LASIK (Laser Assisted In Situ Keratomileusis) is a popular refractive eye surgery that uses lasers to reshape the cornea and permanently correct vision problems like nearsightedness, farsightedness and astigmatism. Since LASIK surgery was FDA approved in the 1990s, over 40 million procedures have been performed worldwide.
Many people choose LASIK because they are tired of wearing glasses or contact lenses and want the freedom of seeing clearly without corrective lenses. The obvious question is: does LASIK truly give you perfect vision for life? Or does your eyesight eventually regress? Let’s take a closer look at how long LASIK results can last.
How does LASIK work?
During LASIK surgery, an ophthalmologist first creates a thin flap in the cornea using a laser. This flap is folded back to expose the underlying corneal tissue. The surgeon then uses an excimer laser to precisely reshape the cornea and correct refractive errors like nearsightedness.
Once the cornea is reshaped, the flap is laid back into place. The flap quickly adheres without stitches. This entire LASIK procedure takes 10-15 minutes per eye. Here are the steps:
Pre-surgery
Prior to the procedure, numbing eye drops are applied to prevent discomfort.
Corneal flap creation
A femtosecond laser or mechanical microkeratome creates a thin flap in the cornea.
Laser reshaping of cornea
An excimer laser sculpts the underlying corneal tissue to correct refractive errors.
Flap replacement
The corneal flap is laid back into place, where it adheres without stitches.
This custom reshaping of the cornea alters the way light enters your eye, allowing images to focus properly on the retina and correcting vision problems.
How long do LASIK results last?
For most patients, the improved vision from LASIK surgery remains very stable over time. Multiple studies show over a 95% patient satisfaction rate 15 or more years after LASIK.
Here are 5 key factors that determine the longevity of LASIK results:
Age at time of surgery
Younger LASIK patients under 40 tend to have more stable vision over time compared to older patients. With age, the eye’s natural focusing power diminishes. LASIK cannot prevent this normal age-related loss of near vision (presbyopia).
Pre-surgery prescription strength
People with higher nearsightedness or farsightedness pre-surgery are more likely to experience some regression than those with mild to moderate prescriptions. However, LASIK can successfully treat most prescriptions.
Accuracy of the original treatment
Use of advanced technologies like wavefront-guided LASIK optimize surgical precision and make vision loss after LASIK very unlikely.
Eye health and healing ability
LASIK outcomes last longer in patients that maintain ocular health. Factors like dry eyes, allergies or injuries may impact the cornea’s long-term stability.
Life changes after LASIK
Major shifts in hormones, weight or medications may subtly affect your vision. Pregnancy, for example, can temporarily alter refractive error.
While eyesight can gradually regress slightly with age, the vast majority of patients report LASIK significantly reduced their dependence on glasses or contacts for years.
Does the cornea “grow back” after LASIK?
The corneal flap created during LASIK quickly adheres and becomes securely bonded. The underlying corneal tissue that is reshaped does not actually “grow back” – once removed by the laser, this tissue is gone for good.
However, the eye may experience very slow topographic changes over time. One long-term study found, on average, the cornea gradually steepens by less than half a diopter over 10 years after LASIK. This minor creep back in corneal curve may result in slight regression in LASIK patients as they age.
But for most people, this regression is gradual and does not significantly diminish the visual freedom achieved with LASIK surgery.
When might LASIK enhancement be needed?
While LASIK outcomes are long-lasting for most, a small percentage of patients do experience vision regression that may warrant an enhancement surgery. Candidates for LASIK enhancement include:
– Patients over 40 who have an age-related loss of near vision needing correction.
– Patients with high nearsightedness or astigmatism before LASIK may benefit from a second treatment if some refractive error returns.
– Any residual refractive errors can be fixed with an enhancement, if indicated.
LASIK enhancement surgeries have a very high success rate of stabilizing vision. Enhancement procedures are generally safe and effective in suitable candidates. Many LASIK surgeons offer free or low-cost enhancements if vision regression exceeds contractual limits.
Pros and cons of LASIK enhancement
Here are some pros and cons to weigh when considering an elective LASIK enhancement:
| Pros | Cons |
|---|---|
| Fix residual refractive errors | Added cost for second surgery |
| Improve visual symptoms | Temporary side effects during healing |
| Reduce dependency on glasses | Risks inherent in any eye surgery |
| Maintain freedom of seeing clearly | May still need reading glasses with age |
In suitable candidates, LASIK enhancement can be a rewarding option for maintaining excellent vision over the long run.
What are the alternatives if you do not want LASIK enhancement?
For mild amounts of visual regression after LASIK, it may be preferable to use glasses or contacts only when needed – rather than pursuing a second surgery. Other options include:
Reading glasses
Over-the-counter reading glasses can compensate for age-related loss of near vision after LASIK. These are inexpensive and non-invasive.
Updated contact lens prescription
Custom soft contact lenses fit to your current cornea can fully correct any residual refractive errors. Modern contacts are comfortable, convenient and flexible.
Refractive lens exchange
This involves implanting an artificial lens inside the eye to restore vision clarity without repeat corneal surgery. It may be an option for high hyperopes.
The best course is determined during a comprehensive exam considering your vision goals, ocular health, lifestyle needs and risk tolerance. An experienced refractive surgeon can guide you through the possibilities.
Does LASIK permanently weaken your cornea?
There were initially some concerns that creating a corneal flap during LASIK may weaken the eye’s natural protective barrier. However, current evidence shows the LASIK procedure does not result in clinically significant thinning or weakening of the cornea for the vast majority of patients.
Here’s what we know today about LASIK’s effects on corneal strength:
Minimal impact on corneal thickness
Femtosecond lasers allow for precise, uniform corneal flaps as thin as 100 microns, preserving corneal thickness. The excimer laser removes 20-30 microns of stromal tissue. Total corneal thickness reduction is mild.
Full flap adherence within days
The flap quickly seals the ablation zone without sutures. Adhesion molecules fully reconnect the flap within 3 to 5 days post-surgery.
No increased risk of ectasia
Multiple studies demonstrate there is no greater risk of ectasia (corneal bulging) after LASIK compared to glasses or contacts.
Only 5% decrease in biomechanical strength
Corneal tensile strength is largely restored to 95% of pre-LASIK levels once healing completes. LASIK does not predispose you to ruptures.
In the rare case of traumatic corneal injury, see an ophthalmologist immediately. Use proper eye protection when participating in sports or dangerous work after LASIK. Overall, the cornea remains stable and strong after uneventful LASIK recovery.
Conclusion
While LASIK cannot completely stop the normal aging changes in vision, clinical evidence shows excellent visual outcomes can last 15 years or more after surgery. For suitable candidates who maintain healthy eyes, the reshaped cornea remains stable long-term.
Over 95% of patients report prolonged, significant reduction in dependency on glasses or contacts after LASIK. Though some visual regression may occur years later, enhancement surgeries are effective options for maintaining visual freedom.