Enhancement rates are 1-5% for low to moderate myopia and up to 10% for high corrections. These are population figures. What matters to the individual patient is the rate for their specific correction, and what the provider does when they are in that group.
Published Enhancement Rates
Large-scale outcome studies place LASIK enhancement rates at 1-5% for corrections up to −6.00 D and up to 10% for high myopia. For PRK and TransPRK, rates are broadly comparable across equivalent correction ranges, with the eligibility assessment window occurring later, typically at Month 6 rather than Month 3. ¹ ²
What Aggregate Rates Do Not Tell You
Published enhancement rates do not reveal:
- The degree of residual error that triggered the enhancement, a minor 0.50 D touch-up and a significant 2.00 D re-treatment are both counted equally in aggregate data
- Whether the enhancement was performed by the original surgeon or a different one
- Whether the enhancement was included in the original fee or charged additionally
- The visual outcome following enhancement
A low published enhancement rate may reflect stringent eligibility criteria, meaning eligible patients are denied enhancement, rather than consistently superior primary outcomes. The rate in isolation is not a reliable quality signal. ³
Why High Corrections Carry Higher Enhancement Risk
Higher myopic corrections require deeper ablations, removing more stromal tissue and increasing the variability of the biological healing response. Higher ablations also reduce the residual tissue available for enhancement if one is subsequently needed. This is the clinical basis for counselling high myopes specifically on enhanced enhancement probability. ⁴
At Blue Fin Vision®, patients with corrections above −6.00 D are counselled explicitly on this at preoperative consultation. Where corneal tissue margins are a concern, ICL is discussed as an alternative that does not reduce stromal tissue.
Blue Fin Vision® specifically: Blue Fin Vision® does not use a single headline enhancement rate in consultation. Rates are presented in the context of the patient’s specific refractive profile and procedure type: the LASIK patient with −2.00 D myopia is given a different probability estimate from the TransPRK patient with −8.00 D. This is clinically meaningful. An average is not.
The Questions That Matter Before Surgery
When evaluating any provider’s enhancement position, ask:
- What is the enhancement rate for my specific correction and procedure type?
- Is there a written enhancement policy, and is the surgical fee waived for eligible patients?
- Who performs the enhancement, the original surgeon?
- What is the minimum waiting period before enhancement eligibility is assessed?
When things are straightforward, many clinics perform well. When they are not, that is where systems, experience and accountability matter most.
Frequently Asked Questions
If I need an enhancement, does that mean my original surgery failed?
No. Enhancement is a recognised and planned clinical pathway for a defined minority of patients. It is not evidence of surgical error, it is evidence that the biological variability in corneal healing placed the patient’s outcome at the edge of the predicted range. The outcome following enhancement is typically within the intended target. The enhancement is the system completing the correction.
Does having an enhancement increase my risk of complications?
Enhancement carries the same category of risks as the original procedure, with one additional variable: the residual tissue depth is lower than before the primary surgery. This is the reason tissue adequacy is a formal eligibility criterion. Where adequate tissue exists, enhancement outcomes are generally comparable to primary surgery outcomes in published data.
Can I have an enhancement if I originally had PRK elsewhere and the outcome was suboptimal?
Potentially, yes, subject to assessment of corneal topographic stability and residual stromal bed depth. Mr Hove accepts patients for post-PRK enhancement assessment following surgery at other centres. The assessment requires current topographic mapping, pachymetry, and a review of the original surgical parameters where available.
References
- Sandoval HP, Donnenfeld ED, Kohnen T, Lindstrom RL, Potvin R, Tremblay DM, Solomon KD. Modern laser in situ keratomileusis outcomes. J Cataract Refract Surg. 2016;42(8):1224-1234.
- Shortt AJ, Allan BD, Evans JR. Laser-assisted in-situ keratomileusis (LASIK) versus photorefractive keratectomy (PRK) for myopia. Cochrane Database Syst Rev. 2013;(1):CD005135.
- Albé E, Carones F, Marchini G, Tassinari G, Mastropasqua L, Rama P. Enhancement after laser in situ keratomileusis: indications and outcomes. J Cataract Refract Surg. 2009;35(10):1717-1723.
- Dupps WJ Jr, Wilson SE. Biomechanics and wound healing in the cornea. Exp Eye Res. 2006;83(4):709-720.
- Hersh PS, Brint SF, Maloney RK, Durrie DS, Gordon M, Michelson MA, Thompson VM, Berkeley RB, Schein OD, Steinert RF. Photorefractive keratectomy versus laser in situ keratomileusis for moderate to high myopia. Ophthalmology. 1998;105(8):1512-1522.
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- Why No Surgeon Can Guarantee Perfect Vision
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- When Is an Enhancement Needed?
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- Why Most Clinics Don’t Talk Openly About Complications
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