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LASER EYE SURGERY – LONG-TERM OUTCOMES
This page is for patients who have had laser eye surgery and are noticing their vision changing again, and who want to understand whether this is true regression, natural ageing, or something requiring treatment.
Regression Is Biological, Not Surgical Error
Regression affects fewer than 2% of low myopes but up to 15% of high myopes.¹ True regression after laser eye surgery occurs when the corneal healing response partially reverses the ablation effect, the epithelium remodels over the ablated surface and the prescription shifts back toward its pre-operative level.² This is a biological process, not a technical failure. It is more common at higher prescriptions, where more tissue is removed and the biological remodelling response is proportionally greater.
Regression is distinct from two other causes of changing vision that are commonly conflated with it: presbyopia (natural lens ageing from the mid-40s) and cataract (natural lens opacity from the 60s onward). Neither of these is caused by or related to the laser correction. Regression occurs within the first one to three years post-surgery; presbyopia and cataract occur on their own independent timelines regardless of whether laser surgery has been performed.
Regression Rates by Prescription Band
- -1D to -3D (low myopia): regression rate at 5 years under 2%. Rarely clinically significant.¹
- -3D to -6D (moderate myopia): regression rate 3-5%. May warrant enhancement in some patients.¹
- -6D to -10D (high myopia): regression rate 8-15%. More common, enhancement policy relevant.¹
- Hyperopia (any): regression rate 15-40%+. Significant, the reason Blue Fin Vision® does not perform hyperopic laser.³
When to Monitor vs When to Treat
Monitoring: residual prescription change under 0.5D, still within functional vision range, stable refraction on two consecutive measurements. Most mild regression is best observed through the three-month and six-month reviews before enhancement is considered. If your vision falls into this monitoring category, continue with your scheduled follow-up appointments and avoid requesting enhancement before the stability window has been reached.
Treatment: refraction change of 0.5D or more, stable over two measurements at least six weeks apart, corneal thickness allows re-treatment, and the patient’s uncorrected vision is affecting function. Enhancement success rate after myopic regression exceeds 90% in published series.³ If your vision has regressed and meets these criteria, contact Blue Fin Vision® to schedule an enhancement assessment with Mr Hove.
The 3-12 month window is the most common timeframe for myopic regression to manifest. Vision that is stable at twelve months is unlikely to regress further in the absence of other pathology. Once you pass the twelve-month mark with stable vision, your laser correction is considered permanent.
Who This Is Not For
This page is not for patients whose near vision is declining from their mid-40s onward. Difficulty reading after laser eye surgery is not regression, it is presbyopia, a completely separate process. The laser correction for distance is working correctly. The natural lens is ageing. These two events are unrelated.
Clinical Perspective
At the Blue Fin Vision® clinic in London, Mr Mfazo Hove counsels every patient on regression risk at the pre-operative consultation, with specific percentages by prescription band, not generic reassurance. Enhancement eligibility criteria are explained before surgery so that if regression occurs, patients understand it is a known outcome managed by a pre-existing policy. In our 2024-2025 LASIK series, the overall enhancement rate was under 2% at twelve months. Patients with prescriptions above -6D were counselled specifically on higher regression risk and directed toward ICL where appropriate, a procedure with no corneal regression mechanism.
Clinical Takeaway
True regression occurs when the corneal healing response partially reverses the laser correction. It is more common at higher prescriptions, up to 15% at -6D to -10D versus under 2% at low myopia. The treatment window is three to twelve months post-surgery. Enhancement is effective in over 90% of regression cases. At Blue Fin Vision®, regression risk is discussed by prescription band at every pre-operative consultation. If you believe you are experiencing regression, book a refraction and review appointment at Blue Fin Vision®, Mr Hove can distinguish true regression from other causes of vision change and advise on your enhancement eligibility.
References
- Alberigo A, Iovieno A, Calossi A, Guerra F, Carlin P, Dapena I. Myopic regression after LASIK: incidence and influencing factors. J Refract Surg. 2010;26(12):896-900.
- Vestergaard AH, Hjortdal J, Ivarsen A, Work K. Long-term outcomes of photorefractive keratectomy for low to high myopia: 13 to 19 years of follow-up. J Refract Surg. 2013;29(5):312-9.
- Barsam A, Allan BD. Excimer laser refractive surgery versus phakic intraocular lenses for the correction of moderate to high myopia. Cochrane Database Syst Rev. 2014;(6):CD007679.
- Mello GR, Rocha KM, Santhiago MR, Smadja D, Krueger RR. Applications of wavefront technology. J Cataract Refract Surg. 2012;38(9):1671-83.
- O’Brart DP, Lohmann CP, Klonos G, Corbett MC, Polkinghorne PJ, Kerr Muir MG, et al. The effects of topical corticosteroids and plasmin inhibitors on refractive outcome, haze, and visual performance after photorefractive keratectomy. Ophthalmology. 1994;101(9):1565-74.
- Medically Reviewed by:Mr Mfazo Hove, Consultant Ophthalmic Surgeon
- Author:Blue Fin Vision® Team