LASIK touch-up with -0.5 in one eye?

[hanksi]

I'm 35yrs old  and received Lasik surgery 2 years ago (had a -2.75 prescription with a very small astigmatism). One of the main reasons I did the surgery was because I'm an avid tennis player and skier, and I wanted to not have to wear contacts when I engaged in my favorite sports.
The surgery went well with no complications. Two years later, the vision in my left eye is 20/20, but my right eye is around -0.5.

This doesn't really bother me during my day-to-day (and I passed my drivers license vision test fine), but I do notice a slight difficulty seeing the ball when I play tennis, especially at night. In general, when I'm driving at night, I can notice a bit of strain.

I talked about this with my eye surgeon last year at my 1-year check-up. He said that if it was really bothering me, I could go in for a free touch-up, but he warned me that it's unknown if a second surgery would fix the issue at such a low diopter. He said that there was a 25% chance it would get better, a 50% chance that it would be more or less the same, and a 25% chance it would be worse. After I was hemming and hawing, he offered to extend my free touch-up period for another year and see how I felt then.

Well, my second check-up is a month away and I don't think I'll get another extension for a touch-up. It's still irking me that my vision isn't perfect and I do sense it when I play tennis or am driving at night.

How accurate were my surgeon's likelihood of improvement predictions? He said doing a follow-up surgery was up to me, but if it was his son, he would say don't do anything given the risks. I'm kind of torn and am unsure if he's maybe saying that to avoid having to do a follow-up surgery...but he is a well-regarded surgeon and I don't want to be so cynical as to think he's trying to save a buck here.

Does anyone have some more concrete advice on what I should do? Or is there a link to some literature that discusses the likelihood of improvement in my case? Thanks so much for any help!

[Ron_AKA]

Since you are younger I doubt that you have thought much about cataracts. Most people  need cataract surgery when they hit the age of 70 or so. One of the complications in going to an IOL to replace the natural lens which has a cataract is the need to measure the eye very accurately. Having previous Lasik makes this process more difficult and accuracy can suffer resulting in errors (surprises) of +/- 0.5 D or more. So there is a long term price to doing Lasik. Also if a multifocal IOL is to be considered the side effects can be worse with prior Lasik. Some things to consider before getting into further Lasik with limited upside.

[John C Hagan III, MD, FACS, FAAO]

Most ophthalmologists would recommend leaving it alone. There is not much upside and significant downside.  You have more trouble at night because when the pupil dilates it creates a myopic shift. This could easily be handled by an inexpensive pair of prescription glasses for night driving.  Also I don't knhow how close you are to 40 but when middle age trouble focusing at near starts you will be happy with that .50 diopter myopia. Besides if you play tennis you should we protective athletic glasses. I have had 3-4 major eye injuries from tennis ball to the eye, this includes one eye that was totally blinded

[Siddaarth_R]

I'm in no way an expert at this type of stuff. I'm not sure about the likelihood of improvement in your case, but you could consider doing PRK. It does cost less, and it's safe to do after LASIK to correct any residual refractive errors. But the problem you need to have a specific corneal thickness to qualify. Other than that however, I think it should work. If anyone who is an expert at this stuff could clarify/back up my comment that'd be awesome.

[John C Hagan III, MD, FACS, FAAO]

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