While the goal of LASIK and other refractive surgery is for you to no longer need refractive correction like that provided by contact lenses or glasses, there are times where you might want to or when it may be necessary.
In the vast majority of cases, LASIK surgery is successful at correcting refractive errors well enough that additional vision correction is not required, with the patients ending up with 20/40 or 20/20 vision. Thanks to this, the vast majority of patients will not need additional correction from things like contact lenses or glasses after the surgery.
LASIK and other refractive surgeries are not perfect, however, and there are a few situations in which you might wear contact lenses following the procedure.
One of the most common misunderstandings of LASIK is that you will never need to wear glasses or contact lenses again. The truth is that most patients will eventually require reading glasses or contact lenses for presbyopia as they age, even if they did LASIK. This is because while LASIK corrects the primary refractive error (nearsightedness, farsightedness, astigmatism), it does not correct for the future changes in your eye. Virtually everyone will start to experience a weakening of the eye called presbyopia, which starts around the age of 40. While the LASIK procedure does its job, new vision changes may arise which require contact lenses to correct them. When a patient experiences presbyopia due to age, they will require vision correction even if they had LASIK in the past. (In these cases, there is often a greater amount of time between the LASIK procedure and the need for contact lenses).
LASIK and similar surgeries like PRK, LASEK, and SMILE, correct vision through the reshaping of the cornea, by removing microscopic amounts of the cornea tissue. Normally, this results in clear vision. Occasionally, however, the procedure may lead to irregularities in the shape of the cornea and unclear vision.
In many cases, irregularities like this are corrected with a follow-up procedure called an enhancement. However, if the cornea is too thin for an additional surgery, or something else makes an enhancement procedure impossible, contact lenses (gas-permeable, scleral lenses, or hybrid lenses) may be recommended.
While not so common today due to new, less invasive types of refractive surgery, some refractive surgeries did require the patient to wear a protective therapeutic contact lens to protect the eye for a few days after the procedure. If your surgeon has a concern about healing your corneal flap, however, they may recommend you wear a therapeutic contact lens (TCL) for a day or two following the operation.
For patients who had a very high refractive error prior to LASIK, the procedure might not have been enough to correct it. These patients, therefore, may need contact lenses to supplement the surgery.
Colored contacts worn for cosmetic reasons (for things like costuming, for example) are more popular than ever, and one may wish to continue wearing their colored contacts following LASIK or another refractive procedure.
Along with the broader question of whether contact lenses can be worn after LASIK, the question regarding the safety of doing so often arises.
The short answer to this question is yes. However, this is a conditional yes, as any contact lenses worn after LASIK or any other refractive surgery must be under the guidance of an eye doctor. According to a recent survey, somewhere between ten and twenty-five percent of patients wear contacts after LASIK according to their doctor’s recommendation.
Contact lenses are medical devices, and should only be worn with the guidance of an eye doctor.
Now that we know there are some situations in which you may be wearing contact lenses following LASIK or another refractive surgery, the next question is what type of lenses they might be.
These are standard soft contacts which can provide additional vision improvement after LASIK. So long as the necessary refractive correction is small, these can work well. However, if a patient has a larger refractive error, astigmatism, or another significant corneal abnormality, these may not be effective or may cause discomfort.
If you had previously worn contacts, you will require a new eye exam and contact lens fitting, since the surgery will have changed the nature of your refractive error and altered the shape of your cornea.
Unlike soft lenses, rigid gas permeable lenses retain their shape on the eye. For a post-LASIK patient, this can be very important, since the cornea may have an irregular shape after a LASIK or other refractive procedure that will make using soft lenses difficult.
They are also capable of correcting high degrees or regular or irregular astigmatism, and, thanks to their gas-permeable nature, are generally comfortable for the wearer.
Because of this, these lenses are the most used among post-LASIK patients.
As the name might imply, combination lenses utilise elements from both soft and rigid gas permeable lenses. They are good for patients who are hypersensitive to rigid gas permeable lenses but need the increased correction provided by rigid gas permeable lenses. In these combination lenses, a rigid gas permeable lens is “piggybacked” atop a soft lens.
A similar option is the hybrid lens, which has a rigid center and a soft lens skirt to get the benefits of both types.
Scleral lenses are often called the most comfortable and most versatile contact lens. They are also often considered a last resort option in patients for whom other lens types haven’t worked. Scleral lenses are large enough to completely cover the front of the eye and rest on the sclera (the “white” of the eye.)
Scleral lenses offer significant advantages that include:
Many patients who have corneal scarring, severe dry eye, or sensitivity following LASIK or other refractive surgeries will find that scleral lenses provide the best fit, vision and comfort.
Since LASIK and other refractive procedures can significantly change the cornea’s shape, fitting contact lenses after such a procedure can be more challenging than fitting lenses for a patient with a regularly shaped cornea.
These fittings are often more time consuming and expensive, requiring special computerised devices such as a corneal topographer to precisely measure the corneal surface.
In cases where large amounts of tissue have been removed, rigid lenses, such as rigid gas permeable lenses. If an even larger amount of tissue has been removed, more specialised lenses, such as large diameter rigid gas permeable lenses, scleral lenses, or reverse geometry lenses may be recommended instead.
Because of the complexity of fitting contact lenses following refractive surgery it is best to visit an eye doctor that specialises in hard to fit contact lenses such as RGP and scleral lenses.
While the goal is not to need contact lenses or any other refractive correction following LASIK (or other refractive) surgery, there are times where patients will want or need to wear contact lenses. In these situations, with the guidance of an eye doctor, contact lenses can be safely worn. If you have any additional questions, or wish to schedule an appointment for a post surgery contact lens exam, you can contact American Family Vision Clinic at (360) 491-2121.