January 7, 2022 | Lasik

Lasik 5 Years Later. What's The Long Term Outcome?

By Barrett Eubanks, M.D.

Lasik 5 Years Later. What's The Long Term Outcome?

Lasik is fantastic in the short-term. What is there not to like about getting near instantaneous improvement in vision! But is lasik too good to be true? What about the long-term. What happens 5 years after the lasik treatment?

After lasik, 5 years later one can expect similar results to when they initially had it performed. But there is a chance they will have a small amount of regression with their prescription.

I should know what the results are like - I had my lasik done on my own eyes a little over five years ago. Here is what I am experiencing now, as well as in general what you can expect 5 years after lasik.

My experience with lasik 5 years later

Really I don't have anything bad to say about my own experience with lasik. 5 years later after lasik and my vision is still great!

Prior to lasik I was a contact lens user. I didn't have a very high prescription (approximately -1.00 in each eye), but I was bothered enough by contact lenses to get lasik done. Contact lenses irritated my eyes; it was also a pain to try and travel with contact lenses. Plus, I also perform lasik so I knew exactly how lasik would work for my eyes.

My results after lasik were spot on. My vision without contact lenses was better than 20/20. (see also What Does 20/20 Vision Mean?). Even though I had a very small prescription, lasik was life-changing!

And 5 years later nothing has really changed. I take for granted on being able to wake up and simply see. I still see just as well as how I saw just after lasik. Getting lasik done on my eyes was a great decision!

So sure, I did great. My vision stayed the same. I didn't develop any long-term issues from the lasik eye surgery. But do I reflect everyone that gets lasik done?

Safety of lasik 5 years later

A concern for everyone considering lasik is losing vision. It is a legitimate concern but fortunately losing vision with lasik is very very rare. But, over the long-term, there is a way one can lose vision from lasik.

If the cornea becomes too weak from the lasik, the cornea can change shape and blur and distort your vision. This is called post-lasik ectasia.

How does it happen

Lasik treatments change the overall thickness of the cornea. Lasik sculpts and reshapes the cornea by removing microscopic amounts of cornea. In addition, the lasik flap from lasik also changes the structure of a good percentage of the cornea. After lasik, you are left with a thinner cornea than when you started. If your cornea becomes too thin, it loses its strength and changes shape.

There are various factors that can predict the risk of this happening. Before lasik, your surgeon analyzes your eyes and risk factors to make lasik as safe as possible. High treatments that change the cornea too much can cause issues. If you have signs of weakness on the scans prior to lasik, you are also at a much higher risk of developing even more weakness after lasik. Alternative ways of correcting vision are recommended for those at a high risk of weakening after lasik.

So will post-lasik ectasia occur 5 years later after lasik?

Post-lasik ectasia doesn't show up in the first month after lasik. It takes time to develop. So perhaps within 5 years?

In a very large review of over 30,000 lasik treatments, the long-term risk of post-lasik ectasia was 0.03%. Fortunately the risk of the cornea becoming weak from lasik is extremely rare.

The vast majority of people who have had lasik DON'T need to worry about post-lasik ectasia. But after lasik, it's still important to have routine eye exams just to check and make sure your eyes are staying healthy. Since, if you do develop weakening of the cornea from post-lasik ectasia, a procedure called corneal crosslinking can strengthen the cornea back up.

What about vision 5 years after lasik?

Someone who has had near-sighted lasik can develop some regression afterwards. This regression causes their prescription to become slightly more nearsighted. This causes their distance vision to be slightly more blurred over time.

Not everyone will get significant regression. Some people may not get any, some people may have regression which is too small to be of any significance. Some people (especially those who started out with very high prescriptions) can experience a larger amount of regression over time.

How much regression are we talking about?

The amount of regression is typically very small. Over a 5 year period, on average one can experience a regression of around -0.40 to -0.50. This is not lasik completely wearing off and you returning to your original prescription.

There is no one single cause of this regression. Most likely a variety of changes within the cornea and the rest of the eye account for the prescription becoming slightly more near-sighted over time.

However, those who do have higher prescription treatments with lasik are at a significantly higher risk of developing more regression in the future.

If regression does occur and becomes significant, it can frequently be treated with another laser eye surgery (frequently PRK).

Of note, many of the studies evaluating lasik regression looked at older generation technology. Given the success of lasik, there hasn't been as many long-term studies comparing the older technology to the current lasers being used today. Does newer technology improve upon the regression rate? Perhaps.. All we need is some studies to show it.

Satisfaction 5 years after lasik

Despite the potential risk of regression, lasik patients remain very satisfied with their lasik treatments. Even those who develop regression still enjoy the fact that their vision after lasik is still better than what it was before. Satisfaction doesn't decrease 5 years after lasik. You just get used to having corrected eyes.

5 years later after my lasik, I'm still satisfied. My sister who is also about 5 years out from her lasik still remarks that lasik changed her life. While we are just a sample of two, there are many many out there who are still very pleased 5 years out from lasik.

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