Surgical treatment for post lasik increase of higher order aberrations

By the title of your question, I assume that your HOAs post-LASIK are increased compared to what they were pre-LASIK. Did you have standard or wavefront LASIK? Although possible, it is very uncommon for wavefront LASIK to cause an increase in HOAs. You don’t mention what your current prescription is. Even with 20/20 vision you might have a small prescription. If you have a small amount of nearsightedness, farsightedness and/or astigmatism (low order aberrations), this can cause glare and starburst at night just as HOAs can. For the sake of answering your question, I will assume you have no residual prescription, and just HOAs. It is unfortunate that the Alphagan P drops are not helping resolve your symptoms. Honestly, in my opinion, that does not bode well for you as far as additional surgery. A smaller pupil will ALWAYS reduce HOAs when measured with aberrometry, so if HOAs are the root cause of your night troubles, it doesn’t make sense that the drops don’t help at all. Some lasers, such as the Visx, offer technology which allows a patient to preview the results of a wavefront treatment (with Visx this is called PREVUE). You can consider this to see if an HOA-only retreatment may help the quality of your night vision. And as you correctly point out, yes the potential risk of this is becoming farsighted. Some surgeons will apply a small amount of farsighted LASIK at the time of the HOA treatment to reduce this risk; some will do the HOA treatment and see what happens, and treat the farsightedness down the road if it occurs. Hope this helps.

Sometimes increasing the optical zone (assuming there is enough cornea) can reduce the symptoms of  night glare and halos. I would advise you to see your refractive surgeon to determine if you are a good candidate for either PRK or a Lasik enhancement with an increased optical zone ideally on a custom wavefront platform.  

The incidence of quality of vision issues after custom Lasik is 1-2% usually confined to higher prescriptions. The cause of this symptom can be traced to irregularities that have been created in the corneal bed after laser ablation. A custom wavefront or topography guided surface treatment can reduce these symptoms by 95% in our hands. The treatment needs to be carefully adjusted to avoid over correction.