Is laser eye surgery permanent
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Is Laser Eye Surgery Permanent?

You might ask, ‘Will my laser eye surgery be permanent?’ ‘Can LASIK wear off?’

In short, laser eye surgery procedures offer long-term vision correction for issues such as nearsightedness, farsightedness, and astigmatism. LASIK and PRK are available for most prescriptions, whereas SMILE is only for short-sightedness and astigmatism.

The procedures reshape the cornea, typically resulting in improved visual acuity that usually eliminates the need for corrective lenses, such as glasses or contact lenses.

However, this doesn’t guarantee immunity from ageing changes or other eye conditions that may arise. Our in-depth article explores the durability of laser vision correction, the factors influencing its longevity, and when additional treatments could be necessary.

Key Takeaways

  • Laser eye surgery, such as LASIK, LASEK, PRK and SMILE, permanently changes the cornea’s shape, correcting sight. Still, age-related changes and some post-surgery complications may necessitate additional procedures.

  • The prescriptions with the most extended benefit from treatment are short-sightedness and astigmatism.

  • The vast majority of patients retain improved vision for life.

  • Age-associated eye conditions such as presbyopia and cataracts are not prevented by laser eye surgery. Age will affect reading vision over time, possibly leading to the need for blended vision techniques, glasses, or further treatments.

  • Post-laser eye surgery care is critical for recovery and maintaining long-term eye health. Regular check-ups are necessary to monitor changes in eyesight or eye health despite immediate eye improvements.

Will My Laser Eye Surgery Last Forever?

Illustration of a pair of eyes with a laser beam correcting the vision

As a form of vision correction, laser eye surgery has transformed countless lives with its promise of reduced dependency on glasses and contact lenses. Laser surgery provides a permanent solution for most patients by altering the shape of the cornea.

But does this mean a final goodbye to blur and a lifetime of clear sight?

Despite its permanence, as we age, natural changes in our eyes can lead to changes over time. While complications are rare, enhancements or secondary procedures may be necessary for a small percentage of patients due to the healing process or initial surgery complications.

How LASIK, LASEK, and SMILE Procedures Work

LASIK, LASEK (PRK) and lenticule extraction (SMILE, SILK) are the three laser eye procedures. But how do they work?

These procedures correct your sight by reshaping the cornea, which allows light rays to focus correctly on your retina. They are subtractive procedures because they remove tissue permanently to correct the four refractive errors found in the human eye:

  • astigmatism

  • long-sightedness

  • short-sightedness

  • the symptoms of presbyopia (blurred reading vision)

A corneal flap is created and repositioned post-operation in LASIK surgery, while LASEK surgery involves peeling back the epithelium to access the cornea. An ultraviolet light from an excimer laser is used to evaporate away a disc of tissue.

SMILE and other lenticule extraction procedures use a femtosecond laser to remove the same shaped disc of tissue from your cornea without needing a corneal flap.

Vision correction has an impressive track record. In our study, 100% of mild to moderate short-sight patients achieved 20/20.

Factors Affecting Longevity of Results

The longevity of laser eye surgery outcomes isn’t solely reliant on the procedure’s success. Several other factors can influence the permanence of results, including age and prescription stability.

There are three ways for you to need glasses or contact lenses once again:

  • Progression – your eyes continue to get worse, so your treatment is no longer sufficient to keep you out of glasses

  • Regression – your treatment starts to wear off, and you drift back to needing glasses or contact lenses

  • A combination of regression and progression: it can be difficult to distinguish which is the root cause, and there may be a double whammy of your eyes changing and the treatment effect reducing.

Progression

Having a stable prescription for at least one year is crucial as it suggests minimal changes in vision that can affect long-term results. If your vision changes yearly, you should postpone any laser eye procedure until it is stable.

We will decline to offer laser eye surgery procedures if there is evidence of ongoing progression of the prescription for short-sightedness and astigmatism.

Long-sight or reading glasses are age-associated problems and will not be stable if the patient is younger than 60. The ageing changes in the eye’s lens progress from birth up to the end of the sixth decade, so we accept these are not stable at the time of treatment. The patient must be counselled appropriately.

We have some rules of thumb when deciding if a patient’s short-sightedness is now stable.

  • First, most patients will stop progressing by the late 20s. Treating anyone for myopia at the age of 28 or older, we can be pretty confident that they have reached their final prescription.

  • Second, patients tend to progress for up to 12-13 years from when they started wearing glasses. For example, if John first wore glasses at ten, he may be stable by 22-23. It is still essential to look at the individual’s prescriptions over the past two years to ensure stability.

  • Thirdly, mild myopia that comes on as a young adult is now common, perhaps because of the use of screens and mobile phones. These prescriptions appear quickly and rarely progress much beyond -2.00 dioptres.

Regression

Regression is when the effect of the laser eye treatment reduces over time, traditionally after the initial six months of healing.

If an additional surgery is needed during the first 6-12 months, this is called a primary enhancement, and the results from the initial surgery are not on target. This differs from regression, which is a longer-term reduction in the benefits of laser eye surgery.

The common causes of regression after laser eye surgery, particularly after procedures like LASIK and PRK, are multifaceted and can include biological and technical factors. They are not fully understood.

Several key factors contribute to regression:

  1. Initial Degree of Refractive Error: Patients with higher initial refractive errors, especially those with high myopia, are more prone to experience regression after laser correction. This is the most common cause of regression. Myopia over -6.00 dioptres will likely get some mild regression over the years. Milder prescriptions are much less likely to regress but not necessarily immune, as any prescription can regress over time.

  2. Ocular Surface Conditions: Conditions affecting the ocular surface, such as dry eye disease, can also contribute to regression. Dry eye disease can alter the corneal surface and affect the stability of the post-surgery refractive outcome. Chronic dry eye has been specifically associated with refractive regression following LASIK and PRK.

  3. Age: Age can influence the stability of laser eye surgery outcomes. As the eye naturally ages, changes in the lens and other ocular structures can affect the eye’s refraction

    . This can lead to regression for long-sight in particular. Needing reading glasses later is not regression, as this is a different eye problem from astigmatism or short-sight. All patients need to be counselled that they will still need reading glasses later in life unless they are having blended surgery (one eye for distance and the other for reading) specifically to treat their closed eyesight.
  4. Technical Aspects of Surgery: The precision and technique used during the surgery can impact the likelihood of regression. Modern lasers use a gentle blend zone at the edge of the treated zone, giving a wider area where the curvature blends into the untreated outer corneal shape. Older lasers used an abrupt blend zone, increasing the regression risk.

Irrespective of the cause of regression, repeat laser surgery may be offered to provide better vision.

The Role of Age in Laser Eye Surgery

The Role of Age in Laser Eye Surgery

Age is an inevitable factor that can influence the long-term results of laser eye surgery. Even though the surgery is permanent, age-linked eye changes can still occur.

Conditions such as presbyopia or cataracts, common with ageing, can impact the long-term results of laser eye surgery, potentially requiring additional treatments or glasses.

Blended vision is a technique used in laser eye surgery to correct presbyopia. It aims to reduce or eliminate the need for reading glasses by focusing one eye on distance and the other on near tasks.

However, cataracts, which result from changes in the eye’s natural lens and become more common with age, are not caused by laser eye surgery but may require additional treatments.

Presbyopia and Laser Eye Surgery

presbyopia and laser eye surgery

Presbyopia is a normal change in mid-life that results in difficulty focusing on nearby objects. This leads to blur during near tasks. Laser eye surgery solves this issue through blended vision and monovision.

Here, the eyes are optimised to have a greater range of clear vision, with the dominant eye typically focused for distance and the non-dominant for near.

Despite these advancements, as we age, presbyopia progresses, and some patients may require supplementary treatments or glasses. While laser eye surgery can correct the issue, it’s essential to remember that presbyopia is an age-related condition, and its progression with age is inevitable.

Cataracts and Laser Eye Surgery

Cataracts are a normal part of ageing. However, they may require treatment due to the changes they bring about in the eye’s natural lens.

Patients with laser eye surgery tend to have cataract surgery at a younger age. This is more due to the regular access to an ophthalmologist rather than any acceleration in the ageing process.

cataracts and laser eye surgery

Another condition that might confuse patients is posterior capsule opacification. This condition leads to clouded vision and resembles cataract symptoms, but it results from thickening of the lens capsule post-surgery.

It’s important to understand that while laser eye surgery can correct many vision issues, it doesn’t make one immune to age-related changes. Also, a laser eye procedure isn’t suitable to treat cataracts.

Enhancements and Follow-Up Procedures

While laser eye surgery offers a permanent solution for vision correction, some patients may require enhancements or follow-up procedures. This could be due to the healing process, initial surgery complications, or other factors.

Before offering another treatment, the patient must undergo another consultation to confirm suitability.

Reasons for Enhancement Surgery

LASIK eye surgery provides a permanent correction to the eye prescription by adjusting the shape of the eyes to focus light correctly. However, there may be instances where LASIK enhancement surgery becomes necessary.

The estimated incidence of regression long-term is 1% per year. So, 90% of patients will retain good vision at ten years following laser eye surgery, and 80% will still see well after 20 years.

This could be due to changes in prescription post-initial surgery or complications arising. In such cases, the cornea is reshaped once again to correct the refractive errors, thus ensuring the effectiveness of the treatment.

Success Rates and Risks of Enhancement Surgery

LASIK and LASEK laser eye surgeries boast high success rates, with the vast majority of patients experiencing significant improvements in their vision:

  • 99.2% of patients achieving 20/20 vision or better

  • 80% of short-sighted patients achieve 20/16 or better after enhancement

  • Approximately 47% of long-sighted patients with a prescription up to +6D achieve 20/16 vision or better following enhancement surgery.

However, it’s vital to be aware of potential risks such as:

  • under-treatment or over-correction

  • substantial vision loss

  • the necessity for additional surgeries

Patients may also experience visual disturbances such as glare, halos, or ghost images, though these effects generally decrease after surgery. Having realistic expectations and being informed about possible side effects and complications is essential for potential patients.

Interestingly, we see less dry eye following an enhancement than the original procedure.

Determining if You’re a Good Candidate for Laser Eye Surgery

Illustration of a checklist with tick marks representing a good candidate for laser eye surgery

Have you thought about getting laser eye surgery? It could greatly improve your vision. If so, are you a suitable candidate? Certain criteria must be met to be considered a good candidate for LASIK surgery.

Candidates should typically be over 18 to ensure their vision prescription has stabilised. Healthy eyes without retinal problems, corneal scars, or eye disease is another crucial factor.

Moreover, the patient’s prescription for vision correction must be within certain limits, as very high prescriptions could yield less predictable laser eye surgery results. Overall health, including controlled autoimmune diseases, is also crucial for candidacy, as certain conditions may preclude a patient from undergoing LASIK.

Pre-Surgery Assessments

Before you go through any laser surgical procedures, pre-surgery assessments are an essential step in the process. These assessments include:

  • A thorough evaluation of the overall eye health

  • Specific checks for any conditions, such as dry eye syndrome or infection, that may affect healing post-surgery

  • Determining if the corneas are of adequate thickness and shape for LASIK

  • Determining if the patient’s eyesight prescription has been stable over time

These assessments also involve measuring pupil size to account for potential side effects that may arise from large pupils following laser eye surgery. Advanced diagnostics are used in laser eye surgery consultations to customise treatment plans to address age-related vision changes and ensure safety and optimal results.

In some cases, patients can ‘try before they buy’ by using trial contact lenses that simulate the intended effect of monovision, thus enabling an informed decision.

Managing Expectations

While laser eye surgery is a ground-breaking procedure, candidates must manage their expectations regarding its outcomes, side effects, and potential risks. Each LASIK candidate receives personalized advice from their surgeon on the outcomes they can anticipate, factoring in the specifics of their condition.

Although the goal of LASIK may be 20/20 vision, perfection is not guaranteed. Significant vision improvement is, however, a common result.

Surgeons need to discuss with patients the realistic likelihood of achieving desired vision correction with LASIK and the possibility that glasses may still be needed for certain tasks post-surgery.

Life After Laser Eye Surgery

Life after laser eye surgery is a journey of discovery as patients experience immediate vision improvement. However, their vision can take several weeks to months to stabilise. Most patients will reach their optimal vision outcome within three to six months after surgery. Post-surgery, many patients enjoy:

  • a reduced dependency on glasses or contact lenses

  • improved distance vision

  • improved night vision

  • improved peripheral vision

However, some patients may still require vision correction for certain activities, such as reading, even with their corrected eyesight. Following your doctor’s instructions and attending all follow-up appointments is important to ensure the best possible outcome.

Even after undergoing laser eye surgery, it’s essential to remember that the eyes are not invincible. Patients might experience heightened light sensitivity and are typically advised to:

  • Wear sunglasses to protect their eyes from bright light

  • Avoid rubbing or touching their eyes

  • Use prescribed eye drops as directed

  • Follow all post-operative instructions provided by your surgeon

Regular eye check-ups with your surgeon are important to ensure the eye’s health and maintenance of vision correction, making laser eye treatment a crucial aspect of the process.

Post-Surgery Care and Recovery

After laser eye surgery, following a specific care routine is essential. Here are some important steps to take:

  1. Avoid showers and stay away from steam rooms, saunas, and swimming pools for a week post-surgery to protect the eyes and aid recovery.

  2. Stay clear of dusty and smoky environments.

  3. Use prescribed antibiotics and anti-inflammatory eye drops.

  4. Avoid wearing eye makeup or rubbing the eyes to prevent infection and complications.

Following these steps will help ensure a smooth recovery after laser eye surgery and provide a better understanding of laser eye surgery procedures.

Recovering from laser eye surgery isn’t just about physical healing; it’s also about giving your eyes a much-needed rest. Patients may experience a ‘gritty’ feeling and common postoperative symptoms like halo effects, hazy vision, and dry eyes, which should improve over time.

Reading print media is not recommended during recovery as it can strain the healing eyes. The individual’s natural healing ability, age, type of treatment received, and adherence to follow-up care play a role in the recovery time and the longevity of laser eye surgery results.

Long-Term Vision Maintenance

Beyond the immediate post-surgery period, it’s vital to maintain long-term vision health. UV-protective sunglasses protect sensitive eyes from bright light after laser eye surgery. Sunglasses not only help manage light sensitivity post-surgery, but they also serve as a crucial defence against harmful UV rays.

Regular eye examinations post-laser eye surgery are critical to detect any early vision changes that might influence the long-term success of the surgery results. Annual eye exams are recommended to monitor for any changes in vision or new eye health issues.

Ophthalmologists might tailor the frequency of post-operative check-ups based on individual patient needs and recovery progression.

Summary

We’ve looked at how long laser eye surgery lasts and discussed if it is permanent, the factors affecting its longevity, the role of age, enhancements and follow-up procedures, and life after surgery.

Laser eye surgery offers a powerful and often permanent solution to vision correction, but it’s not a magic wand. It requires careful consideration, sound medical advice, and realistic expectations. Remember, the aim is not to achieve perfect vision but to improve your quality of life.

Frequently Asked Questions

How long does eye laser surgery last?

The effects of eye laser surgery to reshape the cornea are permanent. Generally, most patients retain benefits for life, but some patients may require an enhancement or secondary procedure due to regression.

Who is prone to regression?

Patients who have high or extreme prescriptions will be more likely to get regression as the years go by. Those with very high myopia may be better served by implantable contact lenses (ICLs) rather than laser eye surgery, which gives a permanent correction.

Does laser eye surgery permanently fix eyesight?

Yes, laser eye surgery provides a permanent correction to eye prescription by permanently adjusting the shape of the eyes to enable them to focus light correctly. However, some prescriptions are prone to regression.

What are the disadvantages of laser eye surgery?

LASIK surgery permanently affects the cornea, increasing the risk of irreversible errors and the potential need for glasses post-surgery. Most patients will experience temporary dry eyes, which can be permanent or long-term. Night vision issues are much less common today, thanks to modern laser ablation patterns. Rare cases may experience ectasia or other visual problems.

Is laser eye surgery worth it?

Laser eye surgery is a highly effective treatment. It is worth it for most people, as most patients experience successful treatment with no serious complications and enjoy good to excellent vision for many years or decades.

Can age-related changes like presbyopia and cataracts affect the results of laser eye surgery?

Yes, age-related changes like presbyopia or cataracts can impact the long-term results of laser eye surgery and may necessitate further treatments. When considering the surgery, it’s essential to be aware of these potential factors.

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