Lee Katzman, MD

Branded postop drops are so important in my practice that we provide them to every patient (this way I don’t need to worry about pharmacies switching out my meds). A strong anti inflammatory steroid (like durezol/difluprednate) 2x per day for 7 days, preservative-free moxifloxacin (antibiotic) 4x per day for 5 days, and preservative-free artificial tears 4x per day for 1 month (or more if needed). Preserved drops (any drop in a bottle) are prohibited the first month, including visine/opconA/cleareyes. If your eyes are red after surgery there is likely a good reason for that (dry eye, rebound off of the aforementioned drugs, etc). So if you stick to the proper regimen and still have irritated red eyes then I would likely advance therapies to other pharmaceuticals. 

This is a complex question to answer, because the length of time your LASIK treatment will last depends on the size of your treatment (are you a -2.00 SPH treatment or a -7.00 SPH treatment?), whether it’s a hyperopic or myopic treatment, your age, and to a small degree, your genetics. LASIK is FDA approved for 18 year olds although I like to wait until at least 21 to establish some level of stability. The eyes may continue to grow into your late 20s or so, but who will continue to grow and who won’t is completely unpredictable. In fact, a recent largescale international study (schallhorn, et al) confirmed that even establishing 2 years of refractive (prescription) stability before LASIK didn’t guarantee stability in the ensuing years. Getting surgery in your mid 20’s is probably ideal for this reason.

All that said, in general, a LASIK treatment could last decades without an enhancement. The data on lifetime enhancement rates is variable, but its somewhere in the 1-5% range. Farsighted patients are far more likely to need a retreatment in their lifetimes, and I tell every single patient the same. The corneal treatments for hyperopia (farsightedness) tend to regress at a faster rate than their myopic counterparts. Regardless, we have lifetime enhancement packages for our patients, so if they come back in 10 years or more and require a treatment, they won’t have to pay anything (which makes the idea of getting an enhancement more palatable). 

Hyperopic (or far-sighted) lasik is a different beast from myopic (near-sighted) lasik (which is far more common). When you hear about friends getting lasik and waking up the next morning and having perfect vision...that’s almost always myopic lasik. Myopes get 95% of their vision in the first 24 hours. Hyperopes heal differently and can take 3-6 months to stabilize. I find that +1 to +1.5 D do extremely well and have a majority of their vision in the first week. Beyond this power, I have seen improvement out at 6 months even! There are some age considerations as well, because a 50+ year old will enjoy the vision they have transiently while recovering (they become nearsighted temporarily). A 30 year, not quite as much. Expectation management on the front end (by the doctor) is critical. Overall, time is on your side. If vision isn’t right after about 6 months your surgeon will likely offer you an enhancement. 

It's actually never good to rub the eyes, but rest assured it is extremely unlikely that you will cause any trauma to your flap just by rubbing the eye. That said, some people really 'go to town' on their eyelids. If the eyes are closed when rubbing, you should be good. Its the unintentional slip of the finger between the lids that could cause the damage. If you absolutely must rub, wait 2 full weeks. Try to use artificial tears when needed (cold drops help with itch, just put them on ice or in the fridge). You can't traumatize the flap without physically being aware of the damage. vision will get blurry and usually pain/discomfort will increase substantially. Call your surgeon right away in that scenario. 

There isn't a perfect age to have LASIK, because there are different considerations for surgery at different ages. Although FDA approved (for certain prescriptions) at age 18, I like to wait until 21 before I offer the surgery in my practice. This gives us a couple years to see stability in refraction, and a few years of college for some (extensive reading years). Invariably, when I do surgery on 30+ year olds they regret not having done the surgery in their 20s. Unfortunately many patients don't have the money needed for the surgery until their 30s (so they couldn't control that situation anyways). The most difficult time to get lasik is probably right at age 40. That's because this is right when patients are starting to strain while reading, and LASIK may exacerbate the situation if a customized surgical plan is not reviewed at length in advance. This same issue is less of a problem by age 50 because patients are well aware of their visual limitations and either really WANT to read without glasses, or don't care much and just want to be able to do sports/drive a car/etc without glasses. 

So in summary, the best time (in my opinion) to get LASIK is when you are at least 21, you're a good candidate, and you have the money. There are very few things in life you can invest money into that you will use every single day, all day long, for potentially decades without needing additional enhancements (which, in many practices, doesn't cost the patient anything out of pocket even decades later).