In most cases, LASIK laser vision correction results are very stable for many, many years, even many decades. However, as aging occurs, over time some patients benefit from a “touch up” or “enhancement procedure” to fine tune their LASIK result. This often occurs not due to changes in the LASIK (ie the LASIK is not “wearing off”), but rather due to unrelated changes in the eye separate from the LASIK, such as aging changes. The flap does heal back in place after the oringal LASIK, but it is always present as a flap in the cornea. Some surgeons have wondered if it is safe or even possible to surgically lift up the original, healed LASIK flap more than one year after surgery. A recent study examined both the safety and accuracy of results of lifting the LASIK flap 10 years or more after LASIK to perform an enhancement procedure. In this study, a total of 23 eyes had an enhancement procedure which involved re-lifting the healed flap an average of 13.9 years after the original LASIK (with individual patients ranging from being 10 to 18.7 years out from their original LASIK eye surgery). In this study, 70% of eyes achieved 20/20 vision and the remaining 30% achieved 20/25 vision after their enhancement procedure. These are very impressive results since not all eyes in the study were capable of achieving 20/20 vision, likely due to other unrelated problems that had developed in the eye (for example, early cataracts developing over the years unrelated to the original LASIK). The most significant complication that arose in the study was epithelial cell in-growth, which occurred to a clinically meaningful degree in 9% of treated eyes. Every human cornea has epithelial cells (skin cells) on the surface of the cornea. These cells can grow under the re-lifted flap when an enhancement procedure is performed and can cause problems if not removed. Epithelial cell in-growth under the flap needs to be treated fairly rapidly to maximum success. Treatment typically involves lifting the flap again and simply wiping away the cells. If performed quickly, success rates can be high. I have personally performed an enhancement procedure on several patients who were well over 10 years out from their original LASIK surgery and have seen excellent results.

One alternative to LASIK with a flap is “flapless LASIK”, more properly called PRK (or LASEK). If a patient has PRK rather than LASIK, then the question of re-lifting the healed flap years later is not an issue since there is no flap in the first place. PRK also can be performed over a healed LASIK flap to allow enhancement of previous LASIK surgery without the need for re-lifting the healed flap. As with lifting the flap, PRK over a healed LASIK flap has its own set of risks and benefits which need to be weighed in considering the best option for the patient.

The good news, of course, is that we do have excellent options for fine tuning old LASIK surgery down the road if there is a need to do so!