Can you have LASIK eye surgery twice?

Do you remember that first morning when you had LASIK surgery and got rid of your glasses? That moment when you realized how clear and vivid the world was... Witnessing this happiness in our clinic is the best part of our profession for us. Years pass, life goes on, and one day you look and your eagle-sharp vision is not as clear as it used to be. Maybe the signs in the distance have started to blur a little, maybe you feel the need to hold your phone screen a little further away. That's when the first anxious question comes to mind: "Oh my gosh, is everything going back to the beginning?" and right after that, can you have LASIK eye surgery twice? I hear this question so often... My answer is usually "Yes, but..." Let me put that "but" part aside now, all those medical terms, and tell you with all my sincerity, as if we were sitting across from each other in my office.

Why Does That Perfect Vision Deteriorate Slightly After Years?

First of all, let's make this clear: A slight change in your vision after years does not mean that your first surgery was unsuccessful. Absolutely not. This is often due to the extremely natural and expected changes in our eyes. The most common scenario we see is what we call "regression". Although it sounds like a bad word, it is actually very simple: Your eye resists the new shape we gave it with surgery and tries to return to its old habits. After all, it is a part of your body; it has its own balance. This situation can be seen a little more in our patients who get rid of very high prescriptions. However, this usually does not occur in the form of a complete reversal of prescriptions, but in the form of a small shift, such as an eye that was reset from -6.00 to -0.75 diopters later. Another common reason is the famous "40-year-old tax" that will knock on the door of all of us: presbyopia. This is not a disease, but one of the most natural signs of aging. The lens inside our eyes can instantly focus from near to far like a camera lens when we are young, but after the age of 40, it gradually loses this flexibility. The result? While you see great from afar, you start adjusting your arm distance to read the menu in your hand and phone messages. In other words, the fact that someone who had LASIK at the age of 25 and sees far as glass, needs reading glasses at the age of 45 is not related to the first surgery. This is the eye's age calendar working perfectly. Laser solutions such as Presbyond exist for this situation; however, because the prescription is quite likely to return within a few years, an intraocular lens (IOL) operation is generally recommended for near vision after 40. Although rare, there may be cases where a part of the prescription remains inside during the first surgery (we call this 'insufficient correction') or the person's myopia continues to progress. We are especially careful about this risk in those who have surgery in their early twenties, when their prescription has not yet settled. This is why at Kudret Eye İstanbul, a patient's prescription not changing for at least a year is a red line for us. Our goal is to provide a permanent solution in one shot. But as I said, everybody is unique, and sometimes they can react in small ways that are different from what you planned. The important thing is to know that there is a solution to all of these situations.

So, Does Your Eye Get a 'Passing Grade' for a Second Time Under the Knife?

Here we come to the most critical question. Before deciding on a second operation, we perform a check-up on your eye, and the most important criterion that allows us to say 'yes' or 'no' is the thickness of your cornea. Let's compare the cornea to a cake with layers. In LASIK, we lift a thin slice (flap) from the top of this cake and reshape it by taking a small amount from the bottom layer with a laser. For a second surgery, it is necessary to have sufficient thickness left so that we can safely take another layer of that cake. If the cornea becomes too thin, its structure weakens, and this can lead to undesirable results. This is a non-negotiable rule for us. The patient's safety comes first. Therefore, the remaining tissue thickness in our measurements is of vital importance to us, even with a precision of one hundredth of a millimeter. Let's say your corneal thickness is sufficient. Is everything over? No. We also look at the general health of your eyes. If there are conditions such as the beginning of cataracts, suspicion of glaucoma, or severe dry eyes, performing a second LASIK would not be the right approach. For example, performing LASIK on someone whose cataracts have just started to form means having to have another cataract surgery a few years later. It's like a waste of time. Instead, recommending a multifocal lens surgery that will correct both the cataract and the eye prescription in one go is a much more logical and permanent solution. In short, we evaluate the eye as a whole; focusing only on the number causes us to miss the big picture. And finally, there is the issue of timing. If your eye prescription is still changing, that is, if it is not "seasonally" but in a constant increase or decrease trend, it is best to stop and wait. It is like shooting at a changing target; you think you hit the bull's eye, but your shot goes in vain because the target has moved.

If You Say 'No' to LASIK, Is That the End of Everything?

If we tell you, "I'm sorry, but you are not a candidate for a second LASIK" after all the tests we have done, please do not see this as the end. It just shows that this is not the safest way for your eye structure. Fortunately, technology has advanced so much that we have a Plan B and even a Plan C. The most well-known alternative to LASIK is PRK, a flapless laser procedure, or its contact-free version, No Touch laser. It is a lifesaver, especially for our patients with thin corneas. Instead of removing that slice of cake in PRK, we scrape off the icing (epithelial tissue) on top of the cake and apply the laser directly. The recovery process may be a day or two more painful than with LASIK, yes, but the resulting quality of vision is exactly the same. In other words, it is reaching the same goal by a different path. If the problem is not just the cornea but a much higher prescription or if there are other situations where laser is not logical, then we focus on the inside of the eye. There is a technology called Implantable Collamer Lens (ICL). You can think of it as a permanent contact lens that is placed inside your eye. These tiny, miraculous lenses that we place behind the iris, in front of your natural lens without touching it at all can correct even very high myopia and astigmatism. This is a great option, especially for young people whose cornea is not suitable for any laser treatment. If you are older and have cataracts, then the most logical option is to replace your own lens that has lost its function and replace it with a multifocal lens that can see far, intermediate and near. This is killing two birds with one stone. Sometimes the best solution is the simplest one. If your vision impairment is very minor, hardly affecting your daily life, a low prescription pair of glasses that you can use only when driving at night or giving a presentation may be the most logical and risk-free option. Remember, our goal is not to sell you surgery. Our goal is to find the right, safest, and happiest solution for you together. Sometimes this solution may be to do nothing. And this is a doctor's decision, the best decision for a patient.