
Ex-FDA Advisor Says of Lasik Eye Surgery: ‘It Should Have Never Been Approved’ - bookofjoe
https://pittsburgh.cbslocal.com/2019/06/17/lasik-eye-surgery-complications-fda-approval/
======
gdebel
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.

~~~
specialist
Thanks for weighing in.

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.

[https://en.wikipedia.org/wiki/Photorefractive_keratectomy#LA...](https://en.wikipedia.org/wiki/Photorefractive_keratectomy#LASEK)

Again, I know exactly nothing about this stuff. I am not saying to have LASIK
or not. Progress marches on and I'm certain techniques have improved.

But I do think this is a good universal heuristic. So am encouraging patients
to ask their care provider if they'd get it done themselves.

~~~
gdebel
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)

------
siffland
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.

No regrets, except I should of done it years ago.

~~~
yonaguska
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.

~~~
marblar
How do I know if I've got the good stuff?

~~~
tmm
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.

~~~
zwily
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.

------
cullenking
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!

~~~
rococode
> Definitely don't cheap out!

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.

~~~
lawnchair_larry
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.

~~~
cullenking
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.

~~~
adamhooper
Also in PDX - where did you end up going out of curiosity? Casey?

~~~
cullenking
Yup!

------
vladgur
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

[1] [https://www.fda.gov/medical-devices/lasik/lasik-quality-
life...](https://www.fda.gov/medical-devices/lasik/lasik-quality-life-
collaboration-project#results)

~~~
alistairSH
__Up to 46 percent of participants, who had no visual symptoms before surgery*

Why would you undergo elective surgery if you had zero symptoms?

~~~
dragonwriter
Poor visual acuity is a significant, life-affecting symptom, and neither
glasses nor contacts are full-time, all-conditions-suitable corrective
measures.

~~~
alistairSH
The quoted statistic literally says "no symptoms". Like you, I assume "can't
see well" is itself a symptom.

------
daeken
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.

~~~
exhilaration
Some data here [1]:

 _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.”_

[1] [https://www.nytimes.com/2018/06/11/well/lasik-
complications-...](https://www.nytimes.com/2018/06/11/well/lasik-
complications-vision.html)

[2]
[https://jamanetwork.com/journals/jamaophthalmology/fullartic...](https://jamanetwork.com/journals/jamaophthalmology/fullarticle/2587831)

~~~
foobiekr
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.

~~~
maxkwallace
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).

~~~
arcticfox
> For anyone reading this who manages their dry eye with eye drops, please do
> some reading or see a specialist

Good advice to check, of course, but my friend that has chronic dry eye from
Lasik was basically told it's a lifetime of drops for her now.

~~~
maxkwallace
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.

~~~
foobiekr
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.

~~~
gdebel
Ciclosporin 2% eyedrops and/or punctum plugs may be useful. I home she'll get
better eventually.

~~~
foobiekr
she went way past both of those. it was not a fun time getting things
compounded.

------
onfire
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!

~~~
blueadept111
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.

~~~
pathartl
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

~~~
stjohnswarts
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)

------
vilhelm_s
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:

    
    
        Completely satisfied         69.9%  (151/216)
        Very satisfied               22.7%   (49/216)
        Somewhat satisfied            4.2%    (9/216)
        Somewhat dissatisfied         0.9%    (2/216)
        Very dissatisfied             0.9%    (2/216)
        Completely dissatisfied       0.9%    (2/216)
    

(this is from eTable 4 in the supplement here:
[https://jamanetwork.com/journals/jamaophthalmology/fullartic...](https://jamanetwork.com/journals/jamaophthalmology/fullarticle/2587831)).

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.

~~~
bogwog
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.

~~~
zionic
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.

~~~
madamelic
Not only is it a measurement of how many lives will be improved, it was a
stopgap on non-regulated procedures.

So the choice was either rubberstamp it so there was oversight or don't and
potentially have even worse cases.

------
CharlesColeman
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.

[https://en.wikipedia.org/wiki/Photorefractive_keratectomy](https://en.wikipedia.org/wiki/Photorefractive_keratectomy)

~~~
d23
I did PRK and have had chronic dry eyes ever since. I can't recommend it. I
would go back to contacts if I had the choice.

~~~
jniedrauer
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.

~~~
peatmoss
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.

------
melling
Orthokeratology contact lenses to reshape the eyes while you sleep are the new
thing for teenagers.

[https://www.npr.org/sections/health-
shots/2015/05/21/4065023...](https://www.npr.org/sections/health-
shots/2015/05/21/406502395/overnight-contacts-can-help-kids-sight-during-day-
but-also-carry-risks)

~~~
davidzech
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.

~~~
Loughla
How do those feel in your eye, though, while you're trying to sleep?

Also, how would you rate your personal pain and discomfort tolerance?

~~~
davidzech
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.

------
schnide05095
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.

~~~
deminature
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.

~~~
RantyDave
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?

------
at_a_remove
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 ..."

I filed that one away.

------
nominated1
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.

~~~
krapht
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.

etc, etc etc

~~~
nominated1
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.

------
RedDeckWins
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.

~~~
JohnFen
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.

~~~
stanski
I can see it making sense if you're nearly blind without your glasses. I'd
feel very vulnerable if I'm so reliant on glasses.

If it's just a slight convenience then yeah... keep that stuff away from me.

~~~
JohnFen
True, I can imagine circumstances where it would be preferable. I was just
commenting about my own situation.

(BTW, I am nearly blind without my glasses, but that's never really bothered
me. I just wear the glasses.)

------
PhasmaFelis
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.

~~~
artificialLimbs
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.

~~~
mirimir
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.

I can still read fine print etc, however.

------
llsf
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.

------
smogcutter
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.

~~~
gamblor956
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.

~~~
Wohlf
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.

~~~
ArlenBales
Just curious, why do sailors want submarine duty? I would have thought, for
sailors especially, the weeks without sunlight would be very intimidating.

------
diveanon
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.

------
consultutah
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.

------
Vysero
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.

~~~
dforrestwilson
If you like to be outdoors, camping etc or in situations where glasses could
be broken it is a no-brainer.

Also if you do the math it can potentially save you money on contacts and the
ever-obnoxious eye checkups.

9 years since I had it done and it is amazing. No regrets so far.

I get out of bed every day and I can just see. No searching for glasses or
going to the bathroom to put contacts in.

~~~
jdietrich
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.

[https://www.rx-safety.com/product-category/master-safety-
gla...](https://www.rx-safety.com/product-category/master-safety-
glasses/prescription-safety-glasses/wraparound-safety-glasses/)

------
dreamcompiler
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.

------
joezydeco
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?

~~~
raverbashing
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.

~~~
ReidZB
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...

~~~
joezydeco
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.

------
notacoward
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.

~~~
CharlesColeman
> 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.

~~~
notacoward
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.

------
schnide05095
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?

~~~
Gigablah
How did your procedure go?

------
overgard
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.

------
m463
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.

------
rchaud
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.

------
the_watcher
> 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.

------
wcarron
My fiance just underwent LASIK about 6 months ago. She has had zero
complications.

It's a very successful procedure, for the vast majority of people who undergo
it. I fail to see why "it should never have been approved".

~~~
brokensegue
i mean if it blinded 1% of people and worked perfectly for 99% of people I
would not want it approved

~~~
dation
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.

~~~
SketchySeaBeast
What's the point of any regulatory agency at all then? Just to correctly
elucidate those odds?

~~~
dation
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?

~~~
brokensegue
yeah that's what regulatory agencies are for. is this the first you've heard
of them?

------
tracker1
> She didn’t need glasses when she got the procedure, so it frustrates her
> that now she does. She blames LASIK for making her eyes worse.

WTF would you get eye surgery if you don't need glasses to begin with!?

------
sgt
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 ?

~~~
deminature
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.

~~~
sgt
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).

------
robocat
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).

------
mistrial9
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

~~~
1000units
They did both eyes at the same time?

~~~
CharlesColeman
I think that's actually pretty common with Lasik, since the "recovery" time to
clear vision is so short.

Other kinds of surgeries have longer recovery times, so they're kinda forced
to do them one eye at at time.

~~~
1000units
Wow, that's a recipe for nightmares. I'm just now remembering a recent story
of a woman killing herself after a failed Lasik operation.

~~~
Noumenon72
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.

------
aasasd
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.

------
ww520
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.

------
techslave
I had LASIK done just the year after a new wavelet tech emerged (or at least,
after my doc had access to it).

Now, >15 years later, I still have 20/13 vision in both eyes, from a starting
point > 20/100.

It’s fantastic and greatly improved my quality of life.

------
Simulacra
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.

------
jijji
i had lasik when i was 24... now i am 44 and would say that number one its
really good, but number two it only lasts for about ten years and then your
eye sight starts to go bad again... my vision was 20/600 before lasik and
20/20 after lasik. I am probably going to have it done again...

------
marcoseliziario
Until the day this thing is done 100% by robots, thanks, I think I will stick
to glasses and lenses.

------
vladgur
#protip If you are considering Lasik, do not watch the cinematic gem that is
Final Destination 5

------
jchen5
I have been looking through the literature on lasik complications since I am
considering lasik and there were several articles recently such as [1] which
goes into a lot more detail. There are a lot of temporary complications/side
effects (e.g. a few months), but what I'm most interested in understanding is
the risk of lasik causing serious, long-lasting or permanent complications.
The main ones discussed in these articles are visual artifacts (halos,
starbursts, etc.) and dry eye (which at the extreme end means constant intense
pain).

Unfortunately, as far as I could tell, there aren't very good studies on the
topic - they're very limited in number of people and in length of time
studied, or they don't measure a control group/baseline - which is a big
problem because there is a surprisingly high prevalence of symptoms in the
population even before lasik. This makes the data very hard to interpret.

E.g. [1] reports that 6 months after surgery, "41 percent of patients reported
visual aberrations, with nearly 2 percent saying the symptoms presented 'a lot
of difficulty' or 'so much difficulty that I can no longer do some of my usual
activities.' But looking at the data from the PROWL-1 and PROWL-2 studies [2],
table 3, 67% of patients had some visual symptom _before_ lasik surgery, with
3.3% / 7.5% having difficulty performing activities and 10.8% / 13.3%
reporting "very" or "extremely" bothersome symptoms (again, before lasik). The
prevalence of severe visual symptoms decreases 6 months after lasik. However,
while some people go from severe symptoms to no symptoms, some of that is just
due to regression to the mean (see note on test-retest in [2]), and there is
also a substantial percentage of the population that goes from no symptoms to
having some symptoms (which is the main thing I am trying to estimate).

Surveying some of the other literature [2][3][4], the overall pattern I saw
was that pre-lasik the prevalence of dry eye and visual symptoms is about 60%
of any severity, 5% severe, 5-10% moderate. Post-lasik they are about 50% any
severity, 3% severe, 5% moderate. Overall they are less postop - but the
question is how many people who were normal preop develop symptoms postop
(minus how many people who were normal develop symptoms 6 months later without
any lasik surgery). I haven't found good enough data to answer this with any
degree of accuracy, other than an upper bound of <1% developing severe
symptoms and <5% developing moderate symptoms. That isn't a very helpful upper
bound to me - a 1% chance of permanent severe complications is a lot, and I
think it's obvious that if the rate were that high we'd know about it. But
from the data it appears plausible that the rate of developing long-lasting
moderate complications is 0.1% - 1%, and the high end of that range is still a
pretty substantial rate of complications. I think the actual rates are a lot
lower, we just don't seem to have enough data to measure it better. I would
love to see pointers to better studies, better analyses of the data, etc.

[1] [https://www.nytimes.com/2018/06/11/well/lasik-
complications-...](https://www.nytimes.com/2018/06/11/well/lasik-
complications-vision.html)

[2]
[https://jamanetwork.com/journals/jamaophthalmology/fullartic...](https://jamanetwork.com/journals/jamaophthalmology/fullarticle/2587831)

[3]
[https://www.ncbi.nlm.nih.gov/pubmed/25896684](https://www.ncbi.nlm.nih.gov/pubmed/25896684)

[4]
[https://www.ncbi.nlm.nih.gov/pubmed/27373395](https://www.ncbi.nlm.nih.gov/pubmed/27373395)

------
GoRudy
I got LASIK at Standard Medical, one of the best things I ever did for
myself...

Didn't read the article...

------
dole
Call me paranoid, but I wouldn't be surprised if stories like these were
pushed by Big Eyeglass (Luxxotica).

~~~
einpoklum
But then, maybe you're just a tool for Big Laser... :-P

------
tedunangst
It's really damning how they were unable to find a single patient happy with
their outcome.

~~~
falcolas
It's pretty unlikely they tried hard then. I know of 4 in my close family
alone. Brother- and sister-inlaw, and two cousins.

There have also been a number of co-workers and distant friends who suddenly
stopped wearing glasses, and seem quite happy with their Lasik.

