A Balanced Look at Possible LASIK Problems
Reviewed by Brad Spagnolo, M.D.
LASIK is surgery and like any surgery it is worth understanding even the most limited problems that can occur. It is important that each and every patient considering LASIK take the time to fully review even the infrequent but possible risks, complications, contraindications and side effects of LASIK in order to have an understanding of possible LASIK problems that might ever occur. You should carefully review what the Food and Drug Administration (FDA) considers the scope of potential LASIK problems. At your consultation make certain that you have the opportunity to ask any and all questions and be sure that you are comfortable with how these might apply in your individual situation. Your LASIK surgeon should take care before, during and after your LASIK surgery to minimize or avoid any risks, complications and side effects, HOWEVER, LASIK is surgery and it is important for you to understand the limitations and possible complications of Laser Vision Correction. The following is an overview list of the possibilities referenced by the Food and Drug Administration:
- Loss of Best Corrected Vision- While not common, it is possible that some patients can lose lines of vision on the vision chart that cannot be corrected with glasses, contact lenses, or surgery as a result of treatment. Ask your LASIK surgeon about the frequency or likelihood of this happening in your particular situation.
- Adverse Visual Symptoms- Particularly in the early years of Laser Vision Correction some patients developed glare, halos, and/or double vision that could seriously affect nighttime vision. Even with good vision on the vision chart, some patients could not see as well in situations of low contrast, such as at night or in fog, after treatment as compared to before treatment. This can still occur in certain situations. Your LASIK surgeon should take every precaution to avoid these complications including careful evaluation of pupil size and using the advanced technology to create a spherical aberration optimized corneal shape during your treatment. LASIK is surgery and it can still happen. Ask your LASIK surgeon about the frequency or likelihood of this happening in your particular situation.
- Dry Eye Symptoms- Some patients may develop mild, moderate or even severe dry eye symptoms. As a result of Laser Vision Correction, your eyes may not be able to produce enough tears to keep the eye moist and comfortable. Dry eye not only causes discomfort, but can reduce visual quality due to intermittent blurring and other visual symptoms. Rarely, this condition may be permanent. Eye drop therapy with artificial tears and/or Restasis® eye drops and/or the use of tiny punctal plugs or other procedures may be required. Your LASIK surgeon should take every precaution pre-operatively to avoid these issues including careful evaluation of your tear film quality and quantity. You may actually be treated for dry eye before your surgery in order to prevent these symptoms from ever occurring. LASIK is surgery and it can still happen. Ask your LASIK surgeon about the frequency or likelihood of this happening in your particular situation.
- Results May Not Be As Good With Very High Prescriptions- We will carefully review with you your expectations of Laser Vision Correction so that you can appreciate whether that you may still require glasses or contacts after the surgery. We may actually recommend alternative vision correction procedures such as Lens Implants for Vision Correction if we feel that you may not achieve your personal goals. LASIK is surgery and this can still happen. Ask your LASIK surgeon about the frequency or likelihood of this happening in your particular situation.
- Full Correction for Some Farsighted Patients May Diminish Over Time- For some farsighted patients, results may diminish with age. If you are farsighted, the level of improved vision you experience after surgery may decrease with age. This can occur if your manifest refraction (a vision exam with lenses before dilating drops) is very different from your cycloplegic refraction (a vision exam with lenses after dilating drops). Your LASIK surgeon should take every precaution to avoid this by carefully considering the manifest refraction, the cyclopedia refraction and calculations for treatment to be performed. It may be recommended that you have alternative vision correction procedures such as Lens Implants for Vision Correction if your surgeon feels that you may not achieve your personal goals. LASIK is surgery and it can still happen. Ask your LASIK surgeon about the frequency or likelihood of this happening in your particular situation.
- Somewhat Limited Long Term Data- Laser Vision Correction has only been available in the United States since 1995. The first laser was approved specifically for LASIK eye surgery in 1998. Therefore, the long-term safety and effectiveness of LASIK surgery much beyond 15 years or so is not known. In your own personal situation you may consider this a long time or not.
- Monovision Risks- Monovision is one clinical technique used to deal with the correction of near vision and Presbyopia, the gradual loss of the ability of the eye to change focus for close-up tasks that progresses with age. The intent of monovision is for the Presbyopia patient to use one eye for distance viewing and one eye for near viewing. This practice was first applied to fit contact lens wearers and more recently to LASIK and other Laser Vision Correction and refractive surgeries. With contact lenses, a Presbyopia patient has one eye fit with a contact lens to correct distance vision, and the other eye fit with a contact lens to correct near vision. In the same way, with LASIK, a Presbyopia patient has one eye operated on to correct the distance vision, and the other operated on to correct the near vision. In other words, the goal of the surgery is for one eye to have vision worse than 20/20, the commonly referred to goal for LASIK surgical correction of distance vision. Since one eye is corrected for distance viewing and the other eye is corrected for near viewing, the two eyes no longer work together. This may result in poorer quality vision and a decrease in depth perception. These effects of monovision are most noticeable in low lighting conditions and when performing tasks requiring very sharp vision. Therefore, you may need to wear glasses or contact lenses to fully correct both eyes for distance or near when performing visually demanding tasks, such as driving at night, operating dangerous equipment, or performing occupational tasks requiring very sharp close vision (e.g., reading small print for long periods of time). Some patients cannot get used to having one eye blurred at all times. Therefore, if you are considering monovision with LASIK, make sure you go through a trial period with contact lenses to see if you can tolerate monovision, before having the surgery performed on your eyes. We want to make sure that you meet the driver's license requirements with monovision. In addition, you should consider how much your Presbyopia is expected to increase in the future. You should discuss you’re the expectation of when you should expect the results of your monovision surgery to no longer be enough for you to see near-by objects clearly without the aid of glasses or contacts, or when a second surgery might be required to further correct your near vision.
- Bilateral Simultaneous Treatment- Most LASIK surgeons routinely perform LASIK on both eyes at the same time. However, you may choose to have LASIK surgery on one eye at a time. Although the convenience of having surgery on both eyes on the same day is attractive, in certain instances this may be riskier than having two separate surgeries. If your LASIK surgeon suggests or if you decide to have one eye done at a time, you and your doctor will decide how long to wait before having surgery on the other eye. If both eyes are treated at the same time or before one eye has a chance to fully heal, you and your doctor do not have the advantage of being able to see how the first eye responds to surgery before the second eye is treated. Another disadvantage to having surgery on both eyes at the same time is that particularly for PRK, the vision in both eyes may be blurred after surgery until the initial healing process is over, rather than being able to rely on clear vision in at least one eye at all times.
Even the best screened patients under the care of most skilled surgeons can experience serious complications.
- During Surgery- A malfunction of a surgery device or other error, such as a poorly formed flap of cornea may lead to discontinuation of the procedure or irreversible damage to the eye. Ask your LASIK surgeon about the frequency or likelihood of this happening in your particular situation.
- After Surgery- Although quite rare, some complications, such as migration of the flap or inflammation or infection, may require another procedure and/or intensive treatment with drops. It is remotely possible that even with aggressive therapy; such complications may lead to temporary loss of vision or even irreversible blindness. Ask your LASIK surgeon about the frequency or likelihood of this happening in your particular situation.
Under the care of an experienced doctor, carefully screened candidates with reasonable expectations and a clear understanding of the risks and alternatives are likely to be happy with the results of their Laser Vision Correction procedure. LASIK is surgery. Your LASIK surgeon should take every precaution and the time necessary to educate you and answer any questions that you might have in order to help you meet your personal vision correction goals.