LASIK Enhancements: What Are They & Who May Need Them?

LASIK enhancement may be necessary if you don’t experience satisfactory visual improvement after your first LASIK procedure. 

Your eye doctor will evaluate your vision and general eye health to determine if the enhancement will be the appropriate solution for you. 

What Is LASIK Enhancement?

To understand LASIK enhancement, you must first understand what LASIK is. Laser-assisted in situ keratomileusis, popularly known as LASIK, is a surgery used in the treatment of myopia, astigmatism, and hyperopia. 

LASIK enhancement is a follow-up LASIK procedure performed if the original LASIK procedure did not yield satisfactory results. This follow-up procedure can also be carried out if your vision changes significantly over time. 

Although retreatment is seldom needed due to advancements in LASIK technology, not everyone gets the desirable 20/20 vision after the first procedure.

LASIK enhancement is similar to the original LASIK procedure. Your eye doctor will first give you eye-numbing drops. Because you already have a corneal flap created at the initial LASIK treatment, the doctor will lift the flap once more using a special tool. 

Necessary corrections will then be conducted beneath the flap. The healing process is like the first LASIK procedure, and your vision will improve over time. 

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Who Needs Enhancement? 

LASIK enhancement is performed to improve results of your initial LASIK procedure. A small percentage of patients do not get satisfactory results with the original LASIK procedure. This group of patients may need enhancement to improve their vision.

Follow-up care after the original LASIK includes your doctor monitoring your vision for several weeks or months. During this period after the first LASIK, you should tell your doctor if your vision does not improve as expected. You will need an enhancement if your vision continues to be less than satisfactory three months after the initial LASIK surgery.

Just like the first procedure, your eye doctor will evaluate your eyes and vision to assess suitability for the enhancement. In addition, the doctor will check if you have enough corneal thickness for a second surgical procedure. 

The doctor’s assessment may show that you are not a suitable candidate for LASIK enhancement. In this case, corrective lenses may be needed.

How Does Enhancement Compare to the Original LASIK Procedure?

The two LASIK procedures are almost identical, except for one notable difference. 

During your first LASIK procedure, the doctor uses a microkeratome or laser to create a corneal flap. Instead of a microkeratome or laser, the doctor uses specialized tools to lift the flap during LASIK enhancement procedure.

The process of re-lifting the corneal flap is painless and only takes about two minutes. Only minimal reshaping of the cornea is needed during the second procedure. The enhancement procedure can therefore take a few seconds. 

For most people, only one LASIK enhancement is needed to get your vision to a desirable level. 

Lift the Flap or Photorefractive Keratectomy (PRK)

Your surgeon has two options for enhancement — lift the flap or PRK. Different situations will call for either of the two approaches, but many surgeons will opt to lift the flap if the visit is within one year after the first procedure. 

Proponents of re-lifting claim it has the following advantages over PRK: 

• Better patient experience
• Quicker visual rehabilitation
• Shorter prescription eye drop schedule
• Fewer postoperative visits 
• Easier postoperative course 
• Less discomfort
• Fast surgery 

Some situations may make photorefractive keratectomy, or PKR, the better alternative. For example, if the flap is of poor quality, thin, decentered, or abnormally small, then re-lifting should be avoided. 

PRK makes it possible to avoid potential complications of re-lifting the flap, which include peripheral flap melt and epithelial ingrowth. Despite the pros and cons of the two treatment approaches, visual outcomes are the same. 

Advantages & Disadvantages of LASIK Enhancement 

Like any other medical procedure, LASIK enhancement is performed to improve your health, in this case your eye health. Benefits of this enhancement include:

• It is a quick and familiar process.
• Patients can achieve clear vision without contacts or glasses.
• It takes only a few days to see improvement in vision.

The disadvantages of this procedure include:

• Risks of infection.
• Patients must go through another healing process.
• Potential additional costs.

Are Enhancements or Retreatments Included in the Cost of LASIK?

When you visit your eye doctor and they prescribe LASIK as the solution for your vision problems, the doctor should also discuss with you the potential for enhancement or retreatment. This discussion forms part of the overall informed consent process, which is a requirement before such medical procedures. 

You can then ask your doctor if they’ll charge you for the enhancement if done within the first year of the initial procedure. There are additional questions you can ask to estimate the total cost of treatment. 

Questions to Ask Regarding LASIK Costs

It’s important to understand the complete cost picture for LASIK, and this includes the potential for any enhancement. Ask the eye clinic these questions:  

1. What does the cost of LASIK here include?
2. Are there any additional costs not included in the LASIK price?
3. Will my insurance cover or reduce the cost of LASIK?
4. Are there any programs available that can lower my out-of-pocket cost?
5. If I need temporary glasses or contacts after the procedure, how much do they cost?
6. Are there any needed prescription medications that are not included in the cost of the procedure?
7. Can I have a written itemized quote of all costs associated with the procedure?
8. In case I need an enhancement, is this included in the price? 
9. Is there a time period during which a needed enhancement is less expensive?
10. In case of complications, what are the costs of follow-up visits and additional treatments?

Answers to these questions will help you make an informed decision about the cost of the procedure. Any reputable doctor or eye center should take the time to answer all your questions thoroughly. 

LASIK Enhancement FAQs

How many times can you have LASIK enhancements?

There isn’t a specific limit to the number of times a person can have LASIK. The answer is individual and dependent on the thickness of the cornea. Talk to your eye doctor about how many enhancements or surgeries are appropriate for your situation.

How much are LASIK enhancements?

If you go to the same surgeon who performed the initial LASIK, they are not likely to charge you for the enhancement if it is within a year or so of the initial procedure. However, this pricing policy may differ from one specialist or hospital to another. 

Make sure to inquire about the potential cost of enhancements before your initial surgery.

Are there other enhancement options?

Yes. Some surgeons may prefer PRK over lifting the flap, especially for enhancements done many years after the initial LASIK procedure.

What is the average period before LASIK enhancement is requested?

On average, LASIK enhancement is performed 5 to 10 years after the initial surgery.

References

1. What Is LASIK Eye Surgery?. (August 2020). Journal of the American Medical Association.

2. LASIK Enhancement: Clinical and Surgical Management. (December 2016). Journal of Refractive Surgery.

3. Re-Treatment in LASIK: To Flap Lift or Perform Surface Ablation. (January 2020). Journal of Refractive Surgery.

4. Comparison of 5468 Retreatments after Laser in Situ Keratomileusis by Lifting the Flap or Performing Photorefractive Keratectomy on the Flap. (June 2017). Archivos de la Sociedad Española de Oftalmología.

5. How Many Times Can a Person Have LASIK Eye Surgery Safely? (June 2018). American Academy of Ophthalmology.

6. Case Study: Enhancement 13 Years After LASIK. (August 2014). Cleveland Clinic.