LASIK Enhancement:
When Additional Surgery Is Needed

By Gary Heiting, OD; reviewed by Brian S. Boxer Wachler, MD

A LASIK enhancement may be needed as a follow-up procedure if your first outcome is less than satisfactory or you have a complication following corrective eye surgery.

In most cases, you can expect a good result following a LASIK procedure even if an enhancement is done to help you achieve better vision. A worldwide study by the American Society of Cataract and Refractive Surgery shows that more than 95 percent of the 16 million people who have undergone LASIK surgery are pleased with their new vision.

But as your eye doctor will tell you before you have LASIK surgery, not everyone will achieve crystal-clear, 20/20 vision after just one procedure.

Each case has a unique combination of variables that can affect visual outcomes. So in some instances, you may need additional eye surgery — often in the form of a LASIK enhancement — to give you the sharpness of vision you desire.

Assessing Visual Satisfaction After LASIK

A number of factors affect your satisfaction after LASIK:

• The characteristics and health of your corneas.
• The type of refractive error you have, such as whether you are nearsighted or farsighted or have astigmatism.
• The amount (strength) of your prescription needed to correct your vision problem.
• The amount of tears you produce and their quality.
• Your age.
• Your expectations.

Although LASIK successfully corrects high degrees of nearsightedness, farsightedness and astigmatism, younger people with mild nearsightedness and astigmatism generally are the best candidates for a good outcome.

Your expectations before LASIK also may play a key role in how happy you are afterward. Remember, the goal of LASIK is to decrease your dependence on glasses and help you to see acceptably well without corrective lenses. Results vary from person to person.

Although many people who have had LASIK believe they see better than they did with eyeglasses or contact lenses before surgery, not everyone has the same experience. After LASIK, you can expect your vision to be slightly better or about the same as it was with glasses.

A small percentage of people may notice their vision is not quite as good as it was before with glasses. But you should be able to drive safely and perform other routine daily tasks without needing glasses or contact lenses.

When Is a LASIK Enhancement Needed?

When evaluating your vision after LASIK, it's important to be patient. Although you should be able to see much better without glasses the day after surgery, it's not unusual for vision to fluctuate for several weeks.

As part of your follow-up care after LASIK, your eye doctor will monitor your vision for several weeks.

Though not expected, it's possible that you may feel uncomfortable driving or performing other visual tasks after LASIK. If this occurs, be sure to tell your eye doctor. If necessary, he or she can prescribe new eyeglasses for you to wear part-time while your vision stabilizes.

If your vision is still noticeably blurred three months after LASIK, you may need an enhancement.

To determine whether you're a good candidate for a LASIK enhancement, your eye doctor will re-evaluate your corneas with the same methods used prior to your first LASIK procedure. Among other evaluations, your eye doctor will check to see whether you have enough corneal thickness for a second surgery.

How Does a LASIK Enhancement Differ From the Original Procedure?

A LASIK enhancement is nearly identical to a primary LASIK procedure, except for one aspect. Rather than using a microkeratome or laser to create a corneal flap, the surgeon performing a LASIK enhancement uses specialized tools.

These tools are manipulated to lift the flap that was created on your eye's surface during your primary LASIK surgery. Re-lifting the flap is painless and typically takes only one or two minutes. Then your surgeon uses an excimer laser to reshape your cornea.

Typically, only minimal corneal reshaping is necessary during an enhancement. So this laser treatment takes just a few seconds.

After the enhancement, you will receive the same post-operative instructions that were given after your primary LASIK procedure. Be sure to follow your doctor's instructions exactly, to reduce the risk of eye infection and facilitate a good visual outcome.

In most LASIK enhancement cases, only one procedure is necessary to restore vision to an acceptable level. However, in difficult cases, more than one enhancement may be required.

How Much Does a LASIK Enhancement Cost?

Many surgeons do not charge an additional fee for LASIK enhancements within one year of a primary LASIK procedure they performed themselves. Others charge a fee only if the enhancement is needed within a specified period of time (usually a year or longer) after the primary LASIK procedure.

When choosing a LASIK surgeon, ask about policies and fees for enhancement procedures.

How Often Are LASIK Enhancements Required?

It's difficult to pinpoint a specific percentage of patients who will need an enhancement after LASIK. Studies show enhancement rates range from fewer than 5 percent to more than 15 percent, based on factors listed above and other variables.

Generally, enhancement rates are higher for people who are farsighted, have higher degrees of refractive error or are older than 50.

Regardless, a surgeon's LASIK enhancement rate is not a good indicator of surgical skill. Surgeon A may have a higher enhancement rate than Surgeon B because of more concern for achieving the best result possible. Surgeon A may perform enhancements even for mild vision problems, while Surgeon B may perform enhancements only when vision problems are considered severe.

Also, surgeons who charge an extra fee for enhancements may have lower enhancement rates because of the financial disincentive for someone to undergo a second procedure.

So it's possible for a surgeon who performs LASIK enhancements more frequently to have good patient satisfaction ratings compared with a surgeon who doesn't perform as many enhancements.

As with any elective surgical procedure, it's important to choose a LASIK surgeon you trust. This means someone who will communicate with you well and show concern about your satisfaction.

Other LASIK Enhancement Options

LASIK enhancement surgeries can be performed to improve eyesight after refractive procedures other than LASIK, such as phakic IOL implantation and refractive lens exchange. In some cases, procedures other than LASIK can be used for enhancements.

For example, a refractive surgeon may prefer PRK rather than LASIK for an enhancement because he or she does not need to create or re-lift a flap for PRK.

LASIK and PRK enhancements also can be used after cataract surgery to eliminate residual refractive errors and sharpen vision.

If you have had LASIK or any other type of refractive eye surgery (including cataract surgery) and believe your vision isn't as sharp as it should be, visit your eye doctor to see whether an enhancement is right for you.

[Page updated July 2008]