Does LASIK “Wear Off”? What You Should Know About Vision Changes After Surgery

Posted by: Clear Vision Cataract & LASIK Center

For many people, LASIK is a life-changing procedure. The clarity it brings can seem almost miraculous, especially for those who have spent a lifetime relying on glasses or contacts. But what happens when the crisp vision you enjoyed after LASIK starts to fade many years down the line? You might wonder: “Does LASIK wear off?” The answer, while complex, often points to normal aging processes or new conditions unrelated to your initial LASIK procedure. In this post, we’ll discuss why your vision might be changing, how LASIK fits into the picture, and what options are available to correct these changes.

LASIK Longevity: Does LASIK Wear Off?

To answer this question, it’s essential to understand how LASIK works. LASIK permanently reshapes the cornea, correcting refractive errors like nearsightedness, farsightedness, or astigmatism. Once corrected, those issues don’t “come back”, and LASIK does not “wear off” in the literal sense except in extremely rare circumstances. More commonly, as your eyes continue to age, and new issues, such as dysfunctional lens syndrome (DLS) otherwise known as presbyopia (the loss of near vision that affects most people starting in their 40s and 50s) or the development of cataracts, can emerge.

Dysfunctional Lens Syndrome (DLS): What Is It?

DLS refers to the gradual aging of the natural lens inside your eye. As you age, the lens can become less flexible, affecting your ability to focus on near objects. This is why many people need reading glasses or bifocals in their 40s and beyond, even if they had perfect distance vision after LASIK.

In the later stages of DLS, the lens becomes cloudy—this is the onset of cataracts. Cataracts are a natural part of aging and can cause blurry vision, glare, and difficulty seeing at night. LASIK does not prevent or cause cataracts, but if you had LASIK in the past, it’s crucial to differentiate between LASIK-related changes and lens-related issues. While it is temping to assume that LASIK wears off, it most commonly is due to lens changes like DLS.

Cataracts: A Common Cause of Vision Loss

Cataracts are another primary reason people notice a decrease in vision quality and assume that LASIK wears off. With cataracts, the lens of the eye becomes clouded, making it harder to see clearly. While this has nothing to do with LASIK wearing off, it is a common vision issue as we age.

If you suspect that cataracts may be the culprit, a simple eye exam can confirm the diagnosis. The good news is that cataract surgery is highly successful, and advanced intraocular lens (IOL) options such as the light-adjustable lens (LAL) can correct vision issues like nearsightedness, farsightedness, and even astigmatism—problems LASIK initially addressed.

The Screening Process: What to Expect If You Are Concerned that Your LASIK Wearing Off

If you’re noticing vision problems many years after your LASIK surgery, the fixt may not be as simple as having a LASIK enhancement. Therefore it’s essential to undergo a thorough screening process with an experienced ophthalmologist like Josh Vrabec MD at Clear Vision Center. Here’s what the evaluation typically involves:

1. Vision and Refraction Test: This test measures your current prescription to assess the significance of your vision changes
2. Corneal Mapping: Detailed mapping of your cornea will rule out changes in shape that could indicate ectasia or keratoconus (KCN), a condition where the cornea becomes thinner and bulges forward. While rare, some LASIK patients can develop ectasia, and it’s critical to rule this out before considering an enhancement.
3. Pachymetry: This measures the thickness of your cornea. If you’re seeking a LASIK enhancement, corneal thickness is a key factor. If your cornea is too thin, PRK or other techniques may be recommended instead.
4. Examination: A comprehensive exam of your eyes can help determine if your vision problems stem from corneal dryness, cataracts or something else. This should be done by an experienced eye doctor.

Treatment Options for Post-LASIK Vision Changes

If you’ve undergone LASIK and now face new vision challenges, a wide range of treatment options is available depending on the root cause of the problem. The following list assumes that your eyes are otherwise healthy, which will be determined at your screening exam.

1. PRK (Photorefractive Keratectomy): If your cornea is too thin for LASIK enhancement, PRK might be a viable option. PRK is a surface-based laser treatment similar to LASIK, but instead of creating a flap, the surgeon removes the outer layer of the cornea before reshaping it.
2. Flap-Lift LASIK Enhancement: For some patients, a simple flap-lift enhancement may be all that’s required to improve vision. If enough corneal tissue is available, your surgeon may lift the original LASIK flap and perform additional laser treatment to fine-tune your vision.
3. New Flap LASIK Enhancement: If the original LASIK flap can’t be used, a new flap may be created, allowing for additional corneal reshaping. This is less common but remains an option in certain cases.
4. Topography-Guided PRK or LASIK: This advanced form of LASIK or PRK uses corneal mapping to guide the laser treatment, allowing for more precise correction, particularly in cases where the cornea has developed irregularities over time.
5. RLE (Refractive Lens Exchange): If DLS or cataracts are contributing to your vision decline, RLE might be the solution. In this procedure, the natural lens is replaced with an artificial intraocular lens (IOL), correcting your vision and preventing future cataract development.
6. Cataract Surgery: Cataract surgery is the gold standard for treating cloudy lenses. Like RLE, the cataract is replaced with an IOL. Today’s advanced lenses can correct multiple refractive errors, ensuring clear vision at various distances.
7. Corneal Cross-Linking (CXL): If ectasia or early keratoconus is detected, CXL may be the best option. CXL is a minimally invasive treatment that strengthens the cornea by using ultraviolet light and riboflavin (vitamin B2). This treatment helps halt the progression of corneal thinning and can stabilize your vision. In some cases, CXL may be combined with other vision correction procedures to achieve optimal results. CXL is especially beneficial for patients whose LASIK has led to corneal instability over time.
8. RGP (Rigid Gas Permeable) or Scleral Contact Lens Fitting: Not everyone is a candidate for additional surgery after LASIK, especially if their corneas are too thin or if they have developed irregular astigmatism. For these patients, custom contact lenses such as RGP or scleral lenses can offer an excellent non-surgical solution. RGP lenses are hard lenses that can correct irregular corneas by providing a smooth refractive surface, while scleral lenses rest on the sclera (white part of the eye), creating a tear-filled vault over the cornea. These lenses can provide sharp, clear vision even in challenging cases where LASIK enhancements or other surgeries aren’t advisable.

Interested in a Post-LASIK Consultation?

At Clear Vision Center, we specialize in helping people who’ve had LASIK in the past and are now experiencing changes in their vision. Dr. Josh Vrabec, is an expert and World College of Refractive Surgery Fellow in refractive and cataract surgery. He not only has extensive experience evaluating and treating patients who feel like LASIK has worn off, but is known for his ability to communicate complex issues with his patients in a relatable way. Our center uses state-of-the-art diagnostic tools to accurately determine the cause of your vision problems, whether they stem from LASIK, lens changes, or other conditions like keratoconus.

You may schedule a consultation with Dr Vrabec at Clear Vision Center to help guide your next vision correction move, whether it be a LASIK enhancement, lens replacement surgery, or even just continued observation. As you’ve already had a LASIK eye procedure in the past, we will perform a series of advanced vision testing and imaging studies, which Dr Vrabec will review with you personally at this consultation. As this is an extensive evaluation, we charge a $250 consultation and testing fee for our initial post-LASIK consultation services. However, if you choose to have a procedure with us, or significant cataracts are discovered on the exam, we will credit this initial consultation fee toward the cost of any future procedure you may have with us.

Conclusion: Does LASIK Wear Off?

If you had LASIK many years ago and are noticing changes in your vision, it doesn’t necessarily mean your LASIK has worn off. Often, the culprit is age-related lens changes like DLS or cataracts. However, with a comprehensive screening process and the right treatment, you can regain clear vision. Whether you need a LASIK enhancement, PRK, corneal cross-linking, or cataract surgery, Dr. Vrabec and Clear Vision Center have the expertise to guide you through your options.

Don’t let fading vision stop you from living life to the fullest—schedule a consultation below at Clear Vision Center today or call us for more information at 248-710-2325