Can laser vision correction surgery be repeated if there is a relapse of refractive error?

From the Guidelines

Laser vision correction surgery can sometimes have a relapse, and in many cases, you can undergo a repeat procedure, but the decision to repeat the surgery should be made on a case-by-case basis, considering the risks and benefits, as outlined in the refractive surgery preferred practice pattern 1. When considering repeat laser correction surgery, it's essential to evaluate the reasons for the relapse and the potential risks and benefits of the procedure. According to the refractive surgery preferred practice pattern 1, rescue laser treatments can be attempted under specific guidelines, such as if the laser treatment is interrupted during the first 10% of the lenticule cut. However, if the treatment interruption occurs between 10% and 100% of the lenticule cut or during the lenticule side cut, the case should be aborted. Some key points to consider when evaluating the possibility of repeat surgery include:

• The presence of adequate remaining corneal thickness, which your surgeon will evaluate 1
• The potential risks of complications, such as microbial keratitis, sterile keratitis, or keratectasia 1
• The potential benefits of the procedure, including improved vision and reduced dependence on corrective lenses 1
• The potential impact on quality of life, including the potential for improved vision and reduced symptoms such as glare or halos 1 It's also important to note that not everyone is a candidate for repeat surgery, particularly if you have developed other eye conditions like cataracts or if your cornea has thinned too much from the first procedure 1. Age-related vision changes like presbyopia (difficulty reading up close) cannot be permanently corrected with laser surgery and may require reading glasses even after successful LASIK 1. For the best outcome, consult with your original surgeon for an evaluation to determine if enhancement surgery is appropriate for your specific situation, taking into account the latest guidelines and research in the field 1.

From the Research

Laser Correction Surgery for Vision

• Laser vision correction is a surgical procedure used to permanently correct refractive errors such as myopia, hyperopia, and astigmatism 2, 3.
• The two main procedures currently being performed for myopia correction are photorefractive keratectomy and laser-assisted in situ keratomileusis, which appear to yield similar visual outcomes 1 year after surgery 2.
• Customized ablation using wavefront aberrometry and its optimized profiles can correct higher-order aberrations and provide better vision quality to patients 2.

Relapse and Repeat Surgery

• There is a risk of relapse or regression after laser correction surgery, which can be managed with repeat surgery or other treatments 4.
• Topography-guided ablation shows potential to improve vision even better than glasses and contact lenses in previously untreated eyes, but long-term outcomes and new complication risks need to be better understood 2.
• Dry eye is a common complication after refractive surgery, and the rates of dry eye can vary depending on the type of surgery performed 5.

Management and Complications

• Optometrists play an essential role in detecting anatomic and functional alterations in vision after corneal laser refractive surgeries 4.
• Complications that arise from the corneal wound healing process can directly impact visual outcomes, but most can be prevented or effectively treated with minimal consequences and minor impact on optical quality 4.
• Accurate and timely identification of corneal regeneration-related complications is crucial for successful counseling and management 4.