Age, Degree of Refractive Error Increase Chances for LASIK Retreatments

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SAN FRANCISCO – Having an initial LASIK correction for high nearsightedness, farsightedness or astigmatism, and being older than 40 years of age, increase the chances of needing LASIK retreatments. These are the conclusions of a study appearing in the April issue of Ophthalmology, the clinical journal of the American Academy of Ophthalmology, the Eye M.D. Association. A retreatment is a second surgery to correct residual refractive error after the initial surgery.

In this study from Hackensack University Medical Center and the New Jersey Medical School, 2,485 eyes of 1,308 patients underwent LASIK surgery for correction of nearsightedness, farsightedness or astigmatism. Out of these, 288 eyes of 233 patients underwent one retreatment, and one eye in each of three patients required two retreatment procedures. The overall one-year incidence of retreatment was 10.5 percent. For nearsighted eyes, the retreatment rate was 12.1 percent, and for farsighted eyes it was 6.2 percent. Rates from previous studies have varied from 5.5 percent to 28 percent.

In addition, patients older than 40 years of age had a significantly higher rate of retreatment than those younger than 40. Those over 40 had a one-year rate of 14 percent, compared to 5 to 9 percent for those in the 18 to 40 year age range.

Peter S. Hersh, MD, the lead author of the study said, “Older patients generally do quite well, but their outcomes are not as predictable as those for younger patients. Similarly, patients with high refractive error and astigmatism also are more likely to need retreatments. This does not signify a bad result, but it does require patient understanding. Therefore, patients should have in-depth discussions with their surgeons regarding the expected outcome for their particular situations.”

This study also found that LASIK flaps can be lifted using a manual technique up to three years after the initial surgery. This substantially reduces the need to recut the flap for retreatments. In this study, only three eyes required the cutting of a new flap.

Academy spokesperson James J. Salz, MD, clinical professor of ophthalmology at the University of Southern California and attending ophthalmic surgeon at Cedars-Sinai Medical Center in Los Angeles, said, “This nicely conducted study shows for the first time that patients over the age of 40 have a higher risk for needing a LASIK retreatment, and it emphasizes the importance of the patient’s informed consent regarding this higher risk. It also shows that farsighted patients are less likely to need an enhancement, and it reinforces the importance of lifting flaps whenever possible so as to avoid the potential complications of recutting a second flap.”

The American Academy of Ophthalmology is the world’s largest association of eye physicians and surgeons—Eye M.D.s—with more than 27,000 members worldwide. For more information on eye health care, visit the Academy’s partner Web site, the Medem Network, at www.medem.com/eyemd. To find an Eye M.D. in your area, visit the Academy’s Web site at www.aao.org.

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