Can a Doctor Tell if I Have Had LASEK Treatment

On routine eye examinations, doctors can be fooled as your eye will appear normal on biomicroscopic testing.  However, if the eye doctor performs more thorough testing such as corneal topography or corneal thickness measurements, then the doctor should be able to ascertain that you have had LASEK, PRK or LASIK.  

As a patient, it is your obligation to detail disclose that you have had prior refractive surgery as this can impact the intraocular pressure measurement, and ultimately, the health of your eye.

LASEK is a form of Advanced Surface Ablation (ASA) just like Photorefractive Keratoplasty (PRK).  The process involves removing the top surface layer of the cornea, the epithelium, reshaping the cornea, and then replacing the epithelium.  A bandage contact lens is then placed over the cornea and it then typically takes three to four days to allow the eye to heal.  At one time, some ophthalmologist thought that superior results were achieved by replacing the epithelium.  Most refractive surgeons haven’t found a significant benefit to LASEK over other forms of ASA.  The end result is the same.  As will all forms of ASA, when healed there is no evidence of surgery visible even with the magnification that an ophthalmologist uses to examine a cornea.  On the other hand, measurements of the curvature of the cornea would show evidence of refractive surgery with either a flattening picture as seen for nearsighted treatments or steepening seen after farsighted treatments.  Other methods may also show signs of LASEK. 

It is important to always tell your eye doctor that you have had any form of eye surgery so that they can best be an advocate for your eye health.  Thinner corneas seen after refractive surgery need to be understood in the diagnosis of glaucoma.  The changed curvature is very relevant to your cataract surgeon when that time arrives.  If your surgeon did not know of previous refractive surgery, the measurements made for the power of your implant could be substantially different than that needed.  We give all of our patients preoperative measurements important for the calculations for the intraocular lenses needed in cataract surgery.

Mark I. Golden, MD, FACS, FICS

After surface ablation procedures such as LASEK & PRK the cornea typically appears perfectly normal once the initial healing phase ends. Therefore, especially years after surgery as in your case, it is often difficult for a doctor to tell that any surgery has been done (even when using our high magnification slit lamps). Of course, you should always give an accurate medical and surgical history when seeing a new physician as withholding information could adversely impact your care.