Contact lens fitting post-laser-in situ keratomileusis (LASIK)

Despite recent advances in refractive surgical procedures a small proportion of patients still achieve sub-optimal results for a variety of reasons. In such cases, contact lenses may provide the only option for visual rehabilitation and restoration of binocular vision post-refractive surgery. The indications for contact lenses post-LASIK may be one, or a combination of the following:
• Initial bandage lens for corneal protection.
• Residual ametropia—over and under correction.
• Irregular astigmatism.
• Anisometropia.
• Decentred ablation zones.In low powered corrections conventional soft lenses can be fitted in the normal way, giving good levels of acuity. Where there is astigmatism (>0.75 DC) then toric soft contact lenses may appropriate.Rigid lenses may prove to be the only viable option in a number of cases where visual correction is required post-refractive surgery, or in the presence of high levels of astigmatism. Fitting can be more complex however, since a conventional rigid lens cannot follow the shape of both the flattened central cornea and the relatively steeper periphery in higher corrections, as the amount of laser ablation increases. Reverse geometry lenses are indicated where there is a significant difference between the flat central ablated zone and the relatively steeper peripheral cornea. On rare occasions scleral lenses may also be indicated.