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    How to manage vision changes over time post-LASIK

    Know what to expect when a patient complains of poor vision years later

    How often have you heard a post-LASIK patient say his surgery “isn’t working anymore” or it has “expired?” While the corneal tissue that was ablated is gone forever, eyes can change over time, and laser vision correction does not stop time. There are many reasons why eyes change after laser vision correction.

    The vast majority of patients treated with the excimer laser have stable distance vision.1 A study published in Journal of Refractive Surgery analyzing 4,937 eyes indicates 90.6 percent of patients still see 20/20 binocularly five years after surgery.2

    In the early days of laser vision correction, up to 10 percent of patients needed additional surgery after the initial healing period.3 A variety of factors have improved the procedure, and the percentage of patients who need an enhancement procedure within the first year after surgery can be as low as 1.4 percent.4

    The patients we will discuss are those who had surgery over one year ago. A percentage of these patients can complain about near vision, distance vision, and fluctuating vision.

    Previously from Dr. Owen: Preparing your patient for PRK

    Post-surgery options

    The most common visual condition ODs see after laser vision correction is presbyopia. While this is not breaking news to any OD, it is to the patient—especially if he was myopic prior to surgery.

    It is important to reassure the patient that his “devastating” condition is normal and happens to everyone. There are surgical options today for a patient who wants to minimize his dependence on glasses for up-close work.

    Currently, two corneal inlays are approved in the United States:

    • Kamra Inlay (AcuFocus) operates on the pin-hole principle—it increases the depth of focus to achieve near vision.

    • Raindrop Near Vision Inlay (Revision Optics) changes the shape of the central cornea, increasing the asphericity of the central cornea while acting as a center-near add for the cornea.

    Both inlays are placed within the stroma of the cornea under the LASIK flap or in a “pocket” created by a femtosecond laser.

    Also, many spectacle options with single vision or progressive lenses can meet the functional demands of your patient.


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    Optometry Times A/V