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LASIK: Know the Rewards and the Risks

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July 27, 2018 -- Dry eyes, glare, halos, and starbursts are all possible side effects of LASIK surgery. But some people may also get long-term complications like eye infections, vision loss, chronic pain, and detached retinas. If you knew that, would you still have the popular procedure? Some patients say they didn’t find out until it was too late and now wish they could turn back the clock.

According to Market Scope, around 10 million Americans have had LASIK surgery since it was first approved by the FDA in 1999. Around 700,000 LASIK surgeries are done each year, but that’s down from a peak of 1.4 million in 2000.

It remains one of the most popular elective surgeries in the country, and its satisfaction rating among patients who’ve had the procedure is remarkably high. Eric Donnenfeld, MD, a former president of the American Society of Cataract and Refractive Surgery, has successfully completed around 85,000 procedures over his 28-year career. He says that overall, 96% to 98% of LASIK patients end up with 20/20 vision. Forty percent to 50% end up with vision that is better than 20/20.

Yet LASIK -- like any surgery -- has risks. Some patients have harmful complications that may never go away, including dry eyes, starbursts, and cornea damage.

The appeal of LASIK is obvious: A chance to ditch the glasses or the daily routine and expense of contact lenses, slippery cases, pricey bottles of cleaning and storage solutions. Over time, it even makes economic sense.

Still, the FDA has no rules on what information patients must be told or what must be disclosed in a consultation. The agency urges anyone considering LASIK to do plenty of research into the risks and have a thorough consultation with the surgeon before the procedure.

Donnenfeld says that while there are no industry requirements for how thoroughly risks have to be stated, a patient should have plenty of chances to ask questions. In his own practice, he gives patients a written explanation of LASIK, has them watch an in-depth video about the surgery, and holds multiple consultations with patients before they agree to go through with it.

Alan Kozarsky, MD, is an ophthalmologist specializing in corneas, external diseases, and refractive surgery. He calls LASIK the “second-best 24-hour medical miracle” after labor and delivery.

He advises patients to always ask their surgeon how good of a candidate they are for LASIK.

“Patients should pick a surgeon that they feel would turn them down as a patient if they weren’t a really good candidate,” he says. “Look for a surgeon who is selective about the patients they’re going to do surgery on. Look for a surgeon with a wealth of experience, a surgeon for whom LASIK is the easiest thing they do.”

Highly selective patients and highly selective surgeons will ultimately lead to better outcomes, says Kozarsky. Patients should be confident that their surgeon has their best interest in mind.

“LASIK can be used as a business. That’s a terrible thing to do. You’re not going to talk to your patients. It’s a second-rate way of selecting patients and doing the procedure,” he says.

Eye Problems After Surgery

For Jason Esveld, LASIK turned into an unexpected nightmare.

“I went in blissfully ignorant of what was really going on here,” says Esveld, 28. “I did my research when I bought a TV, but not when I decided to laser my eyes.”

In December 2016, about 4 days after having the surgery at what he now calls a “LASIK mill,” he had an unsettling pain in his right eye.

“It was a deep ache and sometimes like a sharp, hot sensation, like when you have an inflamed ankle after you roll it,” Esveld says. “I would have days when it was so severe that I was pretty much incapacitated. I couldn’t keep my eyes open because of the pain.”

With LASIK, which stands for laser-assisted in situ keratomileusis, lasers correct eyesight by reshaping tissue under the cornea, the round dome at the front of the eye. The doctor flattens the eye and cuts a flap to reshape the middle section of the cornea. The reshaping of the tissue changes the way light focuses in the retina, making your vision clearer. It can take up to 6 months for eyes to reach peak clarity and for some of the side effects to go away.

It isn’t unusual for patients to have eye problems for the first time after LASIK, including halos, dry eyes, starbursts, and lessened night vision.

Esveld contacted the clinic where he had his surgery about the pain. Burning, itching, and discomfort are all common symptoms for a few days afterward, so his situation didn’t seem out of the ordinary. At the first post-op consultation, he was told his eyes looked “perfect.”

But the 28-year-old engineer wasn’t convinced.

“It gradually got worse. I went in another 2 weeks later. By this time, I had started to do research and learned that there could be nerve-related pain going on. I started to ask targeted questions about nerve sensitivity,” he says. “I remember getting quite confrontational with the optometrist. It felt like we were dancing.”

Esveld’s research led him to believe that LASIK had left him with ocular neuropathic pain, a result of nerve damage in the cornea.

According to the Ocular Surface Journal, central ocular neuropathic pain can be a result of nerves growing back incorrectly as balls of nerves, or neuromas, after sustaining shortening and thermal ablation, a procedure that uses heat to destroy body tissues, during LASIK.

The entire LASIK procedure depends on destroying a portion of the cornea. This process can cause nerve damage and inflammation, which triggers sensory nerves in the eye.

Esveld began to look elsewhere for corneal specialists. Since 2017, he says he has had microscopy scanning to look at corneal cell structure and many rounds of dry eye testing. He has been prescribed blood serum tears, steroid drops for inflammation, various therapies for nerve pain such as anti-seizure medications and antidepressants, and even medical marijuana.

Some treatment options are more helpful than others, but no one prescription solves his problems. They can also be expensive.

“We don’t even understand the ramifications of it yet. There’s no effective treatment for my condition,” says Esveld.

In fact, few studies follow post-LASIK patients for longer than a few months to a year. And according to the FDA, since the surgery is still relatively new, its long-term results are unknown. Case studies as far back as the 1990s document patients having pain, discomfort in their eyes, and impaired vision to the point of affecting mental health, sometimes leading to depression and even suicide.

Luckily for new patients, Kozarsky says that LASIK technology has greatly improved over the years. New lasers are more precise, and fewer patients have the general side effects associated with LASIK.

Also, the number of patients who are considered good candidates for LASIK has dropped, due to more intense screening processes. Kozarsky says surgeons screen patients based on medical charts and personality. According to him, high expectations can lead to disappointments with the surgery.

“Personality is a huge part of LASIK surgery,” he says. “We’re screening for unrealistic expectations. Under-promise and over-delivery is a good way of going into LASIK.”

In general, the success rate of LASIK is exceptionally high, especially for an elective surgery. Success is typically defined by quality of vision and patient satisfaction. LASIK weighs in at 96% satisfaction, according to the Journal of Cataract and Refractive Surgery.

Esveld says if he could turn back time, he would not have the surgery. Esveld, along with many other critics, say that the safety standards for the surgery are too low and that possible consequences are not effectively communicated.

Praise From a Doctor and a Patient

According to Donnenfeld, LASIK is the “safest, most effective procedure that’s ever existed in ophthalmology.” In his 28 years of practice, he says he has performed over 85,000 procedures with no patients who developed chronic corneal neuropathy. In fact, complications from LASIK eye surgery are extremely rare.

This was the case for Alessandra Bhansali. After having LASIK done nearly 6 years ago, Bhansali, 27, has nothing but praise for the surgery. She says that her eyes reached peak clarity within 3 days of the procedure.

“I don’t have to worry about contacts. It makes my routine faster,” she says. “It’s less of a hassle, and it’s really nice to be able to wake up and see everything. The surgery has made my life really convenient.”

LASIK usually takes 15 minutes or less to perform. Despite the short procedure time, it can cost around $4,500 or more. Many clinics offer discounts and coupon deals for the surgery that can take up to $2,000 off the cost.

Donnenfeld doesn’t discourage potential LASIK patients from looking into clinics with coupon deals, but he does suggest researching the surgeon before choosing to use the coupon. Many high-quality practices offer discounts for LASIK surgery, but cost shouldn’t be a patient’s main concern.

“Some doctors are better than others,” he says. “The single most important thing about LASIK is finding a good doctor to perform the surgery. Don’t allow the surgical procedure to be commoditized.”

According to the American Refractive Surgery Council, there are five key qualifications to look for in a surgeon:

  • The surgeon should be experienced, preferably with at least 10,000 successful surgeries performed.
  • Make sure the surgeon meets industry standards with their LASIK screening process.
  • Be comfortable with your surgeon. They should be eager to give informed answers to any questions you have.
  • You shouldn’t feel pressured to have LASIK done, and the consultation shouldn’t feel like a sales pitch.
  • Look out for surgeons who over-promise results. LASIK is intended to improve vision, not necessarily perfect it.
WebMD Article Reviewed by Neha Pathak, MD on July 27, 2018

Sources

Eric D. Donnenfeld, MD, founding partner, Ophthalmic Consultants of Long Island and Connecticut; clinical professor of ophthalmology, New York University.

Jason Esveld, LASIK patient.

Alessandra Bhansali, LASIK patient.

The New York Times: “Blurred Vision, Burning Eyes: This Is a LASIK Success?”

LASIK.com: “LASIK Calculator.”

LASIK.com: “Looking Back: The History of Laser Vision Correction.”

American Refractive Surgery Council: “What Is the LASIK Success Rate?”

American Refractive Surgery Council: “5 Essential Qualifications For Choosing A LASIK Surgeon.”

American Refractive Surgery Council: “LASIK Complication Rate: The Latest Facts and Stats You Should Know.”

FDA: “LASIK,” “FDA Letter to Eye Care Professionals (May 22, 2009),” “Pacific Vision Institute 8/14/14.”

Global Vision Rehabilitation Center: “Treatment for Post-Surgical Vision Loss.”

Groupon: “LASIK.”

JAMA Ophthalmology: “Symptoms and Satisfaction of Patients in the Patient-Reported Outcomes with Laser In Situ Keratomileusis (PROWL) Studies.”

Seminars in Ophthalmology: “Understanding Neuropathic Corneal Pain-Gaps and Current Therapeutic Approaches.”

Alan Kozarsky, MD, ophthalmologist.

Journal of Cataract & Refractive Surgery: “Modern laser in situ keratomileusis outcomes.”

Ocular Surface Journal: “Post-LASIK Tear Dysfunction and Dysesthesia.”

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