LASIK (Laser-Assisted In Situ Keratomileusis) is a surgical procedure designed to permanently reshape the cornea, reducing or eliminating the need for glasses or contact lenses. Many people who had the surgery a decade ago wonder if they can wear contacts again due to vision changes. Wearing contact lenses is often possible years after LASIK, but it requires specialized attention and fitting because the surgery permanently alters the eye’s shape, making standard lenses unsuitable.
Reasons for Needing Contact Lenses After LASIK
The primary reason patients seek contact lenses years after LASIK is the gradual return of some refractive error, known as vision regression. While the procedure aims for permanent correction, the eye can slightly revert toward its original state, resulting in minor nearsightedness or astigmatism. If this residual refractive error is too small for another surgical enhancement, contact lenses are an ideal option for fine-tuning vision.
Another common age-related change is presbyopia, which typically begins around age 40 and is unrelated to LASIK. Presbyopia is the natural, progressive loss of the eye’s ability to focus on nearby objects, such as reading material. Since LASIK primarily corrects distance vision, it does not prevent this condition. Patients often turn to multifocal or monovision contact lenses to restore sharp near vision and manage these long-term visual shifts non-surgically.
The Unique Challenge of Fitting Altered Corneas
Fitting a contact lens onto a post-LASIK eye is challenging because the cornea’s natural geometry has been fundamentally changed. The typical, untreated cornea is “prolate,” meaning it is steeper in the center and flattens toward the edges. LASIK uses a laser to flatten the central cornea, reversing this shape and creating an “oblate” profile that is flatter in the center and steeper toward the periphery.
This oblate shape is incompatible with standard contact lenses, which are manufactured to fit the natural prolate curvature. When a conventional lens is placed on a surgically flattened cornea, it often fails to center properly, leading to poor visual acuity and excessive movement. This instability and improper alignment can cause discomfort or restrict necessary oxygen flow to the cornea.
To achieve a successful fit, eye care professionals must rely on advanced imaging techniques, such as corneal topography or Scheimpflug imaging. These devices create a detailed contour map of the cornea’s altered surface, providing more accurate data than traditional curvature readings. This precise mapping is necessary to design a lens that aligns correctly and avoids resting on the sensitive, surgically treated central zone.
Specialized Lens Options for Post-Surgical Eyes
Due to the oblate corneal shape, most post-LASIK patients require specialized contact lenses designed to accommodate the altered topography. One effective option is the scleral lens, a large-diameter rigid gas permeable (RGP) lens that vaults completely over the corneal surface. Scleral lenses rest their weight on the sclera (the white part of the eye), completely bypassing the sensitive cornea.
This vaulting creates a fluid-filled reservoir between the lens and the cornea, acting as a continuous bath for the ocular surface. This feature is particularly beneficial for patients who experience chronic dry eye, a common side effect of LASIK that can be exacerbated by standard lenses. The smooth, rigid front surface of the scleral lens neutralizes irregularities on the underlying cornea, providing sharp and stable vision.
Alternative options include custom soft lenses, which are manufactured with a “reverse geometry” curve that matches the flatter central post-LASIK shape. Traditional RGP lenses can also incorporate this reverse geometry design to create a tear layer that optically smooths over the irregular corneal surface. Regardless of the lens type chosen, it is important to seek an eye care professional with extensive experience fitting post-refractive surgery patients, as the complexity of the altered corneal surface demands expert assessment and follow-up care.