LASIK is a permanent surgical procedure that alters the shape of your cornea to help you see more clearly. In some cases, you may need a secondary, or enhancement surgery, after an initial LASIK procedure. (Learn More) In general, there is no limit on how many LASIK procedures you can get in your lifetime. (Learn More)
There are several factors that affect whether or not you are a good candidate for enhancement surgery. (Learn More) The thickness of the cornea is one of the main determinations regarding the safety of multiple LASIK surgeries. (Learn More)
Other health considerations and personal factors will need to be assessed as well. As you age, your eyes will change, which can cause the prescription and correction made by an initial LASIK surgery to be altered as well. This can impact vision clarity and may be a factor in considering a secondary LASIK surgery to correct it.
There are risks with multiple surgical procedures, and it may not be the best option for everyone. (Learn More) Your ophthalmologist can help you to determine whether or not LASIK enhancement is safe and optimal for you personally.
The Safety of Multiple LASIK Procedures
LASIK is considered a safe procedure. More than 95 percent of those who undergo LASIK surgery are satisfied with the outcome, the U.S. Food and Drug Administration (FDA) reports. As with any surgical procedure, however, there are risks involved, and a small percentage of people can experience negative side effects or complications, such as visual disturbances (halos, glares, starbursts, poor night vision, and difficulties discerning contrast), dry eyes, and possible vision loss.
Most of these negative side effects clear up within a few weeks to months of undergoing a LASIK procedure. Mayo Clinic publishes that long-term issues related to LASIK are rare. Of course, when you undergo more than one LASIK surgery, the risks can increase and the rate of complication can therefore increase as well.
Generally speaking, there is no cap or specific number of times a person can undergo LASIK surgery. The main factor in determining candidacy for LASIK enhancement and secondary surgeries is the size and thickness of the cornea, the American Academy of Ophthalmology explains.
LASIK uses specialized lasers to create a thin flap in the corneal tissue to reach the stroma, or internal part of the cornea, to ablate and change its shape in order to correct refractive errors. The shape of your cornea is what can cause you to be nearsighted, farsighted, or suffer from astigmatism. LASIK can correct all of these refractive errors that make it difficult to focus and see clearly.
Enhancement surgeries will need to harvest more corneal tissue, and at some point, you will not have enough. Every LASIK surgery will make the cornea thinner. If there is not enough tissue there to work with, LASIK is not a viable or safe option.
Your ophthalmologist will measure the thickness of your cornea to determine your eligibility for LASIK initially and in the case of any enhancement surgeries. There are still laser surgery procedures like PRK that can be performed as enhancement procedures if your cornea is too thin, however. Be sure and talk to your doctor to determine what is going to work best.
Risks of LASIK Enhancements
The Review of Ophthalmology warns that the risk for epithelial ingrowth and corneal ectasia are possible complications of a LASIK enhancement that involves lifting the corneal flap an additional time. The rate of epithelial ingrowth is fairly low in initial LASIK surgery, but the odds for this condition increase with LASIK enhancement.
Epithelial ingrowth is a condition where extra cells collect under the flap and can lead to visual disturbances and discomfort. It may also need to be retreated with additional surgery. The Review of Ophthalmology publishes that surgeons often consider going with a PRK procedure as an alternative to LASIK when doing an enhancement in order to minimize the risk for epithelial ingrowth.
Corneal ectasia is a rare condition that can occur after LASIK, causing bulging of the cornea, often because the tissue was too thin. The risk for this condition can increase with LASIK enhancements, the American Academy of Ophthalmology warns. Accurate corneal tissue measurements are imperative to determine the safety and efficacy of a LASIK enhancement to minimize potential complications.
Reasons for Secondary or Enhancement LASIK Surgeries
There are multiple factors that can be involved in the need for an enhancement LASIK surgery. In the case of significant astigmatism, myopia (nearsightedness), or hyperopia (farsightedness), a LASIK surgery may undercorrect the refractive error. This means that not enough of the corneal tissue is removed and reshaped, and vision is not completely corrected. This can result in the desire for an enhancement surgery to remove more tissue and complete the correction for improved vision.
Another reason for enhancement LASIK surgery is simply aging. As you get older, your eyes change. The American Refractive Surgery Council reports that your vision changes at a rate of about 1 percent each year, so after about 10 years post LASIK, your vision may be 10 percent different.
The Federal Trade Commission publishes that you are more likely to need an enhancement LASIK surgery if you had a significant refractive error (myopia, astigmatism, hyperopia) initially. You may decide to undergo an enhancement LASIK procedure to correct for the new prescription.
It is also possible to develop a secondary condition later in life that will require another laser eye surgery to correct. For example, most people will suffer from "aging eyes" or presbyopia around age 40 or so, the National Eye Institute explains. This is a condition that will make it difficult to read things up close and often requires the use of reading glasses. This condition is not impacted by LASIK, but it is not corrected by the procedure either.
If you have LASIK earlier than the development of presbyopia, you may consider an enhancement surgery called "monovision" to correct for the new condition. Monovision surgery makes it so one eye sees things clearly up close, and the other has more clarity for far-away objects. The two eyes are corrected separately and differently, and they have to work together after an adjustment period.
Another reason for an additional laser eye surgery is the formation of cataracts. According to Harvard Health, around 50 percent of the population will struggle with cataracts between the ages of 60 and 74, and by age 75, approximately 70 percent will have cataracts.
A cataract implant surgery can be done as a secondary surgery years after a LASIK procedure. This is not the same kind of surgery, as it involves replacing the lens of the eye with an artificial one instead of altering the cornea. It can be safely done after a LASIK surgery has been performed earlier.
Considerations for Enhancement LASIK
The FDA reports that it takes about three to six months after a LASIK surgery for your eyes to reach a stable point. For this reason, you should wait at least that long before considering a LASIK enhancement surgery.
You may experience visual disturbances, such as halos, glares, and poor night vision, during this recovery period. Your eyes will need time to heal for your vision to clear.
LASIK is most successful when your prescription has been stable for a year or two before undergoing the procedure. The surgeon can then determine what the optimal correction will be and that your eyes are not likely to change drastically after the surgery. They will age with time, but this process is generally slower.
Similarly, when considering a LASIK enhancement surgery, you will need to ensure that your eyes are stable again. This is generally done by undergoing a remeasurement and eye assessment. This will need to be done at least two times, three months apart, to ensure that the eyes are not changing again. The journal the Review of Ophthalmology publishes that it is also a good idea to simulate with glasses what the correction will look like before undergoing a LASIK enhancement to align expectations ahead of time.
In order to ensure the safety of multiple LASIK surgeries, there are other factors that will need to be considered.
- The cornea is thick enough. Sufficient tissue is present for another surgery.
- You are in good health and not suffering from retinal or lid disease.
- No significant cataracts are present.
- The eyes are stable for at least six months through multiple measurements and assessments.
- Tear production is good, and dry eye is not significant.
It is important to understand what your expectations are before undergoing a LASIK enhancement. It is generally safe and effective; however, it is another surgical procedure, and it will alter your eyes permanently.
An enhancement may not be ideal for everyone. Instead, you may wish to wear reading glasses or a light prescription to correct for minor visual disturbances that can reoccur. Discuss all of your options with your ophthalmologist and surgeon to determine if you are a candidate for enhancement and if it is the right choice for you.
LASIK Quality of Life Collaboration Project. (September 2018). U.S. Food and Drug Administration.
LASIK Surgery: Is It Right for You? (March 2017). Mayo Clinic.
How Many Times Can a Person Have LASIK Eye Surgery Safely? (June 2018). American Academy of Ophthalmology.
How to Approach LASIK Enhancements. (October 2014). Review of Ophthalmology.
How to Eliminate Epithelial Ingrowth. (April 2016). Review of Ophthalmology.
Ectasia After LASIK. (February 2008). American Academy of Ophthalmology.
Ask the Doctor: How Long Does LASIK Last? (May 2016). American Refractive Surgery Council.
The Basics of LASIK Eye Surgery. (August 2012). Federal Trade Commission.
Facts About Presbyopia. (July 2011). National Eye Institute.
Are There Limits to Laser Refractive Surgery After Midlife? (July 2011). Harvard Health Publishing.
What Should I Expect Before, During, and After Surgery? (July 2018). U.S. Food and Drug Administration.