Jan. 24, 2002 -- It has been just over a year and a half since Paula Cofer had LASIK surgery to correct her nearsightedness, and she says nothing has been the same since. Instead of the improved eyesight she was expecting, the 43-year-old Tampa woman ended up with double and triple vision, chronically dry eyes, and a host of night vision problems that include seeing halos and starbursts.
"Everything about my life is different now," she tells WebMD. "Unless I am in very bright sunlight, everything seems washed out and fuzzy looking, and my vision at night is horrific."
Although Cofer's case is extreme, new research suggests that a large percentage of people who have LASIK procedures develop vision problems related to the surgery. And in a review of recent studies, an American Academy of Ophthalmology (AAO) panel concluded that LASIK "is an excellent procedure for many, but not all, patients."
The panel's report noted that LASIK is highly effective in patients with low to moderate myopia, but good results are less certain in those with moderate to high levels of myopia. Serious adverse complications leading to significant permanent vision loss are rare, the panel wrote, but surgical side effects, "such as dry eyes, night time starbursts, and reduced contrast sensitivity occur relatively frequently." The report was published in the January issue of the AAO journal Ophthalmology.
LASIK has become the hottest elective surgery in the United States since it won FDA approval in 1998. Last year, more than a million Americans had the procedure to free themselves from glasses and contacts.
Cofer says she should never have been considered a candidate for LASIK surgery because she has extremely large pupils. The lasers used in the vision correction surgery are not designed for large pupils, so there is a greater chance of postoperative vision problems like glare and halos. The problems are worse at night and in low-light situations, because that is when the pupil is the largest.
A survey conducted by researchers at Ohio State University found that up to a third of the 605 LASIK patients questioned reported problems seeing at night. But 97% of those who responded to the survey said they still would recommend the surgery to a friend. The results were presented in December at the annual meeting of the American Academy of Optometry.
Patients in their mid-40s were not as happy with their postsurgical vision as those in their early 40s. Patients with flatter corneas prior to surgery were also more likely to see starbursts surrounding lights afterward. And patients who had to undergo the procedure a second time were generally unhappier with their outcomes than those who had the surgery only once.
"It is really important for patients to know if they are good candidates for LASIK before having the procedure," study author Melissa Bailey tells WebMD. "That is why it is important to find a doctor that you trust who explains all of the risks and benefits."
Ron Link agrees. A former firefighter, Link now runs an Internet-based support group for people who have had negative experiences with vision correction surgeries. He says most people are told in very general terms about the potential postsurgical problems, but few are warned about their specific level of risk.
"People may sign an informed consent without being told that with their particular preoperative condition their individual risk is extremely high," he says.
California ophthalmologist Richard L. Abbott, MD, says better screening and technological advances are already helping to reduce the incidence of surgical complications associated with LASIK. Over the next few years, such advances may make the procedure an option for more people. Abbott is co-director of the corneal and refractive surgery department at the University of California at San Francisco Medical Center.
"For the vast majority of patients, the technology we have now does a superb job," he tells WebMD. "But clinical trials going on now offer the promise of helping those people who are considered poor candidates for LASIK surgery."