LASIK (Laser-Assisted In Situ Keratomileusis) is a popular outpatient procedure designed to correct common refractive errors such as nearsightedness, farsightedness, and astigmatism. This correction is achieved by precisely reshaping the cornea. The physical alteration to the cornea is permanent, leading to the lasting correction of the initial refractive error. It is a common misconception that LASIK “wears off” over time; vision changes years after the procedure are almost always due to the natural, age-related evolution of the eye, not a failure of the original laser treatment.
The Permanent Nature of LASIK Correction
LASIK involves the permanent removal of corneal tissue using an excimer laser. This sculpting alters the cornea’s curvature, changing how light enters the eye and focuses on the retina. Because the tissue removed does not grow back, the new corneal shape achieved during the surgery remains stable for life.
This permanent structural change contrasts with temporary vision corrections like contact lenses or glasses. Studies show that the vision correction provided by LASIK holds up well over decades, with high patient satisfaction rates reported even 10 to 20 years post-procedure. The underlying correction for the initial prescription is still present, making the term “wearing off” technically inaccurate.
Vision Changes Unrelated to LASIK Reversal
When vision deteriorates years after successful surgery, the cause typically lies with biological processes that LASIK does not prevent. The most common reason for needing glasses again is the development of presbyopia, or age-related farsightedness. This condition begins to affect nearly everyone, regardless of prior surgery, usually starting in the early to mid-40s.
Presbyopia is a problem with the eye’s natural lens, which is located behind the iris, not the cornea. Over time, this lens loses flexibility, making it progressively harder for the eye to focus on nearby objects. Since LASIK only reshapes the cornea, it cannot stop this natural aging process.
A different, though less common, source of vision change is called regression. Regression is a slight return of the original refractive error, often occurring within the first 6 to 12 months as the eye finishes healing. This is typically a minimal shift, and significant regression is rare, though it is more common in patients who had a very high prescription before surgery.
Vision can also be affected much later in life by conditions unrelated to the LASIK procedure itself. For example, cataracts, which are a clouding of the eye’s natural lens, are an inevitable part of aging. Other conditions, such as glaucoma, a disease that damages the optic nerve, can also develop independently of prior LASIK surgery.
Options When Vision Changes Occur
Patients who experience a change in vision years after their initial procedure have several options for restoring clarity. The approach depends on the underlying cause of the vision change. If the issue is presbyopia, a simple solution for near vision is the use of non-prescription reading glasses.
For a minor return of the original refractive error, known as regression, a secondary procedure called a LASIK enhancement may be possible. This “touch-up” involves lifting the original corneal flap and applying additional laser treatment to refine the shape of the cornea. Eligibility depends on having sufficient corneal thickness remaining and a stable prescription.
If presbyopia is the primary concern, other surgical options exist, including monovision LASIK, which adjusts one eye for distance and the other for near vision. As patients age and develop cataracts, a refractive lens exchange can be performed. This procedure replaces the cloudy natural lens with an artificial intraocular lens that corrects both the cataract and any remaining refractive errors.