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Can LASIK wear off?

Patients who plan to undergo vision correction surgery, or refractive surgery, often ask if the result from laser vision correction is permanent. Below is a discussion on the long term effect of eye surgery on your visual perception. Even though LASIK can effectively correct refractive errors such as near-sightedness, far-sightedness, and astigmatism, there can be a loss of the corrective effect over time.

Can LASIK wear off?

  1. In the years following a LASIK surgery, the cornea may experience tissue remodeling.
  2. As the human eye changes its shape, there may be a regression, or return of refractive error resulting in blurred vision.
  3. The vast majority of LASIK surgeries do not result in this type of regression over time.
  4. This risk of regression is not the same for all patients who undergo laser-assisted in-situ keratomileusis (LASIK) or photorefractive keratectomy (PRK).
  5. Patients who are at greater risk include patients who have a larger eye glass prescription (i.e. over -6.00 diopters of myopia) or patients who wear a positive prescription in their corrective lens (i.e. hyperopia).
  6. Although the effect of LASIK can diminish over time for a small subset of patients, the visual acuity can be restored by your surgeon with an enhancement procedure.

How long does LASIK last?

For the vast majority of patients who get their eyeglass prescription corrected by LASIK, it is a permanent fix. For these patients the correction will last for many years without any signs of visual impairment. Eventually, as the human eye ages over the age of 45, there may be disease that can impact the visual acuity. These diseases include:

  1. Cataract formation that can make vision cloudy.
  2. Glaucoma that can impact peripheral vision and the eye’s ability to detect changes in contrast.
  3. Changes in the retina that can cause vision distortion.
  4. Changes in the flexibility of the natural lens can make it difficult to focus objects at a near distance (i.e. presbyopia) which can make reading more difficult.

Who is a candidate for LASIK enhancements?

In a small subset of patients who undergo LASIK, there may be a loss of effect over the course of a few years that is called regression. In these patients a secondary procedure known as an enhancement may be possible to regain the effect of the original laser surgery procedure. An eye examination done by your eye doctor can determine if your eye health and corneal health (determined by corneal topography) is appropriate for an enhancement procedure.

Are there any underlying causes of poor vision after LASIK?

Potential causes of poor vision after LASIK include:

  1. Dry eyes – There is a transient change in your tear production system after a laser vision procedure. Your tear production system usually returns to its normal level of function after several weeks. This dryness on the surface of your eyes can cause a fluctuation of your vision throughout the day.
  2. Undercorrection – Very rarely there can be an insufficient amount of laser treatment applied to your eyes at the time of the laser treatment. Each human eye is unique and may have an unanticipated healing response to the laser treatment. In our experience, less than 1% of patients may have some leftover prescription after the laser treatment. This residual refractive error can usually be treated with an enhancement procedure within a few months of the original treatment.
  3. Vision problems such as halos and glare after LASIK are rare side effects that can impact vision quality, especially in dimly lit conditions. The vision system in your brain will typically take some time to adjust to your eyes and these signs and symptoms will typically diminish over the first few months after laser vision correction.

More FAQ’s about Can LASIK Wear Off

Does LASIK correction fade over time due to natural ageing?

Natural age-related changes of the eye can definitely cause problems that can limit the effect of laser vision correction. These age-related changes of the human eye include:

  1. Presbyopia – A stiffening of the natural lens over the age of 45 that causes a progressive symptoms of blurry vision for near activities.
  2. Cataract – A gradual opacification of the natural lens over the age of 55 that can cause visual distortion and fogginess.
  3. Dry Eyes – Many people over the age of 50 experience hormonal changes that can cause a decrease in tear production, which in turn can impact quality of vision.
  4. Glaucoma and Macular Degeneration – The risk of these age-related diseases of the eye increases over the age of 55.

It is important to note that LASIK generally does not increase your chances of developing these ageing changes of the eye. These ageing changes could occur even if you elected not to get LASIK.

Can regression occur after LASIK, and how is it managed?

Regression is a loss of effect of the laser treatment over time due to remodeling changes of the cornea. The likelihood of having regression after any type of laser vision correction procedure is probably in the range of 15-20%. There are certain risk factors that can make regression more likely. These risk factors include larger refractive errors such as high myopia (i.e. more than a -6.00 prescription), as well as hyperopic treatments for patients with positive prescriptions (i.e. the eyeglass prescription starts with a + which denotes far-sightedness). Newer evidence in the ophthalmology literature also suggests that performing near tasks such as reading, computer work, or phone work for 8 cumulative hours a day may also increase the chances of regression in the years following laser vision correction.

If you are noticing blurry vision in the years following LASIK, you should visit your eye surgeon for a problem solving eye examination. Your eye doctor will be able to measure your refraction and evaluate your eye health to determine if you are experiencing the signs and symptoms of regression. If your eye health permits, a quick and effective laser touch-up procedure may be possible to regain the effect of your original LASIK procedure.

How often do patients need LASIK enhancements?

A small subset of patients, usually less than 20%, may notice a visually significant loss of clarity in the years following LASIK. Some of these patients will elect to return to contact lens usage or eyeglasses. If eye health permits, some of these patients may choose to get a LASIK enhancement to regain the effect of the original LASIK procedure. Depending on their age, some patients may be better candidates for other procedures such as refractive lens exchange where a dysfunctional lens in the eye can be replaced with an intraocular lens that can restore vision at all ranges.

Are LASIK enhancements common, and what do they entail?

LASIK enhancements are not common. If there is evidence of regression, it is typically found several years after LASIK. In these patients, a touch-up or enhancement procedure may be possible to correct the vision. The procedure of choice for an enhancement is usually PRK, or photorefractive keratectomy. This is a quick and effective procedure where the surface of the LASIK flap is gently re-shaped to regain the effect of the original LASIK procedure. PRK generally produces excellent outcomes, but it has a longer recovery time than LASIK. After undergoing a PRK enhancement, patients will typically need a few weeks of healing time to recover excellent vision.

Does LASIK permanently correct astigmatism, or can it return?

LASIK is an excellent long-term treatment for astigmatism correction. Nonetheless, in less than 20% of patients, there can be a remodeling effect over several years that can blunt the effect of the original LASIK procedure. In this small subset of patients there may be a regression or return of some small amount of astigmatism which can reduce the sharpness of the visual acuity.

What causes some people to need glasses after years of having LASIK?

The most common reason why patients who’ve had LASIK wear glasses is because of ageing changes of the natural lens that make near vision more blurry over the age of 45. This age-related stiffening of the natural lens is called presbyopia and it tends to progress all the way out to the age of 65. Often times these patients still retain very good distance vision, but need readers or cheaters to look at small print.

How does LASIK interact with the aging eye, particularly the onset of presbyopia?

Presbyopia is an age-related stiffening of the natural lens in your eye. This reduction in the functionality of your natural lens results in having more difficulty with reading fine print at a near distance. It is important to note that having LASIK does not change the fact that nearly everyone develops these age-related changes in the eye. Even if you choose not to undergo LASIK, you will still develop the signs and symptoms of presbyopia at some point over the age of 45.

Can lifestyle or environmental factors influence LASIK longevity?

Newer evidence in the ophthalmology literature suggests that performing near tasks such as reading, computer work, or phone work for 8 cumulative hours a day may increase the chances of regression in the years following laser vision correction. This regression may manifest as nearsightedness, where things that used to be sharp at a distance are more fuzzy. Taking breaks when performing near tasks may have some protective benefit.

What are the long-term studies showing about LASIK durability?

The vast majority of LASIK patients maintain excellent vision for many years following their procedure. As such, there is a lot of evidence that the results of LASIK are durable and long-lasting. Less than 20% of patients (especially patients with prescriptions greater than -6.00) may notice regression, which is a partial loss of effect of the treatment due to remodeling changes of the cornea in the years following LASIK.

Is there a difference in LASIK wear-off rates between high prescriptions and low prescriptions?

Patients who are more nearsighted, such as patients with prescriptions greater than -6.00 diopters, tend to have a higher risk of regression in the years following LASIK. This elevated risk of regression has to do with corneal healing changes that are more pronounced in patients who start with a larger prescription.

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Dr. Nimesh Pathak is a board-certified ophthalmologist who has dedicated his career to vision correction procedures such as LASIK and premium cataract surgery. He has given thousands of patients visual freedom in pursuit of his goal to deliver the benefits of clear vision with a personalized experience.

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