Dr. Roach: Pros and cons of LASIK surgery
Dear Dr. Roach: I was considering LASIK surgery for my eyes, but I recently saw some concerning information on the news that makes me doubt the safety of the procedure. Is it safe?
Dear L.B.: With 20 million or so procedures done in the U.S., LASIK is a commonly performed surgery. It corrects refractive error so that a person can see clearly without glasses. A laser is used to cut a flap of cornea, and the cornea is reshaped to allow for correct vision, then the flap is replaced. For most patients, it is a painless procedure with almost immediate visual recovery. In a review of large studies, more than 95% of people who have undergone LASIK reported being satisfied with their outcomes.
Though it is one of the safest and most performed eye surgeries in the U.S., there are a few known risks to the procedure. The reshaping of the cornea isn’t always perfect, and repeat procedures are sometimes necessary to optimize vision. This happens up to 10% of the time. The cornea can regress or reshape itself over time; visual acuity can decrease with surgery; and many people will need reading glasses after surgery sooner than they would have had to without surgery. Glare and halos around images can be a problem, especially at night.
Dry eyes are a very common problem. The nerves to the cornea are partially cut during surgery, and this prevents proper lubrication. However, for most patients, post-operative dry eye only lasts for a month or so. It is easily treated with artificial tears, which are always recommended for several months after surgery. Occasionally the ophthalmologist will place a plug over the drainage duct for tears to allow better lubrication. Many ophthalmologists start patients on dry eye treatment pre-operatively to prevent severe dry eye after surgery, usually with great success. I have had patients with symptomatic dry eyes for months after a LASIK procedure. The very rare patient who develops chronic pain can be treated with oral medication.
With so many procedures being performed, there are some more serious complications reported. Rarely, severe damage to the cornea and vision loss have been reported.
Most patients undergoing LASIK do extremely well post-operatively. The best way to prevent complications is to undergo thorough pre-operative screening. Some people are not good candidates for this surgery. There are alternative surgical techniques for refractive surgery that do not carry the same risk of post-operative complications such as dry eye and flap complications as traditional LASIK does. An ophthalmologist with special expertise in corneal surgery should be consulted to provide recommendations about the most appropriate procedure for a given person.
All surgical procedures have risks. It is imperative to understand the risks of LASIK or any other corrective surgery prior to choosing to have it.
Readers may email questions to ToYourGoodHealth@med.cornell.edu.