I had LASIK eight years ago and have now begun to lose the clarity of my vision again. Can I do another LASIK surgery?
Can You Have LASIK Twice?
Doctor Answers (9)
IF your distance vision has began to become blurry, a second procedure may be possible. This is routinely done if the patients cornea is healthy and there is enough tissue left (we remove a very small amount of tissue every time we do LASIK). The surgeon may also choose to do a different type of refractive procedure for your enhancement. This will depend on the status of your cornea and technology available to the surgeon.
If your distance vision is still fine but your near has began to blur, this is not correctable with a second procedure. All patients with LASIK will inevitably loose their near clarity as the age beyond 40 years old. This is a natural aging process and LASIK will not help the near vision, only reading glasses. Your distance vision should remain stable as you age.
It is possible to have your laser procedure touched up(we call this an enhancement) years later if necessary. Although the results of your initial LASIK procedure will be permanent, there is a chance that your vision can change a slight bit, or that laser technology might allow us to do other things with your vision later on. If this is a possibility you would need to have a full examination again to be sure your cornea is thick enough and all of the other parameters are suitable, but then the touchup would be safe and appropriate.
Repeat LASIK is sometimes possible even years later
There is no certain answer to this and it depends on your particular case. If the eye is well healed, there is adequate tissue left, and there is a significant benefit in doing more surgery, then a repeat LASIK may be performed. Our experience is in lifting flaps for retreatments this many years out there is a higher chance of complications such as epithelial ingrowth and you need to discuss this with your doctor. Sometimes a surface or PRK treatment can be performed, but this is definitely off label and not an FDA approved treatment (nor is any repeat laser treatement FDA approved).
Some patients only have very minor changes in their vision, and a repeat surgery is not always in their best interest. It is up to you and your doctor to evealuate your case individually and make that determination.
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Most people that have LASIK are able to have a second or enhancement procedure. For at least the first year, assuming that there is a safe amount of cornea left, that would involve lifting the flap. If an enhancement is needed further out, the treatment may be safer with surface ablation.
Re-treatment for LASIK
The short answer is yes, it is very likely you could undergo a re-treatment or enhancement procedure. You must, however, be carefully screened by your surgeon to ensure that there is enough remaining corneal thickness to safely correct your residual nearsightedness or farsightedness. Whether it is your first or second surgery, in order to decrease the chance of needing a re-treatment, you and your surgeon should be sure that your prescription has remained stable for at least a year or even longer. My re-treatment rate is exceedingly low because I always make sure the prescription has remained stable for at least a year and even longer in younger patients.
Additional LASIK Procedure
LASIK surgery is safe and effective. During the procedure small amounts of tissue are removed from the cornea to change the shape of the eye. From the 20 year LASIK experience we know that the results are very stable, but sometimes refractive changes do occur over time, leading patients and doctors to consider an enhancement procedure. Whether it is appropriate to proceed with an additional treatment depends on a number of factors:
- Find out what is the reason for the change in vision? Is it just a slow drift in prescription or is there something else like a cataract that is now affecting the vision?
- What is the prescription? Is it amenable to correction with the laser? Is it significant enough to warrant the enhancement?
- How much cornea is remaining? Is there enough room for treatment to safely proceed with the enhancement?
- What is the corneal architecture and is it safe to proceed with another treatment?
- How will the treatment affect the need for reading glasses (presbyopia)?
- Are there any other factors that could influence the outcome of the procedure, such as newly diagnosed diabetes, or glaucoma?
To summarize, LASIK enhancements are safe and effective and there is usually no time or age limit. A consultation with an experienced refractive surgeon with access to modern diagnostic technology like Pentacam and treatment technology like the latest EXCIMER lasers like Allegretto EYEQ 400, is the best way to find out if it’s indicated.
Multiple LASIK Procedures Are Possible
Surgeons always try to leave enough cornea for a LASIK enhancement if it is necessary. Today most refractive surgeons prefer to enhance with surface laser (PRK) which spares even more cornea since the tissue ablated is the flap. As a result, it is very likely that you can have further laser if you need it. The one key issue is to be certain that your loss of clarity is due to regression and not to some other eye disease such a cataracts or keratoconus, which your surgeon should be able to determine by examining your eyes.
Repeat LASIK For Right Circumstances
If a person has had LASIK and is under or over corrected, or has astigmatism which affects vision or is less than 20/20, a touch up LASIK or "enhancement" can be performed. I prefer a Custom Wavefront enhancement which corrects both refractive errors and wavefront abnormalities, and is a unique treatment for each eye corrected. As long as the cornea is thick enough, the original flap is lifted for the treatment, so the procedure is less involved that the original LASIK.
you can usually have LASIK done again, provided your cornea is thick enough, so you don't go too deep into your cornea, which would not be safe
i used to enhance LASIK flaps by relifting, or recutting when it was all scarred down so i couldn't get the flap back up again (which is probably your case because it was 8 yrs ago)
the reason this is not ideal is the risk of epithelial ingrowth is 10x higher after an enhancement, because the flap edges are all raggety and not smooth, unlike after the primary cut
a few years ago, i actually transitioned, where i NEVER LIFT OR CUT a new flap anymore, but just laser the surface of the eye to enhance a LASIK. this has many advantages, including decreasing the risk of epithelial ingrowth, flap striae or wrinkles, DLK, debris under the flap, and flap misalignment, to name a few, to ZERO
i believe that within 5 years, more than 50% of all eye surgeons will enhance like this, as the risk profile is clearly much better.
you MUST however, use mitomycin c (MMC) if you move to the surface ablation technique, or you will scar.
in summary, in 2012 i really feel very strongly that your lowest risk for enhancement is on the surface. you also don't have to worry about going too deep, as you are NOT going deeper into the cornea. that's why if you enhance LASIKs by relifting or recutting, you can only enhance once, maybe twice. with the surface ablation techniques (LASEK and epiLASEK), i could enhance 10x if i wanted to, safely (not that i would ever need to)
hope this helps!:)
These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.
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