2 years ago, I had LASIK to correct my hyperopia and
astigmatism. Before lasik, my prescription was as follows:

+7.50 -3.00 x 145
+8.00 -3.00 x 124

After surgery, I am left with about 1.50 diopters of astigmatism
in each eye, with vision of about 20/40. I am no longer as
dependent on glasses, but do need them for anything involving
reading, looking at the computer/tv and driving, since my vision
is a bit fuzzy overall without them. I haven't had any
complications from the surgery other than persistent mild/
moderate dry eyes for which I'm still needing to use moisturizing
drops regularly.

When I had my 1 year checkup, my ophthalmologist wasn't too
keen on giving me an enhancement surgery as he said my
residual prescription isn't very high. I would still like to look into
the idea of getting a touch up procedure done if it's possible to
bring my vision closer to 20/20 and to be able to read and watch
TV without glasses. I am unable to wear contact lenses because
my eyes are now too dry. I'm only 22 years old, so I wont need to
worry about reading glasses for a long time coming.

Would another lasik procedure, or custom laser procedure be
beneficial for somebody with a residual prescription such as
mine? Is there a possibility that an enhancement procedure will
make my already dry eyes worse?

Thank you.

In my opinion, you should not consider additional surgery at this time.

You had very, very high hyperopia (farsighted) vision before LASIK, well outside what most would consider an ideal candidate. You did not provide your current prescription other than your astigmatism, but if all you have is 1.50 diopters astigmatism, then you have received an excellent outcome. Most certainly, it appears that you have received an outcome much better than I would have predicted.

Most people who have LASIK to correct high hyperopia vision experience regression back toward the original refractive error. Considering where you started, it would be reasonable to expect your hyperopia to return to a level of 1.00 to 3.00 diopters. If the hyperopia returns and all other indications indicate that surgery is appropriate, then you may want to consider enhancement surgery for the regressed hyperopia and astigmatism.

Remember that “better” is always the enemy of “good enough”.

Glenn Hagele
http://www.USAEyes.org

I am not a doctor.

Thank you for your insight Glenn, I appreciate it. The last time I
was refracted, i think I only had about a +0.50 power leftover, but
that was over a year ago and my vision feels as though it's gotten
worse since then. I'm going in for another eye exam this summer,
so I'll see how much my prescription has changed.

I am very happy with my results of the first lasik procedure,
considering my starting prescription. I just thought that if there
was a chance of getting 20/20 with an enhancement procedure
before my flap completely seals up (if it hasn't already), that it
might be worth a try.

I agree with Glenn that coming from +8, you had a very good result for only one lasik treatment. I am a fellow high hyperope and had +5.25 with -1.5 astigmatism prelasik. Conventional lasik was done 6 years ago with enhancements at 6 months to correct only residual asitgmatism that all regressed back in. Treating high hyperopia actually induces additional astigmatism. I'm surprised your doc did not suggest to you that enchancements would almost certainly be needed to get you closer to plano and 20/20 from such a high script. My doc told me right away, so I was better able to cope and look forward to the enhancements. I probably should have waited longer tho, since the regression slowly continued and even after the 6 month touch-ups, it kept on regressing for another year or so and finally stabilized at about -1 diopter 2 years out. I'm left with 20/25 uncorrected in good light but that degrades in low light. Luckily I don't have a significant dry eye problem as you do and can watch TV OK without the light correction but do need it for computer and close work or headaches and eyestrain quickly set in. I looked into yet another enhancement possibility but have been advised against it by all docs. I would pass along the same advice to you. Tempting fate and hoping for that elusive 20/20 by lifting an old flap for such a small correction could possibly leave you with other more serious problems like epi-ingrowth, DLK and irregular astigmatism with even worse accuity. If they cant lift the flap, the doc might suggest cutting a new one. That's just tempting fate further and inviting more problems, even with intralasik cut flaps. Fixing residual astigmatism as a high primay hyperope via enhancement seems to be the most difficult challenge for lasik. Plus it would very likely exacerbate your already dry eye problem and could make life really miserable. At your age, I would wait longer for better technology to come along. You might experience some additional minor regression over the next year or so, maybe up to another half diopter of both the astig and the hyperopia, but that would be about it. While there are folks who regress almost all the way back to their original scripts, that is rare and not likely to happen to you if you've noticed only slight degradation after one year. Good luck.

Thank you for your reply Tom.

My doctor did warn me that I will most likely *not* be 20/20
after the first lasik treatment. I was told to expect about 20/25,
and would probably only need glasses for night driving... and
that there was an option of a free "touch up" treatment if I'm any
worse than that. Unfortunately it ended up just a bit worse than
that prediction, though I should really be grateful for the vision I
do have now (which, compared to how it used to be, is
amazing!). I'm just a bit disappointed that if any prescription
was left over afterwards, that it had to be astigmatism. I think I
would have rather had a bit of myopia or hyperopia afterwards,
because at least those conditions are a lot easier and cheaper to
correct with disposable contact lenses. If you couldn't tell, I
absolutely hate wearing glasses!

A little less than a year after my treatment, I asked my
ophthalmologist if i'd qualify for an enhancement treatment and
he told me it wouldn't be worth it. I wasn't sure whether he was
just saying that because he didn't want to (since it would be
free), or if he really actually meant it. So I thought I'd get a few
more opinions.

Thanks!

You can have an enhancement at any time. There is no rush. Although the LASIK flap heals (http://www.usaeyes.org/faq/subjects/lasik_flap_heal.htm) it does not heal like a cut on your arm. LASIK flaps have been lifted 12 years postop.

Well, "lifted" is probably not the most correct term. It is more like separating the cornea at the location of the original incision.

Glenn Hagele
http://www.USAEyes.org

I am not a doctor.

That's really good to know! I'm glad there isn't any rush, and maybe
I would be better off waiting around for new technology to arise as
Tom said, rather than rushing into another lasik treatment.

Thanks for the link :)