Regression after LASIK happens when the vision correction achieved through surgery diminishes over time.
While LASIK is highly effective and offers long-term results for most patients, a few factors can lead to regression, potentially affecting the initial improvements in vision.
Understanding why this occurs is essential for both LASIK patients and eye care professionals, as it sheds light on how to manage expectations and maintain optimal vision post-surgery. This blog dives into the detailed causes behind LASIK regression and offers insights into managing it effectively.
What is LASIK Regression?
Before we explore the causes, it’s important to clarify what regression after LASIK truly means. LASIK (Laser-Assisted in Situ Keratomileusis) reshapes the cornea to correct refractive errors such as myopia (nearsightedness), hyperopia (farsightedness), and astigmatism. Regression refers to a partial return to these pre-surgical refractive errors, meaning your eyesight could deteriorate slightly from the 20/20 (or near 20/20) vision initially achieved after the surgery.
It’s worth noting that LASIK regression doesn’t mean the surgery has failed—it’s typically associated with individual factors and the natural processes of the eye.
How Common is Regression After LASIK?
Studies show that less than 5% of LASIK patients experience noticeable regression within the first year after surgery. However, the likelihood can increase over time, depending on factors such as age, health conditions, and underlying refractive errors.
Key Causes of Regression After LASIK
1. Changes in the Corneal Shape
The primary goal of LASIK is to reshape the cornea to correct refractive errors. However, for some patients, the cornea may gradually shift back to its original shape over time. This biological response can undo part of the vision correction.
Factors that can contribute to corneal shape regression include:
- Thinner corneas: After LASIK, the corneal tissue thins slightly. For individuals with already thin corneas, the structure may be less stable, causing subtle shifts post-surgery.
- Healing variability: Everyone’s body heals differently. Some patients experience more pronounced cellular remodelling, which affects the reshaped cornea.
2. Progression of Original Refractive Error
If a patient’s myopia, hyperopia, or astigmatism was still progressing before undergoing LASIK, the original refractive error could worsen further after surgery. LASIK doesn’t stop the underlying growth or changes in the eye’s refractive power.
For patients with rapidly changing prescriptions (e.g., worsening myopia in younger patients), waiting until the vision stabilises—typically for at least a year—is recommended before considering LASIK.
3. Age-Related Vision Changes and Presbyopia
While LASIK is excellent for correcting refractive errors, it does not prevent the natural, age-related changes our eyes go through. Most people, starting in their 40s, experience presbyopia—a condition where the eye’s lens loses its ability to focus on nearby objects.
Even after a successful LASIK surgery, patients may need reading glasses or additional treatments to manage presbyopia as they age.
4. Undiagnosed or Untreated Dry Eye Syndrome
Dry eye syndrome is among the most common side effects associated with LASIK. If dryness persists and is left untreated, it can contribute to fluctuations in vision quality and a potential perception of regression.
Post-LASIK dry eye happens because the surgery temporarily affects the corneal nerves responsible for lubricating the eye. While most cases of dry eye resolve within a few months, severe cases can interfere with stable visual clarity and mimic regression.
5. Hormonal Changes
Hormonal fluctuations can significantly impact vision stability.
- Pregnancy: During pregnancy, hormonal shifts can alter the thickness or curvature of the cornea, leading to temporary refractive changes. Pregnant and breastfeeding individuals often experience vision fluctuations regardless of LASIK.
- Menopause: Hormonal changes during menopause may exacerbate dry eye, which can influence the perception of LASIK results.
While these changes rarely cause permanent regression, they can create temporary issues that affect visual acuity post-surgery.
6. Underlying Eye Conditions
Certain preexisting eye conditions can affect the long-term success of LASIK surgery. For instance:
- Keratoconus: A progressive ocular condition characterised by the thinning and protrusion of the cornea. For patients predisposed to keratoconus but not properly diagnosed before LASIK, this condition can lead to instability in the corneal shape.
- Cataracts: The formation of cataracts can obstruct light from passing through the lens, causing blurred vision and mimicking or compounding regression.
Patients should always undergo a comprehensive eye exam before proceeding with LASIK to rule out such underlying conditions.
7. Poor Post-Operative Care
The post-operative recovery period is critical for ensuring the long-term success of LASIK. Neglecting follow-up appointments or failing to adhere to the surgeon’s post-surgery advice—such as avoiding eye strain or protecting the eyes—can hinder healing and lead to regression.
For example, rubbing the eyes excessively soon after surgery can disrupt corneal healing or displace the corneal flap, impacting the results.
8. Lifestyle Factors
Certain habits and environmental exposures can influence the stability of LASIK results. Examples include:
- Prolonged screen time: Excessive screen usage contributes to eye strain and worsens dry eye symptoms, which can indirectly hinder visual clarity.
- UV exposure: Frequent unprotected exposure to sunlight can damage the corneal tissue. Wearing sunglasses is critical for LASIK patients, especially during recovery.
- Poor nutrition: Eye health relies on nutrients like omega-3 fatty acids, Vitamin A, and lutein. A poor diet lacking these nutrients can impact overall visual health.
9. High Initial Refractive Error
Patients with a severe initial refractive error (e.g., extreme myopia or astigmatism) may be at a slightly higher risk of regression. While LASIK can correct significant refractive errors, the chances of total stability may decrease with higher levels of correction.
Your surgeon will often consider these factors and set realistic expectations before surgery.
Managing and Preventing LASIK Regression
Follow-Up Treatments
For patients experiencing noticeable regression, enhancement procedures may be recommended. These involve additional LASIK adjustments to refine or restore the vision correction.
However, not all patients are suitable candidates for enhancements—your eye health and corneal thickness will determine your options.
Regular Eye Checkups
Routine eye exams ensure any signs of regression are caught early and managed effectively. Your optometrist or ophthalmologist can monitor your vision changes and recommend lifestyle or medical interventions as necessary.
Lifestyle Adjustments
Taking proactive steps to maintain eye health can go a long way in preserving LASIK results. For example:
- Reduce screen time where possible to minimise eye strain and dryness.
- Ensure adequate hydration by consuming sufficient amounts of water.
- Incorporate leafy greens and fish into your diet for essential nutrients.
- Always wear sunglasses to protect against harmful UV rays.
Artificial Tears and Dry Eye Treatments
For dry eye syndrome, over-the-counter artificial tears or prescription therapies like punctal plugs or medicated eye drops can restore hydration and clarity.
Consult Your Surgeon
If you’re concerned about vision changes post-LASIK, consult the surgeon who performed your procedure. They’ll help determine whether your symptoms indicate regression or another underlying issue.
What’s Next for LASIK Patients?
While regression after LASIK is rare and typically minimal, understanding its causes, helps set realistic expectations and ensures timely management. For many patients, the benefits of LASIK far outweigh the possibility of mild progression.
If you’re considering LASIK or experiencing symptoms post-surgery, work closely with a trusted eye care professional to stay on top of your eye health. Proper planning, ongoing care, and simple lifestyle adjustments can make all the difference in preserving your vision for years to come.
