Unmasking Accommodative Excess After LASIK: A Neuro-Optometric Approach to Blurred Vision in High Visual Demand

Blurred vision following LASIK is commonly attributed to residual refractive error or regression, yet accommodative dysfunction is often underrecognized.This case report details a 31-year-old software engineer who developed intermittent blurred vision, eyestrain, and nearfocusing difficulty post-LASIK despite achieving 20/20 uncorrected visual acuity immediately after surgery.Optometric evaluation revealed accommodative excess-characterised by reduced accommodative facility, elevated positive relative accommodation, and difficulty with plus lenses-likely intensified by prolonged near work and digital device use.Orthoptic findings supported this diagnosis, prompting a structured vision therapy regimen with home reinforcement over 24 in-office sessions.Therapy focused on enhancing convergence awareness, relaxing accommodation, and restoring fusional vergence dynamics.The patient experienced symptomatic improvement and retained an uncorrected visual acuity of 20/20 after the intervention.The accommodative function was further normalised and exhibited a decreased CISS score.This report highlights accommodative excess as a potential post-LASIK complication, emphasising the importance of preoperative orthoptic screening and individualized vision therapy.Assessing occupational visual demands and binocular function may enhance patient satisfaction and mitigate misattributed surgical dissatisfaction.A multidisciplinary, proactive approach may be crucial in refractive surgery workups, particularly among individuals with high near-work exposure.