We report a case of a significant hyperopic shift 2 years after myopic photorefractive keratectomy with an interim of stability. The patient was an otherwise healthy man who reported a sudden change in vision when climbing to altitude. Medical considerations for refractive shifts should be looked at before retreatment is proposed. Diabetes was diagnosed in our patient; after initiation of insulin, the patient's uncorrected visual acuity returned to 20/20 in both eyes.