
LASIK and PRK are “Permanent”
What will happen to my eyes in the future? Will I need to do LASIK again? As Yogi Berra once supposedly said, “it’s tough to make predictions, especially about the future.” Everyone wants to know what to expect with LASIK and PRK surgery, and we all should know, so that we can set our expectations. So I’ll do my best to describe the normal milestones for eye development, then talk about what that has to do with LASIK.
Our Eyes Change Throughout Our Lives.
There are several developmental milestones of our eyes:
- Childhood: under 18 years old
- Ocular Maturity: 18-45 years old
- Dysfunctional Lens Stage I: Presbyopia over age 45
- Dysfunctional Lens II: Cataract Development in our 60s and older
Aren’t Kids Adorable? As children, our eyes develop from birth to age 18 in a number of ways. The actual size of our cornea, iris, and lens doesn’t change much, which is why babies seem to have big eyes: their eyes are big relative to their heads. Aren’t they cute! But what also happens, is our eyes become more nearsighted, or longer from front to back. Extreme myopia is epidemic throughout the world. Exciting myopia research in recent years is showing promise in ways to limit the amount of nearsightedness in children. These treatments may reduce the risks associated with extreme nearsightedness. Retinal detachment, glaucoma, pathological myopia, premature cataract development, and other risks are all associated with high myopia. Our eyes tend to be relatively stable by age 18 and older. Most people believe their eyes to be changing well into their 20s, when in fact there will always be slight ups and downs in the measure of our glasses prescription every time we measure it. We do laser vision correction only on patients over 18 to ensure full ocular maturity.
Young Adults: Wow it’s nice to be young! After age 18, our eyes are amazing. We can see distance and near (either with or without glasses and contacts) due to a flexible natural lens that changes shape to focus more for near objects and relaxes for distant objects. Pretty cool. We generally produce plenty of natural tears and enjoy being able to see a country mile.
Presbyopia: It’s Not Genetic! From age 45 onward I always say, “No one can have perfect distance and near vision in both eyes forever.” Age 45 is predictably about when everyone has some problems seeing either distance, near or both, depending on your prescription. (Latent hyperopia is the exception, whereby people are farsighted but don’t know it until they need reading glasses when they’re under age 45, sometimes, in their late 30s. This is a fairly small percentage of the population though). So people get bifocals, reading glasses, multifocal contacts, monovision contacts, take their glasses off, or just struggle to see near objects. They hold things farther away, need more light, or ask their spouse to read it for them. This is dysfunctional! Which is why it’s been called dysfunctional lens syndrome. I like that term better than the historical “presbyopia” term for the same thing. Makes it sound like you become Presbyterian at some point.
I Hope You Get Cataracts! I’m not saying that to be mean, or to make more money for our practice. I’m saying it because I wish you a long and healthy life. If you live long enough, you will get cataracts. My parents had cataract surgery and now see better than they did when they were in their 20s. (They were both nearsighted, and after cataract surgery they only need glasses for near objects). The risks of cataract surgery are of course not zero, but when you need it, it’s almost always a huge improvement in your vision.
Death and taxes? As an eye doctor, I’d say there may two additional inevitable things in life: presbyopia and cataracts. As we age, first the lens of our eyes becomes less flexible (when we need readers, bifocals etc.). Later, the lens becomes less clear. Often even in our 50s, the lens of our eyes become slightly less clear. Most of the time this progresses over many years to the point where we start noticing glare around oncoming headlights, we struggle to see road signs, we feel like our glasses aren’t working, or need to be stronger. These can be symptoms of cataracts, and eventually we see an eye doctor who can advise us on cataract surgery, where we replace our natural lens with a clear and permanent artificial lens.
Wait…did I say we were going to Answer the Question: Is LASIK Permanent?
The short answer is yes! For most people, LASIK is as permanent as anything is in life. The reduction in nearsightedness, astigmatism, and even farsightedness is permanent. You will still have presbyopia, as the lens inside your eyes gets less flexible in your mid-40s. That same lens will become cloudy in your 60s or 70s.
There aren’t a lot of studies on long-term refractive stability after LASIK and PRK. The best one I could find as of this writing was a military study on 160 eyes (https://pubmed.ncbi.nlm.nih.gov/31125090/). However, when I worked at a corporate LASIK provider from 1999-2012, we looked at our internal data on over 120,000 eyes treated between 2000 and 2010, we found that just under one percent per year of people who had had laser vision correction (LASIK and PRK) needed an “enhancement” or additional laser. The data was admittedly deficient (as is almost every study in one way or another) in that we didn’t break it down into age, gender, starting refractive error, or by laser technology. There was no attempt to follow up on patients who we didn’t see back to see how they were doing. Lots of deficiencies! The high volume of eyes treated over a decade helped me form a strong hypothesis: LASIK and PRK are pretty stable. Farsightedness seems to be more likely to regress as compared with nearsightedness. Older patients could regress, and at seemingly the same percentage. About 1% chance per year (at least for the data period of 10 years) that you will need a touch up laser procedure. Those that needed additional laser were almost always still able to pass a driver’s license test however (20/40 or better uncorrected) They typically say something like, “My vision was awesome for 9 years and over that past year or so I’ve noticed it’s gotten a little blurry.” And that’s a tiny percentage of people who have had LASIK. I’ve often heard people say, “If I had to, do this [LASIK] every year, I would, because it’s so awesome.” The best news: for most people, it’s a one time thing. 7 minutes in the laser room, and you are done with glasses and contacts. Also good news: for the few who need additional laser long term, it’s usually just that: a small amount of nearsightedness or astigmatism that makes night vision a bit blurry.
Yeah, I’d say LASIK is permanent.
Our bodies, including our eyes change as we age. Ocular Maturity, Presbyopia, Cataracts, as we age is (with current technology) inevitable. There are exciting medications and products in the development pipeline that may make current problems obsolete over the next 25 years.
The reduction in nearsightedness and astigmatism that is enjoyed by millions of people worldwide over the past 25 years is revolutionary. Babies born today can expect to live longer and better, and with less nearsightedness than ever before. New technologies will inevitably make our future better. There’s your answer: Yes, LASIK is permanent.
-Dr. Matthew Sharpe