Laser in-situ keratomileusis for farsightedness (H-LASIK)

Surgery Overview

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Hyperopic laser in-situ keratomileusis (H-LASIK) is becoming a preferred procedure for correcting farsightedness (hyperopia). In H-LASIK, a thin flap is made on the cornea using a blade or laser. The flap is lifted, and a laser is applied to the central corneal tissue. The laser makes contact with the cornea in a circular pattern around the central optical zone, which changes the profile of the cornea, making it steeper. The laser removes tissue from the cornea very precisely without damaging nearby tissues. The flap is then replaced, allowing for rapid healing.

H-LASIK is performed in a surgeon's office or same-day surgery center and does not require a hospital stay.

This procedure may not be available in all areas, but it is done in most large cities.

What To Expect After Surgery

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H-LASIK usually requires less recovery time than H-PRK, though it is longer than recovery from LASIK for nearsightedness. Most who have the surgery see quite well the next day. In contrast to hyperopic photorefractive keratectomy (H-PRK), there is little or no pain after the surgery.

Your doctor will want you to come in for an exam the day after the surgery, and for regular follow-up exams for about 6 months.

Following H-LASIK surgery to correct farsightedness:

• You will feel irritation and scratchiness in the eye the day of surgery, and it may tear a lot.
• You may need to wear an eye shield for a few days after surgery.
• Your vision may be hazy or blurry for a few days or a week after surgery. Do not drive until your vision has cleared.
• Your doctor may prescribe eyedrops to reduce inflammation and the risk of infection. You may need to use them for several months after surgery.
• You should avoid vigorous sports, eye makeup, and any activities during which water may get in your eye. The surgeon may recommend that you shower before the surgery, then avoid showering for a day or two afterward to avoid getting water in the eye.
• Dry eye symptoms are common but usually temporary.

Why It Is Done

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H-LASIK surgery may be used to correct mild to moderate farsightedness. Since H-LASIK is a relatively new procedure, the long-term benefits and complications are still being studied. Early results with treating severe farsightedness are not as positive as for mild or moderate farsightedness.

H-LASIK is an elective, cosmetic procedure, done to correct farsightedness in otherwise healthy eyes.

The procedure may not be done for people who:¹

• Have not had stable vision for at least 1 year.
• Are under age 18.
• Are pregnant, since pregnancy may cause changes in the cornea.
• Have a disease or abnormality of the cornea, such as keratoconus or corneal edema, or another eye disease, such as advanced or uncontrolled glaucoma or cataracts.
• Have poorly controlled diabetes, or complications of diabetes that affect vision.
• Have significant risk of injuring their cornea from a job or hobby.

How Well It Works

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H-LASIK is a relatively new surgery, and little is known about the long-term outcomes. Doctors continue to improve the technique and to study the long-term results.

Over the short term, LASIK has been shown to be effective in reducing mild to moderate farsightedness. The results are not as good as LASIK for nearsightedness, but recent studies showed that between 80% and 85% of eyes with 3 diopters of farsightedness were corrected to within 1 diopter of the desired correction.² Lower levels of farsightedness are easier to treat with this procedure than higher levels.

So far, results of H-LASIK for people with more severe farsightedness have not been as positive.

Risks

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The risk of complications from H-LASIK surgery is low, and it decreases even further with a more experienced surgeon. Look for a corneal specialist or surgeon who does the surgery frequently.

The risk of regression, or loss of any improvement gained through the surgery, is greater with H-LASIK than with LASIK for nearsightedness. The exact cause of regression after H-LASIK is not yet known.

Complications and side effects from H-LASIK may include:

• Night vision problems, such as halos (often described as a shimmering circular zone around light sources such as headlights or streetlights). Some studies indicate halos symptoms may occur less often with H-LASIK than with H-PRK surgery.³
• Glare, or increased sensitivity to bright light.
• Double vision (diplopia), usually in one eye.
• New astigmatism caused by wrinkling in the corneal flap or other flap complications.
• Loss of best corrected vision. This may be even less common with H-LASIK than it is with H-PRK.
• Development or worsening of dry-eye symptoms.
• Clouded vision (clouding of the cornea as a result of healing). This is sometimes also referred to as corneal haze. This is less common with H-LASIK than it is with H-PRK and tends to go away quickly.

Serious vision-threatening complications are rare but may include:

• Infection of the cornea (keratitis).
• Elevated pressure inside the eye (intraocular pressure) leading to glaucoma.

Because H-LASIK is a new procedure, long-term risks are not yet known.

What To Think About

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If you are considering surgery to improve farsightedness, consider the different options (H-LASIK, H-PRK, intraocular lens implants, and LTK) and discuss them with your doctor. H-LASIK is fast becoming the refractive surgery of choice for most people.

Though both procedures are new, H-LASIK is being done more frequently than H-PRK, largely due to the good results and quick, painless visual recovery that H-LASIK offers. It is not yet clear whether or not H-LASIK is superior to H-PRK for people with mild to moderate farsightedness.

It is important to retain a record of your original eye measurements from this procedure (your doctor can give them to you), in case you need cataract surgery in the future. This is helpful in calculating the power of future post-cataract implants.

H-LASIK is a cosmetic procedure. The cost of refractive surgery varies in different locations, but it can be a significant expense. Most insurance companies do not cover the cost of refractive surgery.

Complete the surgery information form (PDF) (What is a PDF document?) to help you prepare for this surgery.

References

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Citations

1. American Academy of Ophthalmology (2002). Refractive Errors (Preferred Practice Pattern). San Francisco: American Academy of Ophthalmology.

2. Ge J, et al. (2001). Surgical correction of hyperopia: Clear lens extraction and laser correction. Ophthalmology Clinics of North America, 14(2): 301–313.

3. Hersh PS, et al. (2000). Photorefractive keratectomy versus laser in situ keratomileusis: Comparison of optical side effects. Ophthalmology, 107(5): 925–933.

Credits

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Author	Kathe Gallagher, MSW
Editor	Kathleen M. Ariss, MS
Associate Editor	Michele Cronen
Associate Editor	Tracy Landauer
Primary Medical Reviewer	Martin Gabica, MD - Family Medicine
Specialist Medical Reviewer	Carol L. Karp, MD - Ophthalmology
Last Updated	December 19, 2005