Outcomes Of Laser-Assisted In Situ Keratomileusis In Myopic Older Adults: A Retrospective Cohort Study

With increasing life expectancy and growing demand for refractive surgery among older adults, evaluating the safety and efficacy of LASIK in this population is crucial. While LASIK is well-established in younger adults, concerns remain regarding potential age-related differences in corneal biomechanics, healing response, and visual outcomes. This study aims to assess the refractive and visual outcomes of LASIK in myopic older adults compared with younger adults, focusing on postoperative efficacy, safety, and retreatment rates in a large retrospective cohort.

A retrospective analysis of LASIK procedures performed at Care-Vision Laser Centers, a high-volume refractive surgery clinic in Tel Aviv, Israel. The study included procedures conducted between January 2010 and June 2024, utilizing a standardized surgical protocol with femtosecond laser flap creation and excimer laser ablation.

A total of 29,047 eyes from myopic patients aged 20–40 years (n=28,740) or 55–70 years (n=307) were analyzed. Preoperative, intraoperative, and postoperative parameters were compared between groups. Key variables included corneal thickness, keratometry, spherical equivalent, and best-corrected visual acuity. Postoperative outcomes were assessed, including uncorrected and corrected distance visual acuity, safety and efficacy indices, and retreatment rates. Multivariable analysis adjusted for potential confounders to ensure an accurate comparison of visual outcomes and surgical safety between the two age groups.

Older adults had significantly lower postoperative uncorrected distance visual acuity (0.8722 ± 0.2091 vs. 0.9870 ± 0.1031, p<0.0001) and a reduced efficacy index (0.9388 ± 0.2132 vs. 1.025 ± 0.1067, p<0.0001). The safety index showed a trend toward lower values in older adults (1.010 ± 0.0964 vs. 1.029 ± 0.092, p=0.0611). Retreatment rates were slightly higher in younger adults (0.31% vs. 0.29%, p<0.0001), likely reflecting a higher willingness to undergo enhancement. No cases of postoperative ectasia were reported in either group.

LASIK in myopic older adults remains a safe and effective procedure, though with slightly reduced efficacy and a trend toward lower safety compared to younger adults. The minor differences in postoperative visual outcomes may be attributed to age-related corneal and healing characteristics. The higher retreatment rate in younger adults suggests they may pursue enhancements more frequently. While no ectasia cases were observed, long-term biomechanical stability in older adults requires further study to confirm the long-term safety of LASIK in this population.