Vision Issues After LASIK: When Glasses Don't Help - Ophthalmology

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Understanding vision issues after LASIK surgery can be complex, especially when glasses do not seem to improve visual acuity as expected. Your situation, where you underwent LASIK surgery 20 years ago and are now experiencing difficulties with your vision despite corrective lenses, raises several important considerations.

Firstly, it is essential to recognize that LASIK surgery reshapes the cornea to correct refractive errors such as myopia (nearsightedness), hyperopia (farsightedness), and astigmatism. Over time, however, the eye can undergo natural changes that may affect vision. These changes can include the development of cataracts, presbyopia (age-related difficulty in focusing on close objects), or corneal ectasia (a condition where the cornea becomes progressively thinner and bulges outward).
In your case, you mentioned that your uncorrected vision is 0.8 (which is approximately 20/25), and your glasses prescription is -1.75 diopters with -0.50 diopters of astigmatism. If you are wearing glasses that are correctly prescribed but still unable to achieve better than 0.8 vision, it suggests that there may be other underlying issues affecting your visual acuity.

Here are some potential factors to consider:
1. Corneal Changes: After LASIK, the cornea can change shape over time. If the cornea has become irregular or if there is a condition such as corneal ectasia, this could lead to distorted vision that glasses cannot correct. An eye care professional can perform corneal topography to assess the shape of your cornea.

2. Cataracts: Although you may not have been diagnosed with cataracts, they can develop later in life, even after LASIK. Cataracts can cause blurriness, glare, and difficulty seeing at night. A comprehensive eye exam, including a slit-lamp examination, can help determine if cataracts are present.

3. Presbyopia: As people age, they often develop presbyopia, which affects the ability to focus on close objects. This condition typically begins in the early to mid-40s but can occur earlier in some individuals. If you are experiencing difficulty with near vision, it may be worth discussing multifocal or reading glasses with your eye care provider.

4. Refractive Regression: Over time, some patients experience a regression of the initial refractive correction achieved by LASIK. This means that the eye may gradually return to a state closer to its original prescription. If this is the case, a follow-up procedure, such as an enhancement LASIK, may be an option.

5. Other Eye Conditions: Conditions such as dry eye syndrome, retinal issues, or other ocular diseases can also contribute to visual disturbances. A thorough examination can help rule out these possibilities.

Given these considerations, it is crucial to consult with an ophthalmologist who specializes in post-LASIK care. They can perform a comprehensive evaluation, including visual acuity tests, corneal mapping, and a detailed examination of the lens and retina. This will help identify any underlying issues that may be contributing to your vision problems.

In summary, while LASIK can provide excellent vision correction, it is not immune to the natural aging process or other ocular conditions that can arise later in life. If glasses are not providing the expected improvement in vision, a thorough examination by an eye care professional is essential to determine the cause and explore potential treatment options.