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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


    Corneal astigmatism

    It is unusual to see an increase in corneal astigmatism after laser vision correction. Similar to myopic patients, a patient who has significant with-the-rule astigmatism prior to surgery can develop with-the-rule astigmatism after surgery.10 Oblique astigmatism cases are more worrisome. On rare occasions, increasing astigmatism is the first indicator for corneal ectasia.11

    While an increase in with-the-rule astigmatism is often treatable with an enhancement procedure investigate first with corneal tomography for corneal stability. This test is sensitive for corneas that are developing ectasia. Testing is more important today because we can treat corneal ectasia early with corneal crosslinking (CXL) to reduce or prevent the devastating effects of vision ectasia.

    For example, a patient who progresses to a refraction of +0.25-1.00 x 75 usually has reasonable uncorrected vision, and his best-corrected vision can be 20/20. If we find his eye is developing corneal ectasia, it can be treated with CXL and remain a low astigmat. If this patient goes untreated, the cornea can decompensate to a point where uncorrected vision is worse than 20/200 and best-corrected vision worse than 20/40 with spectacles.

    Related: Extended depth-of-focus IOLs may provide improved visual performance

    Most patients who return to your office years after laser vision correction still enjoy wonderful distance vision from this procedure. Nevertheless, eyes change over time for various reasons, and it is important to understand why the refractive status is changing and how to best manage that refractive change.


    1. O’Brart DP, Shalchi Z, McDonald RJ, Patel P, Archer TJ, Marshall J. Twenty-year follow-up of a randomized prospective clinical trial of excimer laser photorefractive keratectomy. Am J Ophthalmol. 2014 Oct;158(4):651-663.

    2. Schallhorn SC, Venter JA, Teenan D, Hannan SJ, Hettinger KA, Pelouskova M, Schallhorn JM. Patient-reported outcomes 5 years after laser in situ keratomileusis. J Cataract Refract Surg. 2016 Jun;42(6):879-89.

    3. Stulting RD, Carr JD, Thompson KP, Waring GO 3rd, Wiley WM, Walker JG. Complications of laser in situ keratomileusis for the correction of myopia. Ophthalmology. 1999 Jan;106(1):13-20.

    4. Schallhorn SC, Venter JA. One-month outcomes of wavefront-guided LASIK for low to moderate myopia with the VISX STAR S4 laser in 32,569 eyes. J Refract Surg. 2009 Jul;25(7 Suppl):S634-41.

    5. Dirani M, Couper T, Yau J, Ang EK, Islam FM, Snibson GR, Vajpayee RB, Baird PN. Long-term refractive outcomes and stability after excimer laser surgery for myopia. J Cataract Refract Surg. 2010 Oct;36(10):1709-17.

    6. Zadok D, Raifkup F, Landau D, Frucht-Pery J. Long-term evaluation of hyperopic laser in situ keratomileusis. J Cataract Refract Surg. 2003 Nov;29(11): 2181-8.

    7. O’Brart DP. The status of hyperopic laser-assisted in situ keratomileusis. Curr Opin Ophthalmol. 1999 Aug;10(4):247-52.

    8. Alió JL, El Aswad A, Vega-Estrada A, Javaloy J. Laser in situ keratomileusis for high hyperopia (>5.0 diopters) using optimized aspheric profiles: efficacy and safety. J Cataract Refract Surg. 2013 Apr;39(4):519-27.

    9. Sher NA. Hyperopic refractive surgery. Curr Opin Ophthalmol. 2001 Aug;12(4):304-8.

    10. Toy BC, Yu C, Manche EE. Vector analysis of 1-year astigmatic outcomes from a prospective, randomized, fellow eye comparison of wavefront-guided and wavefront-optimized LASIK in myopes. J Refract Surg. 2015 May;31(5):322-7.

    11. Padmanabhan P, Rachapalle Reddi S, Sivakumar PD. Topographic, Tomographic, and Aberrometric Characteristics of Post-LASIK Ectasia. Optom Vis Sci. 2016 Nov;93(11):1364-1370.

    Read more from Dr. Owen here


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