In the past decade, LASIK eye surgery has boomed in popularity. It is easy to understand why: instead of wearing contacts or glasses, after surgery your eyes are corrected to result into (almost) perfect vision. However, sometimes we also hear horror stories: late 2016 Dutch television showed a program in which a house physician laments he's suffering from horrible neuralgic pains after having undergone laser surgery. Experts claim this is an extremely rare side effect from a specific type of LASIK surgery that nobody needs to worry about.
Since yours sincerely has been contemplating such surgery and having had a partner whose eyes were botched by an incompetent eye surgeon, there's the motivation to find out what risks are realistically to be expected and whether they are worth taking.
Any doctor will tell you that all surgery involves risk. If you are considering a surgical procedure, you should educate yourself about the risks associated with that procedure before you head to the operating room. This rule of thumb even applies to popular elective procedures, such as LASIK.
There are several complications associated with LASIK procedures, and some are more prevalent than others. How do you know if you have to worry?
Most studies conducted during the late 1990s suggest that the risk of complications averaged 5%. Since that time, however, newer technology and better-qualified surgeons have reportedly reduced the risks associated with LASIK to around 1%. This level of risk, however, only applies to patients who are meticulously screened prior to surgery. In addition, the American Academy of Ophthalmology reports that around 10% of patients will require some kind of retreatment to achieve optimal results.
The good news is that most LASIK complications resolve relatively quickly after surgery.
- Flap. Among the more commonly reported complications of surgery are flap complications. Flap complications occur in the hinged flap covering the front of the cornea. Doctors typically lift this flap in order to reshape the cornea; then, they replace the flap, allowing it to serve as a bandage.
The flap can be cut in different ways depending on the doctor’s choice of technology. One tool used to cut the flap is a microkeratome, which is associated with the risk of abrasions (more commonly referred to as scrapes) on the eye. However, the use of new technology, including IntraLase, has limited this risk significantly.
Some studies suggest that cutting a flap and then using custom LASIK procedures may result in adverse outcomes, in part because surgeons do not use custom procedures to create the hinged eye flap. Therefore, replacing the flap over the reshaped cornea may result in less than optimal outcomes. For example, the flap may not fit correctly once healed. In this case, a corneal transplant may be required.
Another flap-related risk associated with LASIK is Diffuse Lamellar Keratitis (DLK), also known as the "Sands of the Sahara". This disorder can occur when dead cells lodge beneath the corneal flap. The cornea mistakenly assumes these cells are harmful and initiates an inflammatory response. Unfortunately, this natural response may result in scarring, and permanent vision loss may occur without prompt treatment. Surgery is often required to remove the cells that are causing the irritation.
- Astigmatism & Double Vision. When laser correction is not conducted properly, or when the corneal surface is not smooth, the uneven removal of tissue may result in astigmatism. The symptoms associated with irregular astigmatism can include blurred and double vision. Many patients experiencing this complication will need additional surgery to correct the problem. However, minor swelling can also cause double vision; this side effect usually resolves on its own or less invasive interventions, such as eye drops.
- Keratectasia is a rare condition that results when a surgeon cuts the flap too deeply or removes too much tissue during surgery. Doing so results in weakening and bulging of the cornea and may cause permanent distorted vision. Treatment options for this rare complication include wearing contact lenses, undergoing corneal implant surgery, or even having a corneal transplant.
- Light sensitivity. Some patients experience sensitivity to light for several weeks after LASIK surgery. This symptom is often treated with an anti-inflammatory to prevent the sensitivity from worsening. Despite this intervention, some patients experience this side effect for several months or—in rare cases—permanently.
- Dry eyes are a commonly reported side effect of LASIK surgery that can contribute to inflammation, infection, and blurred vision. It is caused by a failure of the eye to maintain a comfortable level of moisture through tears. Your surgeon will likely give you eye drops to help soothe this side effect in the days following surgery. Most patients report that symptoms of dry eye get better within days. More prolonged dry eye can often be easily resolved using artificial tears. In severe cases, however, surgical intervention may be required to plug the tear ducts in order to keep the moisture produced by your eyes from draining away.
If you currently have chronic dry eye and are considering LASIK, your eye doctor should help you treat and resolve symptoms of dry eye before you proceed. Otherwise, you may not be happy with the results of your surgery. Patients with extreme cases of dry eye may be told that they are not good candidates for LASIK.
- Infections. As with any surgery, some patients will develop infections following the procedure. Severe or untreated infections can lead to permanent vision loss, so any sign of infection requires immediate treatment, such as medication or even additional surgery. Fortunately, the risk of infection is relatively low. In fact, some doctors suggest that your eyes are at greater risk of becoming infected from simply wearing contact lenses.
Nevertheless, some doctors prescribe prophylactic antibiotic and/or anti-inflammatory eye drops to help reduce the risk of infection after surgery. In addition, your doctor may prescribe oral antibiotics or suggest that you take certain steps prior to surgery to keep your eyelids and eyelashes clean.
- Nighttime glare, double vision, and a starburst or halo effect around lights can sometimes occur after LASIK surgery. Some patients may also experience a loss of contrast in their vision that causes objects to look fuzzy or less crisp, even though they may have 20/20 vision on exam. All of these symptoms can be debilitating, especially when driving at night.
Poor night vision most commonly occurs when surgeons use traditional LASIK methods. It may also occur when the surgeon treats too small of an area surrounding the pupil.
Although most patients find that night vision problems go away within several months after surgery, for some patients the effects may be permanent. Possible treatments include prescription eye drops and additional surgery.
- Discoloration. Immediately following LASIK surgery, some patients notice small areas of pink or red discoloration on the whites of their eyes. While these patches of discoloration usually last for only a few days, they can remain for weeks or months or, in rare cases, may be permanent. Although prolonged discoloration may be cosmetically displeasing, they are not necessarily harmful and may not require treatment.
- Over- or Under-Correction. LASIK corrects your vision by reshaping your cornea. The amount of tissue that needs to be removed in order to achieve the proper shape varies for each patient depending on how nearsighted or farsighted they are.
When a LASIK surgeon removes too much tissue (or not enough) during the procedure, the result may be blurry vision or minor visual disturbances, similar to what you probably experienced when going without glasses or contacts prior to surgery. Many patients have to continue wearing contact lenses or glasses to resolve the problem. Retreatment with the laser is often possible. However, retreatment is more likely to be successful in the case of under-correction, when more tissue can be removed with a second procedure.
- Blindness. Severe damage to your sight, possibly including total blindness, is a rare complication of LASIK. In the event that the machine malfunctions or the surgeon makes an error, irreparable damage could be done to your eye. Some of the other, less serious, complications listed above can also lead to permanent eye damage if left untreated.
For most patients LASIK is a fast and very easy surgery. However, for others LASIK surgery is not even a possibility. One of the most important steps you must take as a patient is interviewing a competent physician to rule out any risk factors you may have for a poor LASIK outcome.
For instance, as the lasik procedure thins and reshapes the cornea, surgery on someone with a thin cornea may prove very risky. The risks for those patients are to come out of LASIK surgery with visual disturbances or swollen and bulging eyes.
Your eye surgeon will ask detailed questions about your eye health and evaluate your eyes to make sure you don't have any conditions that might result in complications or poor outcomes of surgery.
Pre-existing conditions that can rule out eye surgery are :
- An eye disease that results in a progressive deterioration of your vision and thinning of your cornea (keratoconus). In fact, if keratoconus runs in your family, even if you don't have it, be very cautious about elective eye surgery.
- Keratitis, uveitis, herpes simplex affecting the eye area, and other eye infections.
- Eye injuries or lid disorders.
- Dry eyes. If you have dry eyes, LASIK surgery may make the condition worse.
- Large pupils. If your pupils are large, especially in dim light, LASIK may not be appropriate. Surgery may result in debilitating symptoms such as glare, halos, star bursts and ghost images.
- Glaucoma. The surgical procedure can raise your eye pressure, which can make glaucoma worse.
You might also rethink having LASIK surgery if:
- You have severe nearsightedness or have been diagnosed with a high refractive error. The possible benefits of LASIK surgery may not justify the risks.
- You have fairly good (overall) vision. If you see well enough to need contacts or glasses only part of the time, improvement from the surgery may not be worth the risks.
- You have age-related eye changes that cause you to have less clear vision (presbyopia).
- You actively participate in contact sports. If you regularly receive blows to the face and eyes, such as during martial arts or boxing, LASIK surgery may not be a good choice for you.
Your eye surgeon will also ask detailed questions about your general health. Certain medical conditions, unrelated to your eyes, can increase the risks associated with LASIK surgery or make the outcome less predictable. These include:
- Any disease or condition that affects your immune system and impairs your ability to heal or makes you more prone to infections, such as rheumatoid arthritis, lupus, HIV and other autoimmune disorders.
- Taking an immunosuppressive medication for any reason
- Depression or certain chronic pain conditions, such as migraine, irritable bowel syndrome and fibromyalgia. If you have one or more of these conditions, you may have more problems with dry eyes and postoperative pain than other people. The reasons for this are not entirely clear but may be related to how you perceive pain.
If you have myopia, your vision may continue to change throughout your teenage years, or even longer, requiring periodic changes in the prescription of your glasses or contact lenses. Therefore, people must be over age 18, and preferably older, before considering LASIK eye surgery.
Certain conditions and medications — pregnancy, breast-feeding, steroid drugs — may cause temporary fluctuations in your vision. Wait until your vision has stabilized before considering LASIK eye surgery.
A patient’s degree of risk varies for each of the complications and side effects listed above depending on their medical history and the current health of their eyes. Carefully weigh your personal risk of complications and side effects when talking with your doctor. Your doctor can help you make an educated decision and decide whether the benefits of surgery outweigh the risks. You can also talk to your doctor about steps you can take to reduce your risk of developing complications, such as treating existing eye problems and keeping your eyelids and lashes clean prior to surgery.
The success of your own LASIK procedure will be determined by your prescription and the competence of the surgeon who will perform the surgery.
Those with moderate nearsightedness will have the best success rates. People with a high degree of nearsightedness or farsightedness along with astigmatism have less predictable results.
Before you decide which laser eye surgery clinic to go to, you’ll need to know the success rate of each clinic you’re looking into. Remember that more experienced surgeons will have higher success rates. When you do your comparison, make sure that you’re looking at the statistics pertaining to patients who had undergone the procedure that you’re about to have.
Depending on your individual circumstances and preferences you may consider other types of surgery, like having implantable lenses.
Corrective lenses can be surgically inserted in the eye to improve vision. This is routinely done as part of cataract surgery (in which the old, cloudy natural lens is removed). It may also be an alternative to LASIK for older adults who may need cataract surgery in the future. Having had LASIK surgery is a negative factor when you may be treated for cataract surgery.
What about me? Reading about complications and precautions made me decide LASIK is not for me. Dry eyes were what made me change to glasses, so I expect serious problems here. Plus I enjoy good night's vision and would hate to risk losing that. So will keep wearing glasses and using eye drops only occasionally instead of chronically.