Refractive surgeon here. I work in a well-known eye hospital in Paris. I operated my sister (PRK) and my best friend (LASIK). My mother underwent PRK when I was a child and I think the amount of admiration/gratefulness that she had for her surgeon afterward actually gave me interest for this surgery.
We regularly operate ophthalmology residents as well, and one of the surgeons of the center underwent LASIK.
However, if you consider surgery, please turn to a well-known and experienced surgeon. It is a very secure surgery that can turn really bad if errors are made during patient selection, surgery planning, surgery itself, and management of the unfrequent complications that can occur.
Patient selection is especially important. So you have to choose a surgeon that really cares about his reputation, and that will not operate you whatever your examination.
A decade back, my SO worked on clinical trials at a research hospital in the eye clinic. I understand nothing about this stuff.
However, I gleened one important bit of advice:
Avoid any surgery, procedure that surgeons themselves avoid. My SO claims that eye doctors avoid LASIK.
Maybe 10 years ago, a visiting eye doctor was lecturing about LASEK (not LASIK), an operation he had done on himself, and other doctors took note. That was evidence to my SO that LASEK was worth considering.
Actually, we looked yesterday how many eye surgeons underwent LASIK/PRK in the previous 5 years to write a study about this specific topic (this . We found 16 people.
LASEK had a surge of interest 5-10 years ago because it was tought that it could have the pros of both PRK and LASIK. Nowadays it is more or less forgotten (no real benefit in comparison with PRK).
Eye surgeons not getting surgery was totally true 15 years ago but it is not anymore (at least in France)
Do you have thoughts on LASIK/PRK vs. refractive lens exchange? I’ve been holding out for something “better than LASIK.” Would love your perspective on whether that’s sensible or misinformed.
It depends a lot on your age, and also on your refraction. Refractive lens exchange can be a good option for high myopia/hyperopia after 60, and can be considered after 45. This is hard to give an advice with no context, the topic is quite complex ;-)
Thanks, I appreciate it. From my layman’s reading, it seems like RLE is very safe and doesn’t have the same side effects as LASIK. I guess my real question is why shouldn’t it be more widely used for younger or less extreme corrections. It’s likely that I am misunderstanding something and I am wondering if it’s obvious to you as an expert what it is.
Ok I get it! It is very simple : RLE implies the removal of the cristalline lens and insertion of an artificial lens that corrects the initial ametropia. The procedure is exactly the same as cataract surgery.
The problem is that the lens is the organ that allows accomodation.
So while it is usually simple to give you a glass free vision for a given distance, you will need glasses for other distance (usually, you will have a good far vision and glasses to read) which is not something that you want when you are young.
The reasoning is that when a cataract surgery will be done anyway a few years after, it is more simple to do one surgery earlier than doing two.
Patients with extreme ametropia are more likely to accept glasses.
Finally, multifocal lenses exists, but they induce aberrations that are well tolerated when they follow the blurry vision and impairment of cataract, but not so well in previously well-seeing patients.
Got it, thanks. I think it is your last sentence that is most clarifying for me. I thought the multifocal lenses were a good solution but it sounds like they aren’t as great as I had hoped. Thanks for taking the time to reply.
Great perspective. Genuinely curious: how often does a refractive surgeon such as yourself visit this website? Do you feel the need to activate the noprocrast feature?
Halos are frequent especially in the months after surgery. They tend to reduce with time. They are usually not noticed in everyday life but rather by night, while driving for example (dilated pupils). They also depend on the type of treatment (optical zone, amount of correction) that you perform, and for the quality/generation of the laser platform... Information is essential.
Chronic pain is usually related to dry eyes. Those patients should not be operated at all. Bad patient selection can result in terrible results.
Loss of visual acuity after refractive surgery is more than exceptionnal. It is usually manageable with hard contact lenses.
The special thing about refractive surgery is the contrast between its apparent easiness (non specialist eye surgeon will often refer to it as an "easy surgery, no technical difficulties") and the rapidity with which hard to treat complications can occur if everything does not go as planned. Little things (water drop on the cornea during the treatment, centration error, mismanagement of flap cut incidents...) can lead to disasters that you sometimes cannot repair.
I wanted LASIK so bad starting around 2010, I had worn glasses since I was 6 for my astigmatism. The reason I did not get it was because someone I worked with had a friend who they messed up one of his eyes and he was legally blind. My sister got it in 2015 and I kept putting it off. In 2018 i was turning 40 and needed readers, the eye doctor said i should get bifocals or LASIK and readers.
I got LASIK in September of 2018, I did my 1 year checkup in September of this year and am seeing 20/15. I used eye drops as instructed and now I don't need them. I still use readers for little print (or more light), but I knew I would need to going into this.
I was advised to skip LASIK recently, as I was told I'd need it again when I got older and expose myself to all the same risks of a bad result over again. I instead decided to invest in much nicer contacts which has been life changing. I didn't realize there was that drastic a difference between crappy contacts(not even necessarily cheap) and good ones.
I was also told in 15 to 20 years i might need glasses again (late 50's, early 60's). I am cool with that.
I once had contacts, they did work OK. My issues were that i suck at putting things in my eye. I never got comfortable putting them in, i know that is a personal issue not the fault of the contacts. Also my contacts had to be weighted for some reason (i cannot recall why), and if my eye got dry they would shift and things would become blurry and i had to use eye drops or tear up (didn't happen a lot, but enough to annoy me). Plus i still needed a set of glasses.
Kind of off topic, my other half, she was making fun of my reading glasses, one day she was struggling to read something and i slapped them on her face and her response was OMG. I laughed, went to take them off her and lets just say i had to go buy myself a new pair (she confiscated them). It is interesting that people think readers are only for older people or you need a prescription, she wishes she would of gotten a pair 5 years ago.
I’m in the same boat as you, I stuck with contacts as the risks of the surgery and age-related need for glasses didn’t make much sense when contacts got me really great vision and no complications. They go in when I wake up and come out when I sleep and I rarely know I have them in.
Somewhat surprising because I am very near-sighted and have astigmatism.
If contacts weren’t as good a solution I probably would have gone for laser surgery. I hated wearing glasses - the biggest aspect was how they distort your vision a little. I can see much better with contacts than glasses.
I used to be the same - 10+ years of waring contacts, I could pop them in and out of an eye without thinking about it in seconds.
But then when I got older I started getting more eye infections and each time you can’t really use contacts as it irritates the eye, so back to glasses.
And then I started reading a bit more about how you can get resistant bacteria infections from contacts (basically guaranteed blindness) I realized I was risking my eyes each and every day anyway, better to bite the bullet and go for a surgery. Risk once and be done with it.
I think the feeling of freedom and one less thing to worry about that I got after the successful LASIK was akin to when I first switched from glasses to contacts. I think its totally worth it.
Do you have astigmatism? Every time I've tried contacts, this has been the achilles heel, because the contacts inevitable rotate a bit and then my vision is intolerably blurry until they get back into place. Maybe it's just my prescription, but my eye doctor straight up told me that I'd never be satisfied enough to switch to contacts (from glasses) full time.
> Do you have astigmatism? Every time I've tried contacts, this has been the achilles heel, because the contacts inevitable rotate a bit and then my vision is intolerably blurry until they get back into place.
I have astigmatism. I had the same problems with older-generation contacts.
I switched to Alcon's top of the line daily disposable contacts and now my contacts almost always line up correctly. The new contact lens technology is amazing.
At one point about 16 years ago, I was prescribed hard contacts that dealt with astigmatism. They seemed fine but the irritation, the pain of daily installation, plus the warnings about never falling asleep with them on made me pass on these. I never experienced the blurriness that you mention in the few weeks that I wore them so perhaps there is some mitigation for the rotation?
I’d like to know too. I’ve worn contacts since I was 12. Originally, non-disposable that I took out and cleaned every night. These were pretty good, but by the end of the year tended to get a bit ratty around the edges. It’s been too long to remember the quality of correction, but I know that contacts have always been better than glasses for me.
Then for years I wore the disposable, extended wear kind you can sleep in. Typically replaced every two to four weeks. Aside from dry eyes in the morning, these were by far the best.
They are not without risk and certainly not for everyone, but they had the highest manufacturing quality, were the most comfortable and seemed to me to provide the best correction.
For the last two years I’ve worn daily disposables. I think these are probably best for eye health since you’re not reusing one set over and over and not leaving them in for days on end, but they have the most variation between individual lenses. Sometimes I’ll get contacts that are instantly irritating. The next in the package will fit comfortably. Quality of correction varies every day too. This I just live with, as it’s not worth (to me) burning through them faster just because my distance vision isn’t as good as it could be today.
I’ve always used whatever brand my optometrist recommended (which I’m sure is whatever they’re being paid to promote). If there is some gold standard brand I should be asking for, I’d love to know.
I trialed 3 different brands of dailies this year. It was a pain, but one of them did end up standing out in terms of comfort for me. My doctor said there is no pattern - it’s really person dependent which is best.
Dailies changed my life. They only started making dailies in something close to my prescription a few years ago.
There's Acuvue and there's everything else. I tried probably half a dozen brands over the years recommended as good by opticians - supposedly premium brands priced accordingly, and Acuvue are dramatically better than all of them.
If there's anyone else who have got close in terms of comfort, quality of vision etc, it's a well kept secret.
That helps confirm someone else's comment that this differs by person, not manufacturer. I kept trying Acuvue and found them very uncomfortable, instead favouring Focus Dailies. Now I am on Costco own brand which seemed even more comfortable.
I’ve had dailies for a long time and now really love acuvue moist. Way less dry. if the delta between weeklies and dailies is 1, moving to acuvue moist has been another 0.3 or so
I tried multiple ones and always got eyes very dry, life was a pain, then I switched to the most expensive I could find, « Dailies total 1 » is the name. No more dry eyes, problem solved. Each lense cost 1€, but I would even pay more for it to be honest.
Can confirm, Alcon dailies total one and Acuvue TruEye are the acceptable ones for the drier eyes. Personally I found Total 1 slightly more comfortable in general, but it lacks the UV filter or something that makes them notably worse than TruEye in sunny weather.
Also, the drops make huge difference: since a better doctor told me to use only preservative-free ones like hylo-comod, I can wear lenses for 20 hours straight without image quality degradation.
For soft contacts there's two primary types in use. Regular hydrogels and silicone hydrogels (SiHy's). Most doctors will prescribe SiHy's now as they provide some key benefits. Those being: better air permeability (dk/t number) and the ability to be used for continous wear (overnight).
The SiHy's had a bit of a tradeoff though, despite being able to let a lot more oxygen through (which the corneas need, they can directly absorb it), they are not inherently wettable. Silicone is hydrophobic, it naturally repels water. So 3 generations of silicone hydrogel are in use. 1st gen has an external wetting agent that rubs off over time. 2nd gen has an internal wetting agent that some people are allergic to. 3rd gen has the molecular structure arranged in such a way they are inherently wettable.
I wear 3rd gen SiHy's now. Cooper Biofinity is the name brand. These are approved for extended wear up to a week. I have done longer than this but risk of complications increase. However, these were a huge improvement over the regular hydrogels I used to wear. If I had them in over 17 hours or so my pupils began to dilate from my eyes being oxygen starved. They are a little stiffer (and hence, slightly less comfortable than my regular hydrogels were). They also have a slightly higher chance of feeling dry due to higher water content than most other SiHy lines.
Anyways, hope that helps. There's a lot of options on the market and for you it might be better to look for a higher water content with lower stiffness, if you need to wear them when sleeping that really limits you to 4 or 5 continuous wear brands. Don't wear a non-approved regularly for sleep, it'll screw up your eyes in a mess of different ways (vascularization and such).
Thank you very much for the write up! I had no idea that things had improved so much. I had switched back to glasses several years ago because of the complaints above. It sounds like I should check out contacts again.
Yes. I wear extended wear contacts that are supposed to be replaced once a month. I take them out and replace them when I notice a significant deterioration in vision, or when my eyes feel scratchy. For me has varied between a month and about 18 months. YMMV
I have very occasionally rubbed my eyes to the point of accidentally removing a contact, mostly this is a habit I have trained myself out of
Most days and nights I forget that I have contacts in, I always sleep in them, makes getting up in the night to pee much safer, and other night time activities more enjoyable
That's great! Having to take contacts out every evening and to then clean them was quite a hassle. I should try contacts again.
>makes getting up in the night to pee much safer
Is that really the case? My vision is only slightly better than yours (although my last check was years ago) and I feel like I could do most things without glasses just fine. Anything that requires reading is difficult though, unless it's on my phone where I can just bring it very close to my face.
Depends on the probability distribution of single Legos in your nocturnal environment.
On a more serious note, when a fire alarm has gone off in the middle of the night and I have to grab a sleeping child and get out of the building, then it's one less thing to worry about for sure
How much are good ones, and how much of a pain are they vs just regular eyes? I've never worn contacts, and the thought of having something in my eye seems very weird. I also tend to get dry eyes sometimes with allergies, will that affect it?
I've worn contacts for ~20 years. I've had gas-permeable 'rigid' contacts, extended-wear (acuvue2 / oasys) contacts (that I nonetheless was advised to remove every night), and recently I've switched to daily / disposable contacts.
The gas-permeable ones were from ye olden times, I don't think most people need to bother with those anymore because materials for soft lenses these days admit much more oxygen. They were also by far the least comfortable.
The extended wear ones were an amazing transition after the previous ones. Barring manufacturing irregularities in any particular contact lens, a few seconds after they're in your eye, you can genuinely forget that they're there. My issue with these was mostly psychological: removing them every night and cleaning them proved to be annoying enough that I would justify just sleeping in them for one night. The second day was much more uncomfortable (dryness mostly). Subsequent days would be miserable, but I seldom made it all the way through day two.
I finally switched to dailies and they are even thinner (read: more comfortable), and it's effortless to take them out and switch to glasses when I'm ready for bed, so I very very seldom end up sleeping in them. (Also, if one happens to fall on the ground or get torn, it's not like you're losing a week's worth of wear on it, you were going to throw it away anyway that night. Just having that peace of mind is nice.) Finally, when traveling, I don't have to pack the travel size contact lens solution and lens case, I just bring however many days' worth of lenses (they come individually packaged). It's been amazing and I recommend it.
If the thought of having something in your eye seems weird, maybe try a trial set. Optometrists (at least all the ones I've used here in the US) will give you a pair of extended wear lenses or roughly a 10-pack of dailies to try out, so that you know how they are before you commit to a year's supply. They'll also generally coach you on inserting/removing. It was awkward for the first month but now it's just a part of my routine.
I've switched to dailies and it's wonderful. I don't normally need them, but they're wonderful for meetings in rooms with 10 foot displays, movies, concerts, etc. Since I don't wear them every day, I can buy a normal 3 months worth (90 pairs) and they'll last me a year. I don't have to worry about keeping them clean, making sure solution doesn't leak.
I work between two offices at the moment, so I keep a few pairs in both desks just in case as well as a pair in my car. I considered going back to glasses before I got dailies pretty much out of convenience alone, but I hate glasses as you don't get an undisturbed field of view and the lens distortion at the edges usually give me motion sickness. Having some dailies really is the best of both worlds.
> I hate glasses as you don't get an undisturbed field of view and the lens distortion at the edges usually give me motion sickness
The reason I switched to contacts was because this effect was so bad that I felt like it was difficult to hold eye contact with one person, and any group conversations had me swinging my head around to point my chin at whoever was talking because otherwise I couldn't meet their eyes. It was very isolating.
I wore extended wear lenses for a while (my vision is okay enough that I've been going without any corrective for years). They are very sensitive to how clean they actually stay, and I think it is quite easy to scratch them up.
What are the good contacts you're using now? I gave up on contacts years ago, but I've never done any research and experimenting to find if there was anything better than the usual Acuvue stuff.
I switched from Acuvue to CIBA vision (now Alcon) Air Optix about a decade ago. I completely forget that I’m wearing them. They are monthly contacts that are approved for multi-day wear. I usually take them out every night, but if I’m on a trip I might keep them in 3-4 days. They have been fantastic. I did have to get a slightly wider diameter to prevent halos at night.
Of course, they were just a recommendation by the optometrist, I wore a pair of trials and they were good enough that I stuck with it.
I had mine done in 2011. I went to a highly reviewed specialist who charged a lot. No coupons for me! One of the best things I ever did. In 8 years, not a single day has passed where I haven't taken a moment to appreciate my 20/15 to 20/10 vision -- no hyperbole. Eye drops for a while. Then less often. Then nearly never.
Now, what I wish I had known is that apparently a knock to the head can dislodge the flap. Still would have gone for it.
Edit: I do have a bit of halo at night with bright lights. A total non-issue for me as my lenses were always scuffed, causing more halo that I get now. And I'll take an eye drop once a quarter or less.
There are a couple other mentions in this thread about PRK. I went the PRK route instead of Lasik, and don't regret it one bit. I chose PRK because it was less risky, and was more durable. Look it up yourself, but brief summary:
- no flap, they remove top layer of cells with a scraper, then laser
- no flap means stronger eyes. if you box, mountain bike, work in a high risk environment, it's the procedure to get
- long recovery time, and it's pretty painful for the first week. ~ 2 weeks to reasonable vision, 4-6 weeks for 20/20 or better.
- less chance of dry eyes (still a semi-common outcome)
My eye doctor, the casey eye institute, pushed lasik, but that was purely for what people commonly want. They were enthusiastic about PRK, considered it a better procedure for people who were OK with the recovery time, with less chance of complications.
My complications:
- dry eyes, but nothing worse than contacts get midway through a day
- sensitive eyes. meaning, a scratch on the eye becomes eye wateringly bad
- slight halos at night, but again, nothing worse than contacts at the end of the day
I am happy with the results, would do it again, and am currently advising my wife to do PRK instead of lasik (she's on the fence of doing anything). I ride mountain bikes, dirt bikes, and do lots of building, so chances of complications with a flap are non-zero. If you haven't read, those complications are pretty bad - get lazik, take a stick to the eye a year later which causes the flap to dislodge, you now have potentially uncorrectable vision in that eye.
Search the rest of this discussion for PRK. If you aren't afraid of pain, discomfort, and a long recovery time, it's the procedure to get.
Also there's a HUGE difference in lasik or PRK providers. As you can imagine, it's worth spending extra. My procedure cost $4k total, which is $3k more than budget lasik providers. However, I worked with some top eye doctors that regularly perform serious eye surgery, and are at the forefront of optometry. Strip mall discount lasik has less time spent on planning, comes with less experience in recommending procedures, and has less experience working with complications. Definitely don't cheap out!
I got PRK in somewhat unusual circumstances, paying $1.6k total. My cornea thickness was compatible with the procedure (which is one of the big reasons to do LASIK over PRK, i think), but my offset was huge (-7.5, where PRK usually caps at ~-5).
The circumstances boil down to having it done in a foreign country, and they used a non-FDA approved eyedrop (toxic if it got in the bloodstream) that allowed the procedure to correct my offset fully. Four years later my vision is going strong.
Long recovery time was 2 weeks with fireworks in my eyes the first two days. After that it was logrithmic improvement in blurriness.
I would also highly recommend PRK, it enabled an entire lifestyle for me which heavy glasses actively discouraged, and there isnt a day i miss waking up to a blurry space.
This is so important for any surgery where mistakes can be life-altering. When I was a teenager we cheaped out on braces with a dentist 3x cheaper than the other one we'd spoken to, and my teeth are now slightly misaligned and I have a fairly weak bite.
Fortunately it doesn't affect my outward appearance and I've gotten used to it as it's not too bad, so it was almost worth it for the valuable life lesson.
Most doctors will use the same equipment in the same area. For PRK they do a tomographic scan of your eye to determine a number of parameters, and then your doctor pre-programs the procedure.
In my case, the most direct action my doctor had during the procedure was cut back/replace the outer flap, and apply the drops.
I say this because 'cheap' (at least to me) implies someone with less skill or lower ability performing for a lower price. Since so much of the process is automated I'd say that only a small part of this applies.
Especially for those who are looking for a good price, ask revealing questions like where the equipment is, when it was recently obtained, how often this particular doctor has done it. And since costs aren't directly attributed to manual labor (and can easily crest 10k+ for a region), dont be afraid to negotiate and price compare.
How do you know which providers charge more because their product and competence is actually better, rather than because they are a low quality facility that just decided to charge more?
I don’t believe it’s as simple as finding a more expensive provider to ensure better outcomes.
In my case, I went to a world class eye institute that is part of OHSU. I am lucky in that we have a pretty serious research hospital here in Portland, so I didn't have to travel.
I don't know how you find the best in your area, but I was mostly referring to the strip mall lasik centers. If you aren't familiar with these, they are a budget lasik provider that has past generation equipment, run by technicians instead of eye doctors. They run ads on billboards, and in the local coupon books that are delivered to your house....These are the places that I think are mostly being referred to by the article.
>I ride mountain bikes, dirt bikes, and do lots of building
This is the main reason why I'm sceptical of laser eye surgery and contact lenses - even if you have 20/20 eyesight, there are a lot of circumstances where you should be wearing protective eyewear anyway. Laser eye surgery makes your eyes more vulnerable to damage and doesn't obviate the need for protection from dust, debris, caustic substances and UV radiation.
I religiously wear eye protection. Sticks can make their way around glasses / goggles. The flap created during lasik doesn't need an object in the eye to dislodge though, a blow to the head will do it in the right circumstance. Lasik makes your eyes more vulnerable to damage, PRK does not. This is why police/military/sports require PRK for corrective surgery, rather than lasik.
The article links to a FDA study on outcomes [1] but is very selective at what it chooses to highlight.
Here is what article singled out:
“In a recent study, the FDA found nearly half of participants who had no visual symptoms prior to the surgery reported having some complication three months after surgery.”
AND here are ALL the conclusions from the linked study results:
* Up to 46 percent of participants, who had no visual symptoms before surgery, reported at least one visual symptom at three months after surgery.
* Participants who developed new visual symptoms after surgery, most often developed halos. Up to 40 percent of participants with no halos before LASIK had halos three months following surgery.
* Up to 28 percent of participants with no symptoms of dry eyes before LASIK, reported dry eye symptoms at three months after their surgery. This is consistent with previous studies.
* Less than 1 percent of study participants experienced "a lot of difficulty" with or inability to do usual activities without corrective lenses because of any one visual symptom (starbursts, ghosting, halos, glare) after LASIK surgery.
* More than 95% of participants were satisfied with their vision following LASIK surgery.
* Participants were more than twice as likely to report their visual symptoms on a questionnaire than to tell them to their health care provider
So what this means is that more than 50% of participants of the study had NO visual symptoms 3 months after the surgery and including those that did have some symptoms, 95% of ALL participants were happy with the outcome.
Add me to those 95% -- I had my Lasik done a decade ago at the Stanford Eye Center and had a quick recovery with zero complications and zero side effects
I suspect the halo thing is not an objective problem. People just get alert and start noticing it, or could not see it before due to blurriness. That was my impression after having several conversations with my wife who had LASIK and complained about halos.
It finally convinced her, when several consecutive days I had what she described as "halos" because I was tired and could not properly focus at late night.
Myself having a nearly perfect vision at the time never paid attention to them before she expressed her concert about that effect after surgery.
I'm not sure in your wife's particular case, but halos are a negative side effect of LASIK in some cases. It is not something that is always there the patient can now see. It has to do with the size of a patient's pupil versus the size of the area that can get corrected. Patients with very large pupils are told not to get the surgery period due to adverse halo effects.
I have decided against LASIK due to the potential for halos. I am susceptible to optical migraines and when I have one I see halos and it drives my nuts. I would hate to have even a fraction of that experience every day.
I have halos after LASIK and they don’t bother me. I understand how they would have a negative association because you experience them at the same time as a migraine, but they don’t cause me any suffering. They’re just... things that in my visual field that I don’t pay much attention do. When I notice them, they are a gentle reminder of how fascinating brains and eyes are.
Unrelated, but you're the first person I've ever heard who had optical migraines, which I have too. I experience them as shooting lights followed by essentially a shut down in vision in the affected eye. Never thought about Lasik making it worse but glad to never have done it if that's the same experience. It's miserable when it happens.
If you believe my conclusion, the halos after LASIK are not a real problem: there's actually no difference in experience between people who underwent LASIK and complain about halos and a healthy person: both see the same halos under the same conditions (e.g. night time and/or being tired). It is just that people after LASIK suddenly start paying attention to those halos.
I suspect it is a very mild form of post-surgery paranoia. I have a very similar thing after a minor surgery in the abdomen area: I started paying waaay more attention to what happens in my stomach.
And honestly, three months doesn't seem long enough for a followup. My wife got LASIK and I think it was about six months before her eyes were back to normal (wrt halo and dryness).
All of the symptoms listed were clearly discussed and raised as risks of LASIK when I got it (also at the Stanford Eye Center, with the only issue being somewhat more frequent dry eyes)
They mean of all the people who did not have one of the three side-effects of LASIK before the surgery, 46% now suffer from such symptoms after LASIK. Basically suggesting that LASIK caused these complications.
Poor visual acuity is a significant, life-affecting symptom, and neither glasses nor contacts are full-time, all-conditions-suitable corrective measures.
He was directly asked if the hearings could have potentially killed IOL's and replied
>they were shooting very hard for control. They said intraocular lenses are drugs and the FDA needed to control drugs
He is one man giving his opinion on what the opposing side was thinking during a debate over thirty years ago. The FDA likely had legimate reasons to continue their fight, they aren't actively hoping people can't see.
Holy observation bias, Batman! The only thing even resembling actual negative statistics in this article is the ballpark estimates by the ex-FDA advisor, and those are just guesses.
You can find negative experiences, sure, but what is the actual incidence of that? Without that data, this is utterly meaningless. It certainly isn't damning.
A recent clinical trial [2] by the F.D.A. suggests that the complications experienced by Mr. Ramirez are not uncommon.
Nearly half of all people who had healthy eyes before Lasik developed visual aberrations for the first time after the procedure, the trial found. Nearly one-third developed dry eyes, a complication that can cause serious discomfort, for the first time.
The authors wrote that “patients undergoing Lasik surgery should be adequately counseled about the possibility of developing new visual symptoms after surgery before undergoing this elective procedure.”
I wonder how people who got dry eye will age. As you age dry eye symptoms tend to increase and can be associated with recurrent corneal erosions which, aside from being painful, can get infected, which can be absolutely terrible and vision threatening in extreme cases.
Dry eye is hell especially if you work at a computer.
As an aside, Ocusoft Retaine drops are the best thing I’ve found for dry eye; I’ve never met anyone else with the problem who uses them but it’s like night and day.
Eye drops do not treat the underlying cause of dry eye (unhealthy/insufficient tears, inflammation (e.g. blepharitis), or in rare cases neuropathic pain). They are just symptom relief.
For anyone reading this who manages their dry eye with eye drops, please do some reading or see a specialist. If all you do is use eye drops, your dry eye will likely get worse.
Eye drops bolster your tear film and help prevent desiccating stress to the eye surface, but they lack growth factors and other important compounds found in biological tears, and can even contribute to washing those away.
Last, whatever you do, don't use eye drops with preservatives (e.g. benzalkonium chloride).
How many quality opinions did your friend get? I also know people with DED and from my experience not all docs understand the disease well. Obviously you know more than I do, but I'm very skeptical that there isn't more to the story than "a lifetime of drops". Also, I hope your friend has tried autologous serum drops.
That is a great suggestion IMHO. ASTs are pretty amazing but they're not a cure for everyone.
In the case above, I'm referring to my spouse. Her entire family has this problem - dry eye, frequent / continuous corneal erosions - setting in by their mid-late thirties. These are the people who end up wearing sleeping goggles, ointment, taping their lids shut, etc. It's not a lack of tear production, it's poor corneal basement layer adhesion for some undiagnosed reason and, probably, eyelids drifting open during sleep.
Specifically, "Visual symptoms and dissatisfaction with vision were common preoperatively. Overall, the prevalence of visual symptoms and dry eye symptoms decreased, although a substantial percentage of participants reported new visual symptoms after surgery (43% [95% CI, 31%-55%] from the PROWL-1 study and 46% [95% CI, 33%-58%] from the PROWL-2 study at 3 months)."
Anecdotal, obviously, but the only person I know that has had Lasik now has terrible, chronic dry eyes. I took stats with her; she said it never even crossed her mind that it might actually be pretty risky.
Yeah, the headline scared the heck out of me, since I had lasik done about 10 years ago, but (at least in the article) there's no way to tell if the people who are having problems wouldn't have had problems if they hadn't gotten lasik in the first place.
MY STORY:
I was recently interested in Lasik because I could no longer wear contacts. I ran into Dr. Oz's expose video right away, and realized that since at least 2013 there was a constant local/national news cycle promoting the lasikcomplications.com group.
This freaked me out quite a bit.
I read many of the negative posts, not all, but a large number said something like "Dr's told me my cornea wasn't thick enough but I had the procedure anyway."
In the U.S. ~9 million people have had Lasik, internationally it's 30 million. There FB group has effectively no membership, their FDA petition has less than 2k signers.
The site mentions suicide rate prominently, but the baseline suicide rate from https://afsp.org/about-suicide/suicide-statistics/ is 14.0 per 100,000, and it didn't seem like that rate was higher for people who got Lasik, it seemed lower really.
Ok, so I was confident that people with real complications have an outlet, and that outlet seems to be concentrated in this single group, so english world complaints should be pretty reliably represented in this group... and there just aren't that many complaints.
so...... statistically outcomes look great.
RESULT:
I got Lasik 4 months ago, couldn't be happier with the outcome, due to my risk tolerances if I could have kept wearing contacts I wouldn't have gotten it but everything has been hunky dory. On the plus side because I can easily wear sunglasses again my light triggered migraines (transitioning to sunlight is a problem) have all but disappeared and I am back long distance cycling again because my vision isn't jostling on the bike any longer.
Also, this group definitely juices its numbers by focusing on the large percentage of people who have dry eyes and halos during the recovery period and they include those as "complications", I had those for the first month, I've since met a surprising number of people who got Lasik (they come out of the woodwork once you get it) and people have different lengths of recovery from dry eyes, the longest I've met was 7 months and they were still very happy with getting it.
Had PRK 10 years ago, which I always describe to people as the closest thing to a miracle I've ever experienced. Went from not being able to read my bedside clock to better than 20/20. Of course, I am getting older so I need readers now, but my long distance vision is still perfect. Would have done it sooner!
I had PRK and it left me with astigmatism in both eyes. Afterwards I had both eyes redone and the "touch up" made it better, but it was still bad enough that I needed glasses to correct my vision. I'm trying to decide whether it makes sense to try again a third time.
Whether or not a third time would work, my laser surgeon already told me it would be the last time he'd try to fix it (which is a different tune than he was singing originally).
Since my surgery, I've bumped into a number of other PRK patients who've had similar troubles.
Also, the procedure left me with "haloing", which means that when its dark outside and you see lights, they all have a white halo around them, which is super annoying.
Another word of warning to potential PRK patients: the recovery period for me was measured in weeks (over a month, for me), and during that time my vision was hampered enough to make it difficult or impossible to work on computer screen. All in all, I wish I never had PRK.
I was recommended if I wanted corrective surgery to do PRK over LASIK and the recovery period is honestly what worries me the most. I'm pretty sure my eyes are tuned so well to displays that even contacts give me eye strain when working on stuff. Having that recovery period would be detrimental to me
Eyes don't "tune". Eye issues are strictly genetic unless there is some traumatic damage done to the eye (impact, chemical, staring at the sun too long, etc)
Also had PRK about 10 years ago, cost me $3k. Best money I've ever spent, my vision is still around 20/20-20/30, and was recently offered a super cheap "touch up" to correct back towards 20/10-20/20 with topo mapping of the cornea.
So in the study the article refers to, when asked after 6 months "Currently, how satisfied or dissatisfied are you with the result of your LASIK surgery?" on a 6-point scale, the responses were:
If the FDA guy concludes from this that the procedure should never have been approved, I'm tempted to say that it reveals more about the risk-averseness of the FDA than about the dangers of the procedure.
Three percent dissatisfaction and another four percent merely ‘meh’ is pretty high for an elective, perhaps even cosmetic, procedure that operates on something as fragile and irreplaceable as the eye.
I understand the 'cosmetic' argument, and would like to offer my personal experiences as a counter.
I was 20/200 overall vision, and wore glasses since I was 11. At age 27, before going into law enforcement, I underwent the Lasik operation, and it was definitely a life changer.
Living near swamps, in the south, it wasnt uncommon to walk outside from an air conditioned building, and have your glasses instantly fog. My skin gets incredibly oily and the glasses would slide down my face. It was hard to find frames that didn't leave huge uncovered and distracting gaps in my peripheral vision from being too small.
In the academy, I saw plenty of guys have to deal with glasses falling off of their faces while doing pushups/working out. They'd have to evaluate "Do I want to see or do I want to not break my glasses" during defensive tactics training.
Post graduation, I can only imagine how negatively glasses would've impacted my job. Water getting on the lenses in the rain, splatter getting on them while tracking people through the woods. Sweat and condensation blocking your vision. This assumes they stay on.
Having to wrestle around with someone to get them into handcuffs is difficult enough, and its incredibly easy to get tunnel vision. Staying aware of your surroundings is important, and there would be a significant amount of due stress if you couldn't see what you were doing because your glasses got knocked into a ditch.
I had to start wearing glass at age 25, and have been wearing them since. I also live in a very damp area (coastal, not swampy), and indeed, if I go out from an air-conditioned building on a hot summer day, my glasses might fog up.
But - frankly, your story is very difficult to relate to, and some of it sounds unreasonable. Oily skin cannot make glasses fall off your nose, unless they don't fit to being with; they're (supposed to be) supported by the structure of your ear and nose, not by static friction; you should have changed your frame.
Now, yes, they can fall off if you lean all the way forward; or if you throw your head around during physical activity. Or you don't want them to be at risk when playing soccer or volleyball or what-not. Well, you get prescription goggles for that; They're not that expensive.
I was really depressed and annoyed with having to wear glasses for a couple of months after I started to. Then, gradually, I forgot about them. That is, I didn't forget to wear them, I forgot about the hassle of wearing them. Yes, occasionally I get annoyed by raindrops, or a thumbprint, or having to tighten one of the screws. But it's really not as bad as you describe.
Caveat: My visual acuity without glasses is better than yours.
Improper use of contacts can scratch ones eyes and not everyone can comfortably wear contacts. The risk of LASIK may not appeal to some, but saying "what about glasses or contacts?" is a silly question from the perspective of someone who has had LASIK. It's a personal choice.
Also, some of the negative responses to such a survey can be avoided by proper screening of candidates and not just wanting to take the money of every person who walks in the door. For all we know, the people who responded negatively to that survey were never good candidates for lasik in the first place and are just frustrated they spent the money for little change in their vision.
I wore contacts for several years before my eyes became sensitive to them. I'm unsure if it was the cleansing agents or the contacts themselves. It wasn't dirty contacts, even new contacts would irritate my eyes. I stopped wearing them when I couldn't bear to keep them in for more than 4 hours.
This is only my own experience, but I'm quite certain that contacts are not a solution for everyone.
I had lasik when I was 30 (I think) I've been incredibly pleased with it.
This is an important perspective. If these were the rates for a necessary medical intervention, we would be ecstatic. Because for a necessary medical intervention, the patient's baseline is not good. But wearing glasses is mostly a nuisance, not a health issue.
I've worn glasses since I was seven-years-old. They are a nuisance sometimes. But elective surgery, particularly for my eyes, makes me nervous. I don't want to take even a 1% chance of chronic eye problems to get rid of glasses.
Well, I would say we'd also need a little more information about the 'dissatisfied' responses. It could be that none of them worsened the person's eyesight, they were just dissatisfied with the level of improvement, or that they still needed corrective lenses after the lasik. Or maybe not, but hard to tell simply from those poll questions, many people have unrealistic expectations.
Anecdotally, I know two people who had minor complications (chronic dry eye; sensitivity to light), but enough that they regretted the procedure. I also know more people who are very happy with it. But that's enough to dissuade me.
I'm in the same situation as you. Worn glasses/contact lenses from a young age.
A 1% chance of life-changing complications with something as critical as vision is, honestly, a shockingly high number for something I had assumed was far more safe.
Right now you have chronic eye problems, in the form of a lack of focusing ability. When I underwent LASIK, I knew my eyes weren't perfect before it, and that they wouldn't be perfect afterward, either.
The problem was never the surgery, it was the hype. I've regressed about 1 diopter over 15+ years, but that's better than being at 6 diopters and being almost unable to function without glasses.
In any event, taking away informed choice isn't what I want my taxes to pay the FDA to do.
I wear glasses as well. I've considered laser eye surgery. But I've decided against it, and all it took was learning about some of the bad outcomes. It's just not worth the risk. My eyesight is not that bad and glasses are fine. With my vision, 1 in 10 chance of being unsatisfied is not worth it. Sure, 9 of 10 times I'm happy, but I would far unhappier with a negative outcome for something so unnecessary than I would be happy with a good outcome.
This is a dangerous perspective on the issue. Why should the FDA approve an elective procedure that has the possibility of ruining your life? Lots of perfectly healthy people people who had a bad outcome have committed suicide due to the unbearable pain and suffering.
If this was a life-saving procedure with a 50/50 chance of working with no alternatives, then that's different. But an elective procedure where a perfectly healthy person sees an advertisement one day, and has their life ruined the next is not something that should be acceptable.
I think the issue highlighted by this article is that the risks have not been accurately communicated. It's not really been advertised as HAVING side effects, and the doctors most willing to fight for your money are probably the least likely to tell you about them.
If commercials for LASIK were like drug commercials ("... side effects include vomiting, migraines, and death..."), we'd likely have a more informed populace.
That might be a fair argument but I got lasik about 20 years ago (it was the best money I ever spent). And when I went through my assessment more than one doctor and at least one office person went through the risks with me and I was given all the paperwork explaining the risks - that I read. So IF all Lasik facilities do that, explain the inherent risks and give them to you in written form, then people are doing this with informed consent. It isn't like you see a commercial and then go get your eyes zapped no questions asked...there is a pretty through assessment and discussion of the risks involved and what to expect afterwards.
It's entirely acceptable on a society level if the numbers are low enough. If 1 in a billion die from a vaccine, do you approve it? There's probably at least one person who died in an accident from an airbag that otherwise wouldn't have without an airbag. Do we remove airbags despite them being statistically safer? This kind of "Zero Allowable Risk" attitude is quite frankly technophobic.
None of those examples you gave work here. The numbers that die from vaccines are much lower than the numbers that die without them, and it's a problem where a decision must be made. And nobody chooses or is convinced to be in a car accident. Shit just happens.
The people who get LASIK chose to do it either because they saw an advertisement or someone convinced them to do it. Nobody's life is saved by LASIK, and people can live a perfectly good life without it. They can wear glasses or contact lenses, or wait until someone comes up with a safe alternative to LASIK.
Read through some of the stories [1] from people who have had complications so you see that this isn't a minor statistic that can be easily ignored. Peoples lives are actually being ruined.
Thanks for pulling out the data! One problem is that "somewhat", "very", "completely" don't give a good picture of how dissatisfied these 2.7% of patients are. It's possible some of them developed serious dry eye which can be totally debilitating.
This doesn't mean the procedure shouldn't have been approved, it most likely means that folks need to do better patient education and qualification. Not everyone needs to be a good candidate.
It's also possible that these results vary a lot between LASIK docs. I'd expect that some qualify patients more thoroughly than others. Risk for developing side effects can be assessed beforehand, to some extent.
I would say losing your eyesight and/or feeling the pain of snowblind for months on end are hazards we should be averse to. You have no idea how important your vision is until you start to lose it, and snowblindness in particular feels like rubbing sandpaper on the back of your eyes with no way to stop it. I can see why someone who experiences either of those symptoms from an elective surgery that they were told is "safe and effective" would want to kill themselves.
I don't think society is becoming more risk averse. We still do a ton of drugs, drink, drive, fly, fight and commit crimes.
As we learn the dangers of things people start the arduous process of protesting them. See bpa, Teflon. Both got phased out after years and years of denials and lawsuits. Bpa and Teflon may have been mostly phased out, but they have been replaced by unknowns, which are reasonably expected to be about as bad as their predecessors.
Rather, I think the stakes for equivalently sized day to day risks are getting bigger because lives are getting more complicated, and bad bets can snowball a lot easier now.
Want to see risk? Take a good long hard look at the speculative and corporatedebt markets. hardly a risk adverse market.
Teflon (PTFE) and BPA are nowhere close to being phased out. Every single metal can in America is lined with BPA, and there is pretty much nothing that used to use PTFE that has stopped using it.
This is like buying a car that has a .9% chance of conking out on the side of the road, a .9% chance of colliding with another vehicle with no injuries, and a .9% chance of blowing up when you turn the key.
Or, you could stick with your reliable car that has some scratches and dents and needs a quart of oil when you fill up.
"Results A total of 262 participants were enrolled in the PROWL-1 study (mean [SD] age, 29.1 [6.1] years), and a total of 312 participants were enrolled in the PROWL-2 study (mean [SD] age, 31.5 [7.3] years). Visual symptoms and dissatisfaction with vision were common preoperatively. Overall, the prevalence of visual symptoms and dry eye symptoms decreased, although a substantial percentage of participants reported new visual symptoms after surgery (43% [95% CI, 31%-55%] from the PROWL-1 study and 46% [95% CI, 33%-58%] from the PROWL-2 study at 3 months). The percentages of participants in the PROWL-1 study with normal Ocular Surface Disease Index scores were 55% (95% CI, 48%-61%) at baseline, 66% (95% CI, 59%-72%) at 3 months, and 73% (95% CI, 67%-79%) at 6 months. The percentages of participants in the PROWL-2 study with normal Ocular Surface Disease Index scores were 44% (95% CI, 38%-50%) at baseline and 65% (95% CI, 59%-71%) at 3 months. Of those participants who had normal scores at baseline in both the PROWL-1 and -2 studies, about 28% (95% CI, 19%-37%) had mild, moderate, or severe dry eye symptoms at 3 months. While most participants were satisfied, the rates of dissatisfaction with vision ranged from 1% (95% CI, 0%-4%) to 4% (95% CI, 2%-7%), and the rates of dissatisfaction with surgery ranged from 1% (95% CI, 0%-4%) to 2% (95% CI, 1%-5%)."
I would really like someone to explaine these figures to me:
The data says a lot of people have mild/moderate visual visual artifacts (halos, starbursts, etc.) and dry eye prior to getting lasik. Lasik appears to make some of those symptoms disappear in many people, but also causes symptoms to appear in a smaller number of people.
E.g. for dry eye, from PROWL-1 [2], table 2: before: 45% any severity, 6% severe; after 6 months: 27% any severity, 3% severe; and those changes included 19.5% of those without symptoms developing new symptoms and 65% of those with prior symptoms seeing those resolve.
But it's really hard to interpret the data because a surprisingly large fraction of people report changes (both no symptoms to symptoms and vice versa) over some period of time without having lasik at all! ("14% (95% CI, 3%-35%) to 29% (95% CI, 13%-49%) of participants answered that they either did or did not have a symptom on the test and vice versa on the retest")
The results do not suggest failure, there are many other explanations for such results. The patient may have expected better vision than they have (eg 20/20 but wanted 20/15), or their prescription wasn't stable so vision deteriorated slightly after 6 months.
The study had 8 people where the surgery caused "very" or "extremely" bothersome visual problems, and 4 people reporting difficulty performing activities due to these; I guess those are included in the 6 dissatisfied people.
After LASIK my wife complained for months about seeing a halo around street lights at night time, until I convinced her, that with my then nearly perfect vision I also see them depending on how tired I am.
Before that she believed they were caused by the surgery, so might have responded "slightly dissatisfied" on the survey.
She probably never saw the halos before it, because her vision would simply blur them out together with everything else. Or simply never paid attention.
Is there any info on where they got the procedure? From what I understand, LASIK is quite reasonably safe, as long as you don't goto a place advertising "SUPER SUPER CHEAP LASIK ONE EYE FREE" etc. You get what you pay for.
I wouldn't be surprised at all if actually those are from cheap doctors.
You've got two replies reasonably arguing with the basis of your post, but it's important to keep in mind something more fundamental, even if we take your overall argument as given to start with:
>I wouldn't be surprised at all if actually those are from cheap doctors.
Even if this was completely true, the ease or difficulty of a medical treatment is a fundamental part of that treatment. If a treatment is simply incredibly hard for humans to perform effectively and carries risk of significant irreversible damage, that is a very different treatment in practice than one that is trivial and/or with minimal/temporary downsides even if it goes wrong. It's like with medicines themselves, where there is the concept of a "therapeutic index", the ratio between the minimum effective dose and a lethal dose. Some medicines have wide indexes, up to the point where it's essentially impossible to overdose (raw matter effects would hit first). These are fine to just have offered OTC for self-medication. Others, including very valuable ones, can have extremely narrow windows and thus require specialist prescription and ongoing monitoring/adjustment, up to and including only for use in a hospital.
Allowing "cheap" (inexperienced? unskilled? incorrect training?) practitioners to perform LASIK was itself a medical choice. Current training/licensing regimes are an inextricable part of the LASIK procedure, and if in practice there have been significant adverse results that should still be reviewed. It wouldn't have to mean banning the procedure entirely, but if it's a lot more dangerous than originally assessed the how|who|where of its performance might need refinement. "Caveat emptor lol" isn't how a good medical system is run.
Speculating like this is useless and generally counterproductive. It’s just a way of stating your internal biases, it’s best to recognize that bias and consider how that impacts your perception.
For example, you could say, “I’d like to think these failures are a result of lack of skill or experience on the part or the doctor, careless errors, or perhaps poorly maintained tools/equipment, and not a fundamental issue with the procedure itself which could effect even skilled and diligent practitioners. I wonder if the study accounted for the experience level of the practitioner?”
It's not so much the cost, as the amount of experience a given doctor has. You may be surprised to find that some of the cheaper options are safer because of the increased experience. Skill is an entirely different factor to consider, again not associated with pricing.
Given how much sugar the many people take in, it can really effect one's eyesight as metabolic syndrome and type 2 diabetes escalates. Overweight people and diabetics without strict controls should generally not consider something like LASIK.
Disclaimer, I'm a fat guy and t2d, this is practical not meant to be offensive.
I had laser eye surgery, but I went with PRK. Less invasive, more durable, far less wasteful of cornea, and its end results are just as good as LASIK's. The only downside is it's a little less convenient because each eye takes a few weeks to heal, so people usually do one eye at a time.
The LASIK procedure is just utterly insane in comparison, especially given its extremely limited advantages.
The argument years ago that convinced me NOT to have this procedure done was that they'd have to remove fully half my cornea. I'm assuming there are ways to recover from that with a corneal transplant, but that's a big risk and a lot of resources consumed just for the sake of not wanting to wear glasses.
Flash forward fifteen years and I'm diagnosed with early onset cataracts. Turns out they can pick a lens implant that corrects out the distortion caused by the shape of the eyeball. That was the procedure that got me to where I didn't need glasses, even though that wasn't remotely close to the primary motivation.
I also had dry eyes after PRK, for about 6 months. Been back to normal for a long time though and I consider the minor discomfort for 6 months well worth it.
I occasionally have mild dry eyes after my PRK a couple years ago (very infrequent discomfort in the morning when I wake up), but over all, I’m happy with the results.
The staff and doctor all tried mightily to get me to do LASIK, and after I refused multiple times, every staff member confessed that they either did or would have made the same choice.
Do you not have the choice? (I was under the impression that PRK couldn't correct very large prescriptions, but maybe it is larger than contacts? They claim it is very reversible, but the studies I read made it seem like maybe your eyes start to have permanent changes due to different growth rates, so are you saying you wish you had never done it? Or are you just saying "if I were you", but using phrasing that I am misparsing?)
LASIK seems to work well for many people. My sister had it years ago, and I have several friends who've had it too. None of them, to my knowledge, have any regrets whatsoever.
For the people it works for, LASIK is great. For those who experience complications (the corneal flap needed for LASIK never heals entirely, therefore it can become displaced, causing much discomfort and possible permanent damage under the right circumstances), it can be long road of chronic issues because they wanted to save some recovery time over PRK. My recommendation (having had PRK done a decade ago) is to prefer PRK over LASIK, and take the recovery time needed. You're going to have your eyes for a lifetime. Take shortcuts elsewhere.
Surgeons should be required to offer PRK over LASIK and explain the many advantages in terms of less risk of complications and lower cost. I had to get PRK because I have thin corneas, but I'm not sure it would have even been raised as an option for me had that not been the case.
100 percent. My biggest beef with LASIK was it was rapidly commercialized and commodified by surgeons who were maximizing for volume, not patient outcomes. I won't disagree it's helped improve quality of life for a lot of people, but at the cost of folks who saw a significant decrease in quality of life because they weren't steered towards better options (surgical or otherwise). Misaligned incentives.
It does, but, for most people i know (including myself), they consider them totally worth it. I got halos after the surgery (went away within a few months, thankfully) and somewhat dry eyes (still got it after 2 years), but having dry eyes and needing to use eye drops a few times a day instead of dealing with glasses/contacts is definitely a trade off i am very happy with. And the doctor told me about the possibility of that before i decided to go for LASIK, so I wasn’t even that surprised at all.
If you knew that there were alternatives two years ago (like SMILE and ortho-k) that you are no longer a candidate for due to LASIK and that possibly additional therapies in the future are ruled out, how would that impact your satisfaction? I see a lot of comments comparing LASIK vs. glasses for eternity and not so many including other alternatives.
I was totally aware of both back then, and I knew I won't be a candidate for newer stuff afterwards, and I am absolutely fine with it.
The way I see it, my vision was really bad before LASIK. It got perfect with LASIK. Yes, it might degrade a bit with time, but definitely not even close to the level it was before. So either way, I am ending up in a better spot that I started from.
Also, additional therapies aren't completely ruled out. The clinic I got it at provides lifetime corrections for free, if I end up needing it in the future.
I've used Ortho-k for 16 years, and I've absolutely loved them. I still confuse the heck out of people when I show or tell them I wear rigid contact lenses while sleeping. I've used glasses and dailies, and I without a doubt prefer Ortho-k. I do find it really weird that insurance doesn't cover it though - probably explains why they haven't become too widespread.
I started wearing them when I was 7, so at this point in time they don't bother me at all. I'm pretty sure they bothered me quite a bit back when I started wearing them, but I would still say my tolerance is quite high.
My older bother started them at the same time as me, and he couldn't handle it, so he swapped back to glasses after a few years.
As an anecdote, it didn't work for me, unfortunately. Tried for 9 months, 3 different sets of lenses.
Apparently I don't have enough corneal tissue, which resulted in poor and increasingly bad vision starting every day around 3pm (~9 hours after removing lenses). My pupils also dilate surprisingly large, with no lenses being able to pull tissue over the entire dilated pupil, resulting in super nasty halos around light sources. The halos alone were bad enough that I wouldn't have been able to safely drive at night.
I am glad, though, that the attempt was completely, 100% side-effect free (except for my wallet). After a day or two, my vision returned to its terrible origin, with no halos or discomfort or anything.
This is a bit disturbing of a headline to see, literally a couple hours before I'm scheduled for a Lasik procedure.
But after reading the article, I don't know how much weight there is to this. Seems to be a small sample and that report is heavily highlighting a couple negative items out of a largely happy pool of patients.
Was there any connection to the doctor or clinic? Did some clinics or equipment have a higher rate of complications? I'm getting mine performed at a well reviewed practice in San Jose.
This article isn't enough for me to cancel the procedure, but it was enough of a scare to put me on the edge for a second. Sensationalism? Maybe not quite, but it'd be great if these reports would work to remove their bias.
LASIK in the 90s versus LASIK in 2019 is almost an entirely different procedure. Modern LASIK procedures involve mapping the eye on a microscopic level, evaluating vision acuity at hundreds of points on the eye surface, and then allowing an automated laser to perform the procedure. This is known as a wavefront-guided LASIK procedure and produces outstanding results.
LASIK in the 90s involved physically cutting the surface of the eye with a keratome (blade) and relied on the precision of the surgeon's hand.
And yet they still make a big deal of how you can come in for a "tune up" or whatever. If it's so accurate, how did I end up an entire diopter off target?
Here are some relevant quotes from the FDA study for you.
In each of the PROWL studies, less than 1 percent of patients experienced difficulty performing their usual activities following LASIK surgery due to any one symptom.
...
* Up to 46 percent of participants, who had no visual symptoms before surgery, reported at least one visual symptom at three months after surgery.
* Participants who developed new visual symptoms after surgery, most often developed halos. Up to 40 percent of participants with no halos before LASIK had halos three months following surgery.
* Up to 28 percent of participants with no symptoms of dry eyes before LASIK, reported dry eye symptoms at three months after their surgery. This is consistent with previous studies.
* Less than 1 percent of study participants experienced "a lot of difficulty" with or inability to do usual activities without corrective lenses because of any one visual symptom (starbursts, ghosting, halos, glare) after LASIK surgery.
* More than 95% of participants were satisfied with their vision following LASIK surgery.
Participants were more than twice as likely to report their visual symptoms on a questionnaire than to tell them to their health care provider
These risks are not bullshit. On high contrast images I see not just 'halos' but more like blobs. Things it ruins: stars - looking at the night sky is ruined forever; good quality cinema - white letters on a black background are toast. Etc etc. I regret the almighty shit out of Lasik, but most people don't.
The procedure itself was as comfortable as they could make it, you know, for cutting a flap in your eye and blasting part of it away.
This morning I went in for followup and have 20/15 vision. A mild amount of blood under one flap which will dissipate within a week.
So far, only mild discomfort after the initial healing yesterday, which was pretty irritating. Now, it just feels like there's an eyelash that won't go away. I have to keep reminding myself that I can't adjust my contact lenses any more.
There is some staring I noticed looking at the clock display in a dark room, but nothing worse than the old pair of glasses I was wearing in the interim. But that's supposed to almost completely fade over 6 months.
I know that, "time will tell", but thus far, I'm very optimistic. I'd definitely recommend this doctor to anyone.
A few years back I was getting a little eye surgery done, under local, a quasi-regular thing with me. Because I like hearing about people's jobs, I asked my surgeon what he thought of LASIK. He has a very dry presentation. He paused and then began, "You'll notice I'm wearing glasses ..."
Dry eyes and halos, many I speak to say they have these issues. Followed by “I don’t regret it, best thing ever”. I walk away mostly confused.
Watching my sister, who had it done ~10 years ago, struggle to stay between the lines on the freeway at night due to halos I wrote it off completely. Even with these issues she’s perfectly happy with the results. Again, I don’t get it.
I have halos, very occasional dry eyes. Was worth it.
I was myopic (20/350) that got corrected to 20/15. Things I can do now:
* Being able to lay in bed and look around the room and see things in focus.
* Being able to lay in bed and look at my significant other and it not be a out-of-focus blurry mess.
* Being able to get up in the middle of the night to go to the bathroom without hunting for glasses.
* Being able to go swimming without goggles.
* Avoiding the discomfort of contact lens wear and cleaning.
* Being able to do read while laying on the couch without bending my frames.
* Avoiding possibility of eye infection due to dirty contact lenses.
* Avoiding the need to clean and wash glasses due to dirt.
* Avoiding the painful removal of contact lenses after falling asleep with them in due to tiredness.
Most of this reads like quibbles to me. The thought of possibly having permanent eye damage, no matter how “insignificant”, in exchange for minor convenience/vanity and only myself to blame is a bit too much.
In my sisters case, she now has prescription night driving glasses and prefers not to drive at night with my niece. I’m not sure why but “was worth it” is what she’d say and similar reasons to yours are what she’d give.
Am I one of the lucky ones? I see quite a few negative comments about dry eyes, halos, etc., but for me that really only lasted about a week or two. It healed so quickly that I actually don't even remember now how long it took, exactly. With that said, I made sure to go to a surgeon with a lot of experience, using the latest proven tech. I spent $4500 on it and I feel it was worth every penny.
My wife is an ophthalmologist and would never get LASIK. The benefit of potentially not having to put contacts in every morning just does not outweigh the possible complications.
Yes, this is why I was never willing to get the procedure done. The risk/reward ratio is too unfavorable. Even if the percentage of people who have problems is very low, those problems are permanent. To take the risk of permanent injury just to avoid the inconvenience of wearing glasses never made sense to me.
I can't read the full article, so this might be incorrect. The summary seems to indicate that they're only considering vision loss, but most of the reports that I've heard of about lasik problems aren't vision loss as such, but the introduction of artifacts.
Isn't the cumulative risk of complications from contacts similar to the risks of LASIK? Contacts increase the rate of eye infections and corneal ulcers. In some cases these issues lead to permanent damage, even blindness.
Sounds like she s overly cautious. I hated all kinds of glasses and contacts, and even some dryness sometimes and some glare at night is incomparably better than having to rely on those. Then again, i m lucky that i only had to do it in one eye, so i can compare vision with the intact one. Still, would recommend 100%.
When I was being fitted for contact lenses for the first time a few years ago, I asked my ophthalmologist about implants and he basically acted like I was insane for wanting that procedure versus laser.
After experiencing truly dry eyes for the first time - from contact lenses - I will probably never get laser correction. Even a 1% chance of having permanent dry eyes at that level of discomfort sounds horrific.
Also, the slight chance of losing near vision in exchange for far vision is not worth it imo. I'd like to put off needing glasses to read in bed for a few more decades.
I didn't know it was this bad, but I decided not to get LASIK for a different reason. It'd fix my near-sightedness, but also normalize my superior close-up vision. I can easily read ultra-fine print that most people need a magnifying glass for, and LASIK would destroy that. Absolutely not worth the small benefit of getting rid of my glasses.
Ha! I thought I was the only one that loved being able to see any swimmers in my water bottle. I guess that's more of a drawback, but being able to have magnifying vision is pretty awesome. I use contacts sparingly when working, and glasses the rest of the time, and the maintenance thereof is not really a big deal.
I'm very nearsighted. But as I've aged, my "best distance" has increased from ~20 cm to ~40 cm. So now it's perfect for computer work. And I only need glasses for driving, movies, etc.
Yeah, totally! It's great for working on small objects, tiny screws, and so forth. It's honestly like an everyday superpower.
I take my glasses off to read up close; I can't make out faces across a room without them, but at close range they actually make things blurrier. Contacts kill it, too, which is why I didn't use them for long. I've been thinking of getting a pair just for using in VR, since my glasses don't fit well, but I dunno.
I didn't even realize people with normal eyes couldn't see as closely as I could. Is it really true that normal eyes have a near point of almost 10 inches?
My husband is an Optometrist, and it did not do LASIK for his own eyes. Actually, I do not think I know one Optometrist in our circle of friends who did LASIK. They pretty much all wear either contact or glasses.
It does not seem like we should ban LASIK, but LASIK is not for everyone. And here in US, LASIK is a lucrative business. I would not be surprised that some LASIK have been done on people who were not good candidate at the first place. And now those people are disappointed, after spending several thousand dollars.
Interesting side note about LASIK, it’s caused problems for the navy: it’s getting harder and harder to fill submarine crews. It used to be that for top-qualified recruits, the ones with perfect vision became pilots and the rest got stuffed into subs. Then the military started providing LASIK, and suddenly no one’s dq’ed from flying because of their vision. The submarine force is a tough sell to begin with, but when the alternative is Top Gun forget about it.
Not sure where you heard that. Submarine duty is considered prestigious in the US Navy and most people who serve aboard a submarine wouldn't be rated for (or even interested in) pilot duty.
I was going to say the same thing, submarine duty is highly competitive. Every sailor I knew who wanted to get it had to work very hard and was very excited when they did.
I am a happy lasik success story. The procedure changed my life and allowed me to start diving again, it is the best money I have ever spent.
I think it is unfair to blame suicides on the procedure, as they warn you about the risks beforehand and are clear that you may have some halos/blurriness for a few months.
Blame the suicide on mental illness, because that is where the problem actually lies. Anything else seems like an emotional play to get money from a lawsuit.
There has been nothing I’ve spent money on that has been as useful and valuable to me as getting lasik 15 years ago. If I had known ho much it would change my life I would pay 10 times as much.
I was considering LASIK but why risk it? Glasses aren't so bad and I could always get contacts if I really wanted. Even without my glasses I can see okay, not great but okay.
If I'm in an environment where I'm likely to break my glasses, I want to be wearing some kind of protective eyewear - a scratched eyeglass lens is a lot easier to replace than a scratched cornea. Wraparound safety glasses are comfortable, extremely durable and can do double duty as sunglasses.
Oh, well, my vision is not that bad. I suppose if I could barely see when getting out of bed in the morning then perhaps I would consider it more seriously. I only had to get them because I failed a drivers vision test but just barely.
Most people I know who have had it are happy. But I'll never do it. I have a fantastic microscope available just by taking off my glasses and I don't want to lose that.
A long time ago it was promised that the FDA would eventually approve intraocular lens replacement for vision correction as well. What ever happened to that?
It does exist but it's a much more invasive procedure, and I think it's used only for much higher prescriptions (+/-10d and above) - not sure it's approved by the FDA though.
I think whether or not LASIK is suitable depends on corneal thickness, corneal steepness, and the level of correction needed, just as a baseline, or so it was explained to me. I was investigating intraocular lenses not too long ago as an alternative because my ophthalmologist advised that I'd probably have difficulty seeing in low-light conditions if I underwent LASIK.
(Apparently my "parameters" are such that I'm in a gray area where some surgeons will perform LASIK, but others won't. My prescription is pretty high in one eye (around -8). I ended up not being a great candidate for any corrective eye surgery, intraocular lenses included.)
Anyway, intraocular lenses are definitely more invasive, but from what I recall they sounded like a better option to me than LASIK in general: apparently vision quality is better than LASIK with IOLs, there's no removal of corneal tissue, and chance for complications was lessened. (Well, as I understood it, there were fewer minor complications, but more possible major complications, which is maybe not a trade-off many people want to make.)
Of course, they cost about 2x as much as LASIK.
I'm pretty sure they are FDA approved, especially given their use in cataract surgery, although the ones in cataract surgery replace the natural lens whereas the corrective type typically do not...
Well I think that's where I was going with this. Cataract patients get their lenses replaced regularly and the surgery appears to be a much lower risk than before. A relative of mine, during his cataract surgery, even had the option to get a corrective factor put into the new lens.
It is also used for areas that require a certain color correction as well, usually aircraft or combat roles and is covered under tricare for combat and pilots.
I'm kind of glad that I wasn't a candidate for LASIK when I was most seriously considering it (pupils were too big). I know several people who've had it and been delighted, but I also keep reading these horror stories about it making a bad situation worse. At my current age (54) the benefits are likely to be temporary at best, so it's just not worth the risk. Eyesight is not something to gamble with.
Same here. Been wearing contacts for 25 years and they work fine. I've had several occasions where something has hit my eye, and the contacts have protected it from probable severe scratching.
> At my current age (54) the benefits are likely to be temporary at best, so it's just not worth the risk. Eyesight is not something to gamble with.
Also, if you're that old, it might mean an instant need for reading glasses (if you don't already have them).
Being nearsighed is like permanently wearing a pair of reading glasses. Given how much of my day is taken up reading vs. using distance vision, part of me regrets getting my eyes corrected to 20:20.
Indeed that is the case. I've already been wearing progressives (+2.0 add) for several years. I think presbyopia is something a lot of folks don't consider when they opt for LASIK. It might make your vision better for one decade, but then worse for two or more. Maybe people just can't internalize that age will catch up with them too. Maybe they just hope that medical science will come up with something new by then, so they can have the best of both worlds. Didn't work out that way for me, though I do think we've passed Peak Eyeglass and glasses will seem as outdated as buggywhips some day.
This is only a mildly disturbing headline to see, literally a couple hours before my Lasik procedure...
But from what I see in the article, the negative experiences are few and far between, not to mention, they don't seem to take into account variation between different clinics. Is there a connection in quality to the doctor or their practice? Is there some problem with a piece of equipment?
I ran into a lot of the complications this article mentions (halos, dry eyes, and for a few weeks afterwords a blurriness from cells dying called something like "superficial protein keratitis"). All of them were temporary though and cleared up after a few weeks/months. (Well, except the halos, but they're not that severe and I already had bad night vision and halos before this, it just made them a little more pronounced) I do think it's a procedure you should really think carefully about before you do it, but I wouldn't want the FDA to ban it or something. Overall I'm currently happy with it.
My suggestion would be, if you're thinking of doing it, make sure the eye doctor who checks out your candidacy is one you trust and hopefully have been with for a while. When it comes down to it, the procedure itself is pretty safe and automated so the part to optimize is screening people before the procedure happens.
I had it in one eye, and after a some eye-1 vs eye-2 comparisons, I never had the second one done.
Now many years afterwards, the only thing I see clearly is that I should never have gotten the surgery.
Both eyes continued to have changes in prescription, and I now wear contacts in both eyes.
By the numbers, it would seem like I have pretty good vision. Corrected I have 20/20 in my non-surgery eye and 20/25 in the eye that had the surgery.
HOWEVER - the non-surgery eye focuses quickly and accurately, even in low light and at night. The surgery eye can read the eyechart as well, but it takes longer, I have to blink and wait and maybe... eventually... I can read the 20/25 line. At night, I get visual artifacts.
I recommend good contacts instead. Your vision will change and you can just get different contacts.
Additionally, contact lenses have advanced. They can now correct almost any level of vision including astigmatism and can be thrown away monthly or even more frequently.
Lately my FB feed has been full of Lasik ads, and hilariously, the headline on their banner image was "You will not go blind after LASIK". Perhaps I should feel relieved that FB doesn't yet know that the only non-essential surgery I'd be willing to have would be to re-align my teeth.
> She didn’t need glasses when she got the procedure, so it frustrates her that now she does.
Why did she get LASIK? When I got it, it was made extremely clear that it wouldn't help with reading glasses-level problems and may in fact cause me to need them.
I think it also depends on the person (their vision/health/etc.) as well as the surgeon's experience plus the equipment. The hours/days following the procedure are also pretty critical. You have to be very careful to not rub your eyes or anything like that and get plenty of rest while using the eye drops as prescribed.
If you don't like those risks then don't undergo it but for other people will find the risks acceptable and want to have it done. Being approved doesn't mean it is forced on anyone.
Is the point of a regulatory agency to decide for hundreds of millions of people what their acceptable level of risk? What if thousands of people die from not having access to medications that a regulatory agency deems too risky?
I asked for LASIK but was turned down by the eye doctor / surgeon because my vision is -9.5 and he felt it was too high of a risk.
My optometrist also said to stay away - my eyes are very healthy, so why tamper with them?
I wear glasses every day as I can't seem to read and focus properly using contact lenses (tried about 5-6 times the last 15 years) and the quality is great. I use those high index glasses that are so thin you'd think they are -3.
I still think about some kind of surgery though - maybe ICL ?
It's worth investigating whether you're a candidate for PRK or the more recent SMILE procedure. LASIK is not applicable to high prescriptions, owing to how much cornea loss would be required to correct them.
I did some research now and SMILE doesn't seem to be too widespread yet, but LASIK, PRK and ICL are widely available. For my case it seems like ICL is the best option. It's also reversible (not that I'd easily want to reverse and have a knife shoved into my eye again).
Scientific test here: I had only one eye LASIKed and the quality of vision is far below that of the other without LASIK with contact lens (both were approximately -6).
ANYONE who gets both eyes done at once has no baseline to compare against.
I can compare.
The great advantage to engineers/craftspersons of not getting LASIK if you are short sighted, is that you can take out your contact lenses for close/fine work.
The eye with LASIK is useful for swimming, travelling, and convenience of not using contacts (which sometimes irritate).
I met a man whose life as a programmer ended after a failed Lasik in the early 2000s - it was quite traumatic and he had serious financial problems afterwards
Lasik is a great example of the kind of positive-sum risks I would take if suicide were legal and easy. As it is, I risk being legally required to endure fifty years of blindness, so I won't try it.
While we're exchanging anecdotes here: what I gathered from people's responses on the web is, operation outcome differs considerably depending on the clinic and who knows what else. Three are also apparently a dozen, if not more, variations on the few major procedures.
However, I also notice that better results are reported for later surgeries, over e.g. five years.
One data point. I had Lasik done about 15 years ago. No problem so far except for the occasional dryness after waking up in the morning. After all the years, still have 20/20 on one eye and the other deteriorated to 20/30. I would consider a success.
I had mine in 2002 but it wore off In 2012 so back to glasses. Corneas too thin to do enhancement, eyeballs odd shaped so I can’t do contacts. Not much more I can do.
