Risk factors, incidence, and treatment options for post-LASIK regression: a systematic review

Background: Laser in situ keratomileusis (LASIK) describes the use of excimer laser ablation on the stromal bed to reshape the cornea and it is now one of the most commonly performed elective procedures across the world. However, the postoperative course of LASIK can be hindered by refractive regression, defined as a tendency of the eye to return toward its original refraction. Regression has a detrimental effect on long-term stability and predictability of LASIK. It can impair visual performance and quality of life. The primary aim of this systematic review was to comprehensively collate and analyze existing research on post-LASIK regression. Methods: This was a narrative systematic review of the literature. Databases were systematically searched for studies about regression of visual acuity after LASIK surgery for myopia treatment. It included patients aged 18 years and above, with stable refractive errors, and those without autoimmune diseases or diabetes. The review included 16 articles. The risk of bias was assessed, and then the data were qualitatively analyzed. Results: Myopic regression after LASIK surgery is a common issue, with an average incidence of 25% to 31%. Risk factors include older age, aspherical ablation, larger treatment zone, higher preoperative myopia, and smaller optical zone. Treatment options include routine postoperative review, artificial tears, and topical therapy. Alternative refractive correction options include small incision lenticule extraction, which offers comparable results to LASIK for hyperopia correction. Conclusions: Myopic regression after LASIK surgery, influenced by risk factors such as age and larger treatment zones, can be treated with postoperative care, artificial tears, and topical timolol therapy.