Should I have an Enhancement?

Can "new technology" fix my bad LASIK (Or Radial Keratotomy Or PRK)?

Over the years I have been asked these questions many times. Currently, there are no surgical procedures or treatments that will restore the vision and comfort lost (dry eyes, reduced night vision, higher order aberrations etc.) to its pre-surgical state. If you search through the internet, you will find numerous eye care providers world-wide advertising new laser and other procedures that will eliminate the blurred, distorted vision you are now experiencing. This is just not possible. These additional refractive surgical procedures may make your vision somewhat better but they will not give you the quality of vision that you had with your eyeglasses or contact lenses before your surgery. In addition, with each successive procedure, the risk of additional complications increases significantly. I have seen many patients made worse by additional surgeries, sometimes much worse.

When seeking help on the internet or through other forms of advertising, beware of wordings that are intended to mislead you into thinking that another refractive surgical procedure will restore your vision quality and comfort. Don't get caught up in "high tech" wordings implying a new technology that can help you regain your former life. Some of the technologies being promoted include:

  • Very high frequency ultrasound technology
  • Therapeutic wave front guided LASIK
  • All laser LASIK
  • Topography guided custom ablation
  • Trans-epithelial PTK
  • Small treatment zone topography guided algorithms
  • Wavefront guided ablation

LASIK, PRK, ALK and Radial Keratotomy (RK) are surgeries. You cannot undo the damage done by these procedures. The risk of additional vision loss is greater with each successive procedure. This is true regardless of where it is done or who performs the surgery.

Since the early 1980's when radial keratotomy first appeared in the U.S., I have counseled patients not to get involved with these sight threatening surgeries. Over the last 30 years, I have taken care of thousands of patients whose vision have been damaged. The only treatment that will work to restore lost vision and ocular comfort due to refractive surgery is a gas permeable scleral lens. Scleral lenses, when fitted correctly, will replace the cornea as an optical surface. In other words, the irregular surface caused by these surgeries becomes irrelevant. These lenses vault over the compromised cornea and rest on the white portion of the eye (the sclera). The space between the back surface of the lens and the front surface of the cornea is filled with unpreserved saline solution. Because of this, the compromised cornea is always in a wet environment which provides comfort and promotes healing.

This is a computer enhanced image of a damaged cornea after LASIK, shown in 3 dimensions. Note that this cornea does not have a smooth spherical surface but instead has the appearance of what once was a spherical surface cut down the middle. There is no way that another refractive surgery will give this cornea the smooth spherical surface necessary to focus light to a point on the retina, as with normal vision. While this is an extreme case, it clearly shows the problems involved in restoring a normal optical shape to flattened Lasik corneas. The patient essentially has two options, a cornea transplant or a scleral lens. A transplant is risky and will almost certainly leave the patient needing a scleral lens anyway. In other words, the patient gains nothing from the transplant.


"People who say it can't be done
shouldn't interrupt the guy doing it."
-- Roger D. Davis, PhD

Dr. Boshnick on CBS This Morning

See Dr. Boshnick and Dr. Morris Waxler (former FDA chief research scientist on refractive surgery) talk about bad LASIK