LASIK Eye Surgery

“Would you take the risk of jumping out of a plane with a parachute?” I asked the patient.

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She had just asked me if she should toss away her eyeglasses and have her vision corrected by laser-assisted, in situ keratomileusis (LASIK) surgery. Millions of North Americans have had this procedure done and are happy with the result. But now the Food and Drug Administration (FDA) wants stronger warnings of complications on patient-information material. The problem is that just as some parachutes fail to open, there can be devastating surgical complications. LASIK surgery permanently changes the shape of the cornea, the clear covering at the front of the eyeball. A laser device is used to cut a flap in the cornea leaving a hinge at one end. A computer-controlled laser then vaporizes a portion of the tissue underneath the flap and the flap is replaced. A good result is very appealing, as who wouldn’t prefer good vision without glasses or contact lenses. But so much has been written about the benefits of LASIK surgery that it’s prudent for prospective patients to be aware of its potential hazards. After surgery, the flap that was cut in the cornea and then placed back in its original position may move, causing problems. There is also the possibility of infection any time an incision is made anywhere in the body. This may require intensive treatment and may lead to temporary loss of vision or even irreversible blindness. And it’s important to remember that computer-controlled laser devices may not always do what they’re supposed to do. Some patients suffer side effects that impair the quality of their eyesight even if visual acuity is improved. For instance, even with good vision of the eye chart, some patients do not see as well in situations of low light contrast, such as driving at night or in a fog. In one study, 41 percent of patients gained daytime vision, but some lost nighttime vision. In another study of shortsighted people who had laser surgery, 80 percent could not see a traffic sign at 15 car lengths, and 40 percent could not see the sign at 4 car lengths. This is worrying. We’re all concerned about drunken drivers. But with millions of people having LASIK surgery, one wonders how many drive at night. Moreover, laser surgery cannot stop aging, and as we age, nighttime vision decreases. This makes a double-whammy. Some post-operative patients have developed debilitating visual problems such as double vision, or have complained of glare halos. It’s also possible for patients to be under treated or over treated, resulting in less than 20/20 vision. In one study, 36 percent of those who had surgery on both eyes still needed glasses. Another report stated that from 2 percent to 10 percent of people still require glasses after LASIK surgery. Others develop the dry eye syndrome. In these cases, the eye is unable to produce enough tears to keep the eye moist. This can cause not only discomfort, but also intermittent blurring, and it can be a permanent problem requiring regular eye drops. So what does all this mean? It’s not the intention of this column to put the fear of death into anyone who contemplates LASIK surgery. Rather, it’s wise for people to follow the time-tested advice given in Roman times, caveat emptor, let the buyer beware. Simply, you must be a well-informed patient before agreeing to LASIK surgery. And anyone who tells you there are no complications is either a liar or a fool. The decision is even more difficult when LASIK surgery is being done for convenience rather than necessity, considering that the great majority of cases end with good results. The problem is you never know when a rare complication is going to occur. It’s a terrible day when loss of vision occurs simply because you wanted to toss away glasses. So you must always be willing to accept some risk when contemplating LASIK surgery. Never forget that on rare occasions, even a well-packed parachute fails to open.