Post-LASIK Myopia Progression: A Patient's Concern

After LASIK, myopia continues to worsen?

Dear Sir,
I originally had around 1000 degrees of myopia in both eyes.
After undergoing LASIK, my vision was initially clear, but this improvement did not last.
In the first year, my prescription changed by 100 degrees, and it has continued to worsen, with my current prescription being 600 degrees in each eye.
I visited the original clinic for an examination, but the doctor could not provide an explanation.
Before the surgery, my prescription was stable, but it became unstable afterward.
I asked the surgeon if the increase in prescription was due to the cornea becoming thicker after the surgery, but he stated that it was due to the axis of myopia.
I cannot understand why this is the case; my prescription was stable before the surgery, yet the axis of myopia became unstable afterward.
I kindly request an explanation.
Best Regards,
JJ

JJ, 40~49 year old female. Ask Date: 2007/11/26

Dr. Zhang Yanrui reply Ophthalmology

Your condition is quite complicated and may be due to pathological (progressive) high myopia or unstable refraction caused by corneal thinning.
A thorough examination by a physician is necessary to determine the underlying cause, and further surgery is not recommended.

Reply Date: 2007/11/26

More Info

Dear JJ,
Thank you for reaching out with your concerns regarding the progression of myopia after your LASIK surgery. It’s understandable to feel confused and anxious about changes in your vision, especially after undergoing a procedure that was intended to correct your refractive error.

Firstly, it’s important to recognize that LASIK surgery reshapes the cornea to improve the eye's ability to focus light on the retina, which can significantly reduce or eliminate the need for glasses or contact lenses. However, the outcomes can vary from person to person, and some individuals may experience changes in their vision post-surgery.

In your case, it appears that you had stable myopia prior to the surgery, but have since experienced a regression in your vision, with your myopia worsening from -10.00 diopters to -6.00 diopters in each eye. This phenomenon is not uncommon and can be attributed to several factors:
1. Natural Progression of Myopia: Myopia can continue to progress even after surgical intervention. This is particularly true for individuals who had high levels of myopia before surgery. The eye can continue to elongate, leading to increased myopia.
2. Post-Surgical Changes: After LASIK, the cornea is reshaped, which can lead to changes in the eye's optical system. While the goal is to create a more favorable curvature, some patients may experience fluctuations in their vision due to healing processes or changes in the corneal structure.
3. Refractive Stability: The stability of the refractive outcome can be influenced by various factors, including the healing response of the cornea, the thickness of the cornea post-surgery, and the overall health of the eye. In some cases, the cornea may not heal as expected, leading to changes in vision.

4. Myopic Shift: Some patients may experience a myopic shift due to changes in the eye's axial length or the curvature of the cornea. This can happen if the cornea becomes steeper or if the eye elongates after surgery.

5. Astigmatism: If there were pre-existing astigmatism that was not fully corrected during the LASIK procedure, or if new astigmatism developed post-surgery, this could also contribute to visual changes.

Regarding your concern about the cornea becoming thicker after surgery, it is essential to clarify that LASIK typically involves creating a flap in the cornea and then reshaping the underlying tissue. The cornea does not become thicker in a way that would cause myopia to worsen; rather, the reshaping is intended to flatten the cornea to reduce myopia. Your surgeon's mention of "myopic axis" likely refers to the orientation of your myopia, which can be influenced by the shape of your eye and the cornea.

Given your situation, it would be advisable to seek a second opinion from a refractive surgeon or an ophthalmologist who specializes in post-LASIK complications. They can perform a thorough examination, including corneal topography and wavefront analysis, to assess the current state of your eyes and determine the best course of action.
In some cases, enhancement procedures may be considered if the cornea is healthy and there is sufficient corneal thickness. Additionally, options such as glasses or contact lenses may be recommended to manage your vision effectively.

It’s crucial to maintain open communication with your eye care provider and express your concerns clearly. They can provide you with the necessary information and support to address your vision issues.

I hope this information helps clarify your concerns, and I wish you the best in your journey toward better vision.

Best regards,
Doctor Q&A Teams

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