Every patient and refractive surgeon wants to achieve perfect vision correction with one refractive surgery procedure. Unfortunately it is more difficult to accurately predict results with a large refractive error than with a small refractive change. Hyperopia (farsighted, longsighted) is more difficult to correct than myopia (nearsighted, shortsighted), and astigmatism adds to the challenge. Also, we are talking about microsurgery on human biological tissue. Sometimes things simply don't go as planned.Before you have any additional surgery, you should discuss with your doctor CLAPIKS. This is a technique that uses eye drops to make the cornea more malleable and Rigid Gas Permeable (RGP) contact lenses to reshape the cornea to correct minor
overcorrection and undercorrection.
Do not be in too much of a hurry to have enhancement surgery. Fluctuations in vision can last several months. You want to wait until your eyes have settled down before having an enhancement. It is common for the eye to regress back toward the original refractive error. You don't want to have additional surgery until the regression has resolved. Most enhancements are performed between three and six months after the first surgery, but can be performed earlier and much later. Discuss the probabilities with your doctor before you proceed.
If you are needing enhancement surgery for conventional or custom wavefront LasikAll-Laser Lasik, PRK, LASEK, or Epi-Lasik, it is probable that most of the required refractive error was corrected with the first surgery. Since smaller changes tend to be easier to accurately predict, you should be able to reasonably expect a good outcome, however there are exceptions.
Hyperopia correction and myopia correction are significantly different with different techniques and different expected results. As a general rule, hyperopia is more difficult to predictably correct than myopia (more). If you were originally myopic and have been overcorrected into hyperopia, you need to revisit the entire issue as if you were having surgery for the first time. For the most part, you are having surgery for the first time.
If your initial surgery was Lasik or All-Laser Lasik, the doctor will probably lift the existing flap. Although the Lasik flap does heal (more), it does not heal the same as a cut on your arm and the Lasik flap can be lifted years after surgery. Well, "lifted" is probably not the right term. It is more like separating the cornea at the location of the original flap. All-Laser Lasik flaps tend to adhere more firmly to the underlying stroma, but they too can normally be manipulated and lifted. It is rare that a new flap must be created for enhancement.
If your initial procedure was PRK or LASEK, the epithelium will be manipulated during an enhancement surgery just as it was with the initial surgery.
If your initial procedure was Epi-Lasik, you cannot have Epi-Lasik for your enhancement. The epikeratome used to create the epithelial flap requires the Bowman's layer for stability. During the initial surgery, the Bowman's layer is ablated away. PRK or LASEK would be the most likely methods for an Epi-Lasik enhancement.
If your initial surgery was CK, you need to be very careful about the technique used for an enhancement. CK regresses with time. The ratio is about 1.00 diopter for every 1-3 years. That means that CK is a temporary correction. Eventually, the cornea will return to preoperative levels.
You do NOT want to have a permanent enhancement surgery to correct any problem induced solely by CK. Because the effects from CK are temporary, eventually all CK effects will dissipate and your eye will return to its condition before surgery if you do absolutely nothing at all. What you don't want to do is use a permanent correction technique such as Lasik, PRK, or LASEK to correct problems induced by a temporary procedure. Additional CK enhancement surgery may be appropriate, but in nearly all cases CK enhancement with Lasik, PRK, LASEK, Epi-Lasik or any other refractive surgery procedure is not appropriate.
If you are ready to choose a doctor to be evaluated for conventional or custom wavefront Lasik, All-Laser Lasik, PRK, LASEK, Epi-Lasik, CK, RLE, or any refractive surgery procedure, we highly recommend you consider a doctor who has been evaluated and certified by the USAEyes nonprofit organization. Locate a USAEyes Evaluated & Certified Lasik Laser Eye Surgery Doctor.
