LASIK Enhancement: When Additional Surgery Is Needed
A LASIK enhancement is a follow-up LASIK procedure that sometimes is performed if the outcome of your original vision correction surgery is unsatisfactory.
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 in findings published in 2008 showed that more than 95 percent of the 16 million people who had undergone LASIK surgery were pleased with their new vision.
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, which could be a factor in dry eyes after LASIK.
- 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 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.
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 with glasses before LASIK surgery. But you should be able to drive safely and perform other routine daily tasks without glasses or contact lenses after vision correction surgery.
When Is a LASIK Enhancement Needed?
When evaluating your vision after LASIK, it's important to be patient (no pun intended). 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 to months.
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 until your vision improves and stabilizes.
If your vision is still noticeably blurred three months after LASIK, you may need an enhancement.
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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 considerations, 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 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 additional reshaping of the cornea 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 you 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 cases, only one LASIK enhancement 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 performed within one year of a primary LASIK procedure that they performed themselves. But pricing policies can vary considerably among refractive surgeons and surgery centers.
When choosing a LASIK surgeon, ask about policies and fees for enhancement procedures and the additional follow-up care needed if a LASIK enhancement is performed.
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 age 50.
Regardless, a surgeon's LASIK enhancement rate is not a good indicator of his or her surgical skill. For example, Surgeon A may have a higher enhancement rate than Surgeon B because Surgeon A is more likely to recommend additional surgery to achieve the best visual result possible, even in cases when the outcome of the primary LASIK procedure is quite good.
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 a surgeon who performs LASIK enhancements more frequently may have better patient satisfaction ratings than 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 (RLE). And in some cases, procedures other than LASIK may be used for enhancements.
For example, a refractive surgeon may prefer PRK rather than LASIK for an enhancement because he or she doesn't need to create or re-lift a flap for PRK. For enhancements done many years after the original LASIK, PRK is preferred by most surgeons, as it generally carries less risk of surface cells growing under the flap (epithelial ingrowth).
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 procedure is right for you.
About the Author: Brian Boxer Wachler, MD, is an ophthalmologist and refractive surgeon at the Boxer Wachler Vision Institute in Beverly Hills, Calif. He has pioneered treatments for keratoconus, participated in many FDA clinical trials for new refractive surgery technologies and written several books. He is a member of All About Vision's editorial advisory board.
[Page updated July 2014]