LASIK Risks and Complications – Safety of Laser Eye Surgery

The cause of ectasia after LASIK is unknown, but the removal of too much tissue from the cornea during the procedure appears to be a risk factor.

The incidence of ectasia after LASIK has been estimated to be 3 cases per 1,000 surgeries.⁹

Most experts believe careful screening of patients can reduce the risk of ectasia further. For example, individuals with unusual pre-operative corneal topography or a family history of keratoconus should be disqualified from LASIK surgery, say many surgeons.

The primary symptom of ectasia after LASIK is blurred or distorted vision that cannot be corrected with eyeglasses. High astigmatism may also develop. Estimating the true risk of post-LASIK ectasia is especially challenging, because sometimes it can take two to five years after surgery before signs and symptoms appear.

A new treatment for ectasia that shows promise is corneal collagen cross-linking with riboflavin (C3-R), which can strengthen and stabilize the cornea.

Communicate with Your LASIK Surgeon

No surgery should be taken lightly, and anyone considering LASIK should be aware of all risks involved. The best way to do this is to ask your LASIK surgeon plenty of questions during your pre-operative consultation. Be sure to discuss all concerns you have with your surgeon or other eye doctor(s) involved in your decision.

Many factors are taken into account to determine if you are a good candidate for LASIK surgery. The doctors helping you make this important decision should be able to discuss the risks and rewards of LASIK in terms that are specific to you.

Keep your expectations realistic

Though most people who have LASIK enjoy 20/20 eyesight without corrective lenses after surgery, this does not mean your vision will be perfect after the procedure.

Some people who see 20/20 after LASIK notice glare or halos at night. And while some say their vision after LASIK is sharper than it ever was with eyeglasses or contact lenses, others will have the opposite experience, and feel their vision after LASIK lacks the definition it had prior to surgery—even if they can read the 20/20 line on the eye chart in their doctor’s office.

The best way to think about LASIK or any vision correction surgery is to expect it to improve your vision, but also to be aware that it may not completely eliminate your need for eyeglasses. It is possible you still may need glasses for certain tasks, like driving at night. And nearly everyone needs reading glasses once they reach a certain age after LASIK.

If you expect nothing short of "perfect vision," LASIK may not be the right choice for you. Be sure to discuss your expectations with your eye doctor prior to deciding to have LASIK or other vision correction surgery.

LASIK Alternatives

If you and your LASIK surgeon decide you are not a good candidate for LASIK, there are other vision correction procedures that may be a better fit. Ask your doctor to discuss these options, which include PRK, LASEK, Epi-LASIK, and lens-based surgeries, including phakic IOLs such as the Visian and Verisyse implantable lenses, and refractive IOLs for a procedure called refractive lens exchange.

If you are over age 40 and have presbyopia, you may want to consider a presbyopia correction surgery such as conductive keratoplasty (CK) or refractive lens exchange with an accommodating IOL such as the Crystalens implant or a multifocal IOL like the ReSTOR or ReZoom lens. If you have cataracts, these lenses can also be used during cataract surgery to give you greater independence from reading glasses after surgery.

Each of the above procedures has risks and potential complications as well. Be sure you fully understand the rewards and risks of any vision correction procedure, as well as LASIK eye surgery cost, before you sign the consent to proceed with surgery.

SOURCES:
¹Dry eye after LASIK for myopia: Incidence and risk factors. European Journal of Ophthalmology. Jan 2007.
²Tracking CustomCornea’s early clinical outcomes. Optometric Management. Feb 2004.
³PRK, LASIK stable at 10 years in large series. Ocular Surgery News. Jan 1, 2007.
⁴LASIK risks justify consideration of surface ablation techniques. Ocular Surgery News. Apr 15, 2007.
⁵Epithelial ingrowth is primary LASIK complication. Ophthalmology Times. April 1, 2007.
⁶Epithelial ingrowth seen increasing in older population. Ophthalmology Times. Sep 1, 2007.
⁷A new generation of LASIK. Optometric Management. Sep 2007.
⁸Determining DLK after LASIK. Contact Lens Spectrum. Dec 2007.
⁹Numerous risk factors found for corneal ectasia after LASIK. Ophthalmology Times. Aug 1, 2007.

Last updated: February, 2010