Hacker News new | comments | show | ask | jobs | submit login
Lasik’s Risks Are Coming into Sharper Focus (nytimes.com)
339 points by sohkamyung 40 days ago | hide | past | web | favorite | 233 comments

As a subscriber I love the New York Times, but like many articles in the Wellness section this is low quality.

The article starts off with:

>A recent clinical trial 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.

And then five minutes of reading later leads to this valuable insight:

>But many of the trial’s 574 participants reported having visual aberrations and dry eyes before surgery, and the study concluded that Lasik slightly reduced the prevalence of these problems.

Why... didn't they put that in the same paragraph? The title of the article leads me to believe this obfuscation was on purpose.

Then, a few minutes later into the article, they state:

>The study’s lead author ... said the researchers had concluded that the multimillion dollar trial was too small to produce meaningful results, and that the purpose of the study had shifted from determining how many patients have problems functioning to developing a questionnaire that might be used in future research.

Ugh. I just spent 10 minutes reading an article formed around a flawed study that contradicts the title. Filled with circumstantial evidence and discussion about clearly biased people (like the guy with seemingly no credentials who runs lasikcomplications.com).

You also cut the article to fit your point. E.g. full text regarding 574 participants:

=================================== quote

But many of the trial’s 574 participants reported having visual aberrations and dry eyes before surgery, and the study concluded that Lasik slightly reduced the prevalence of these problems.

Three months after surgery, however, glare, halos and double vision were common, affecting 50 to 60 percent of all patients, with up to 5 percent characterizing them as “very” or “extremely” bothersome.

Even after six months, some 41 percent of patients reported visual aberrations, with nearly 2 percent — or one in 50 — saying the symptoms presented “a lot of difficulty” or “so much difficulty that I can no longer do some of my usual activities.” And one-quarter of the patients followed six months had mild to severe dry eyes.

=================================== end quote

Note that wording here is unclear, because "many" is not quantified and we don't have percentage change over time here. Did it increase or not and by how much. But due to this it is possible to interpret this part however your want - that lasik made things worse or that it didn't.

Are these 5% and 2% from the ones that had an issue (hence, from the 50%/60%) or from all patients?

Also, did this trial use a microkeratome or the femtosecond laser for flap creation?

For anyone who hasn't read the article, the parent is very misleading. The article presents at least half a dozen studies, interviews at least 20 people, and their list of credentials is exceptional.[0]

In this case at least, it's not the Times' research that is 'low quality'.

[0] I copied and pasted the credentialed people quoted in the article below; I only made it 80% of the way through and then realized it had become absurd:

Diana Zuckerman, president of the nonprofit National Center for Health Research in Washington

Dr. Eric Donnenfeld, who was Mr. Puglisi’s surgeon and a past president of the American Society of Cataract and Refractive Surgery

global medical director for a large laser eye-surgery provider

Researchers at Ohio State University

one surgeon’s 2017 analysis of more recent data

Morris Waxler, a retired senior F.D.A. official ... [and] former chief of the diagnostic and surgical devices branch in the F.D.A.’s division of ophthalmic devices

Dr. Cynthia MacKay [ophthalmologist]

Dr. John Vukich, chair of the American Society for Cataract and Refractive Surgery’s refractive clinical surgery committee

Dr. Malvina Eydelman, director of the division of ophthalmic and ear, nose and throat devices at the F.D.A.’s Center for Devices and Radiological Health

Dr. Anat Galor, an associate professor of clinical ophthalmology at the Bascom Palmer Eye Institute at the University of Miami.

Dr. Pedram Hamrah, director of research at the New England Eye Center at Tufts Medical Center

I'd say we're both right: the article is based around a flawed study that hilariously contradicts the title and is full of circumstantial evidence. You are right that they cite plenty of other studies and quote qualified people. But I'd claim that the faults I cite instantly disqualify it from being a quality objective piece, and that there are likely better places to get a well argued viewpoint.

> I'd say we're both right

I'd say the parent comment is factually wrong:

> the article is based around a flawed study

The article is based around at least 6 studies and a long list of interviews with experts. And the article's subtitle says, studies show (note the plural). So it's false to say the article is based on one study.

> a flawed study that hilariously contradicts the title

The title is, Lasik's Risks Are Coming Into Sharper Focus. Which study contradicts those words? Certainly not the one discussed in the GGP, which supports the claim that there is growing information about the amount of risk from Lasik. Again, the line quoted above is false.

> circumstantial evidence

I'm not sure what the parent refers to with that term, but as I pointed out, there is a large amount of evidence and experts analysis in the article. Circumstantial evidence is not a bad thing; it's evidence and is admissible in court, for example (AFAIK). It's just generally not considered sufficient by itself; in this article, it certainly has plenty of company.

> disqualify it from being a quality objective piece

They quote people and research on all sides of the issue, extensively.

> hilariously ... instantly

For me, hyperbole disqualifies comments from being taken seriously. It conveys a desire to rant and be dramatic, not a desire to reason about the facts. In fact, the former is often used as a substitute when the latter is lacking.

I don't agree with your logic or conclusions (even ignoring the factual inaccuracies pointed out by others). Those two "observations" you linked are in no way mutually exclusive and it may very well make it the same/better for some people and irreparably worse for others.

Side note: Anecdotally, my late father had the exact same issues as what is presented early in the article. Needed eye drops every 30 minutes to an hour and his quality of life dropped dramatically as a result of lasik.

That's a wrap, folks. This comment is more valuable by far than the article.

I've learned to read the comments to any posted NYT article, than visiting said article itself.

I've learned to read the HN comments to any posted article first - and then decide whether or not I want to catch up with the article itself.

Internet rants might sound smarter-than-thou, but I read the articles for myself:


I value my time somewhat so if something sounds the least bit dubious, I peruse the top comments first.

Only reason I read comments for NYT articles is to see if anyone has a scathing criticism about the article, and there usually is.

My RSS reader filters them out. I also built a browser plugin for myself to remove links to domains I never want to go to, NYT is 1 of them, mostly because of the paywall. Haven't made the plugin work for mobile FF yet though, thats how I got here.

I scan through HN's list of articles, and click "hide" on all NYT articles, before even reading titles. Same for many other newspapers and a few "usual suspect" websites. (This article was an exception, as I've had LASIK in the past 20 years, and it caught my eye.)

Haaaaah, I see what you did there.

Wink wink.

I had LASIK a little over a year ago and it turned out very well for me, due in part to having a great doctor and due in large part to all of the research that I did before having the surgery. However, one thing I emphasize to everyone considering it is that (despite the marketing) it should be considered a major elective surgery with a possibility of serious complications, and that anyone considering it should weigh the pros and cons and do their own research before deciding.

Articles such as the one here tend to gloss over patient adherence to post-surgery self-care, which is one thing I believe makes or breaks successful LASIK (in my personal experience and from what I have read). This means eye drops on schedule round the clock, antibiotic eye drops on schedule round the clock, eye protection at night for the first week, avoiding dusty conditions for however long the doctor prescribes, avoiding getting water in the eye for however long the doctor prescribes, etc etc.

I also believe that thanks to a rise in LASIK's popularity and marketing some people do not see it as being "Major surgery being performed on your eyeballs, which you need in order to see". It seems to be talked about more like Botox or Invisalign or any other "lifestyle" type of procedure when in reality it's much more serious than that. Anyone considering the surgery should research carefully beforehand, weigh the pros and cons of the surgery for themselves, and compare multiple doctors before deciding to go ahead with the procedure, same as for any major surgery.

Again, due to its popularity, there are good doctors and then there are patient mills, and from my research pre-LASIK I believe that negative outcomes are greater when someone goes to a "patient mill" vs a good doctor, possibly because the doctor does a better job, or possibly because post-surgery instructions are emphasised more at a good doctor than at a patient mill.

I had LASIK almost 20 years ago, from one of the leading practitioners in the then-fairly-young field, and I scrupulously followed the post-op regimen, yet I still experience noticeable halos and starbursts with lights at night, and my eyes are considerably more sensitive to the sun (I basically can't tolerate being outside in the daytime for any length of time without sunglasses, whereas I never even owned a pair of sunglasses before the surgery).

These are fairly minor issues for me, and I've never regretted getting LASIK, but a reputable surgeon doesn't guarantee lack of side effects.

I've never had Lasik, I'm severely nearsighted, but I've become much more sensitive to light as I've aged.

I'm barely nearsighted, really just use glasses so that I can read presentations in meetings... and yeah, my eyes have become significantly more sensitive to both light and change rapid changes in light.

"a reputable surgeon doesn't guarantee lack of side effects."

Absolutely! Side effects are possible for anyone getting the surgery, and like I said in my parent comment (or hoped to say), everyone should weigh the potential pros and cons to decide if the rewards outweigh the risks. For me, I already had terrible night vision (due to my astigmatism) and sensitivity to light, so after reading about potential side effects I determined to go forward with the surgery.

Also, I believe that advances in the LASIK procedure over the years have mitigated a lot of the side effect risks (though not reduced completely), so people getting the surgery today will have less side effects then you did getting the surgery 20 years ago.

> Articles such as the one here tend to gloss over patient adherence to post-surgery self-care, which is one thing I believe makes or breaks successful LASIK (in my personal experience and from what I have read). This means eye drops on schedule round the clock, antibiotic eye drops on schedule round the clock, eye protection at night for the first week, avoiding dusty conditions for however long the doctor prescribes, avoiding getting water in the eye for however long the doctor prescribes, etc etc.

I had LASIK from a well-regarded doctor in 2015 and I wasn't told to do any of these things, except avoiding opening my eyes under water.

Right, so does that mean the post-surgery care that I was recommended is on the "extremely conservative" end and your doctor was more lax, or does that mean your doctor wasn't as well-read as others, or something else? Like the comment up-thread, how does one pick a good doctor for something like Lasik, which is seen as a minor medical procedure but is absolutely a major surgery?

You ask your Lasik doctor if he were to get Lasik surgery, what doctor would he personally use?

> I believe that negative outcomes are greater when someone goes to a "patient mill" vs a good doctor

A dangerous belief to propagate without any data, insofar as it again trivializes the risk, i.e. "I'll be fine, I picked a good doctor". What makes a "good" doctor? More expensive? More likable? Nicer offices?

For medically necessary procedures, data can be a bit of a double-edges sword, as it might make some doctors shy away from more difficult cases. For elective surgery, this actually sounds like a win.

"What makes a "good" doctor?"

Exactly the crux of the issue- I've only been to one doctor for getting my LASIK procedure, so I'm not sure what the best combination of data points would make a "good" doctor.

For me, I researched all of the doctors in my area, read reviews on many different review websites (specifically paying attention to people who had complications and what they said about the doctor's follow-up attitude), picked a couple of doctors who looked right for me, and then had consultations with each of them.

I also paid attention to which doctors didn't downplay the negatives of the surgery- because some doctors absolutely play up the "it'll be great and it's totally safe and nothing bad ever happens!" and some are way more realistic about it being a major surgery with a serious risk of complications.

I'd also argue that doctors who cannot offer a reasonable standard of care should not be licensed.

> I believe that negative outcomes are greater when someone goes to a "patient mill" vs a good doctor

The highest correlation to surgical success is number of that type of procedure performed by a surgeon. I'd be interested to see that research if you still have it.

I think this is a unique view, but I've come to appreciate nearsightedness. Partially because I like having the ability to soften the external world by removing my glasses (like wrapping myself in a warm fuzzy blanket), but even more so because it grants me the ability to see things near me in sharper focus than someone with 20/20 vision.

I can put on contacts or glasses to see something at a distance just as clearly as someone with naturally perfect vision, but someone with 20/20 vision would strain to view something as close to their nose as I comfortably can. (Great for reading!)

I fully admit that this perspective is borne out of my attempt to find the good in a conventionally undesirable situation. But having found it, would I trade it? I don't think I would...

As a person who recently wore contacts every day until dry eyes and an injury forced me to switch back to glasses, I have almost entirely the opposite experience. It bothers me to wear glasses again. My prescription is quite strong, so it creates a pretty significant distortion, stronger towards the edges of the lenses. It's hard to do sports, as I now have a background fear about losing/breaking them, and the distortion messes with my hand/eye coordination. I had an episode skiing where I actually got nauseous from disorientation. As a result I do far less sports and that leads to other things. Ultimately, it has kind of screwed up my sense of scale of things, too, because the glasses make everything appear a bit smaller.

When I take off my glasses the distortion goes away, of course, but I can't read street signs, see people's expressions, watch movies, and other things. Watching an incredible sunset or mountain scene with my own eyes...it's like looking at a 200x100 pixel image Gaussian blurred to fill the whole field of view.

I might agree with you if my prescription is less, but TBH I wish I could get rid of these damn spectacles.

On the other hand, it did teach me a bit about philosophy. E.g. now I realize that to see the world "clearly" I require lenses, I just never noticed before. All of my perception is actually through lenses, not just my eyes. Touch, taste, smell, feeling, all distorted by my senses. And it feeds into my mind, the biggest, most distorted lens of all :)

If you don't mind can you share how your contacts damaged your eyes? I wear daily disposables almost everyday and sometimes forget to remove them at night... is that how you damaged your eyes?

In my case my eyes just kept getting drier and drier, and that eventually caused conjuctivitis (inflammation of the eyelid and the covering of the eye). It was mistaken for an eye infection originally. Conjuctivitis + contacts led to an injury of the epithilium, either caused by the contacts literally bonding to and ripping off the epithilium, or by debris being caught and scratching, unable to be washed away due to lack of moisture. The symptoms were cloudy, blurry vision, itchiness, sensitivity to light, and pain. Cloudy vision and pain are f'in scary.

In my case I ended up with lesions that had to be treated with antibiotics, lubricating gel, and a kind of "bandage" contact lens, since the inflammation of the eyelids can cause further damage of the eye.

Please do be careful with your eyes. Don't sleep in your contacts, use lubricating drops, and if you feel debris or other discomfort, take them out!

I was lucky thanks to antibiotics warding off any potential infection. An infection coupled with an injury can threaten your sight. The prognosis is generally pretty good for minor epithilium and corneal damage, usually. For me, it was mind-alteringly painful, but after healing my vision is pretty much perfect with the glasses I had before. Despite being annoyed by my glasses, I am truly thankful that I can see! It is hard to communicate what 2 weeks in a dark room with the question of blindness stirring in your head can make you face.

not a candidate for lasik?

No, given that my eyes are already so dry, and this plus contacts led to me injuring my corneas on more than one occasion, one of which meant I spent ~2 weeks in a dark room, essentially blind. So doctors recommend I do not do Lasik. :(

ah bummer. yeah i had noticable dryness after mine, which went away only after a few months.

contacts are really dangerous, and i feel like this is not emphasized nearly enough. i didn't even realize that as a contacts-wearer until i started to research lasik (i learned that wearing contacts was more likely to end up causing me vision problems than lasik, which is what convinced me to get it).

What about Lasek? Generally has less complications and less invasive, but takes more time to heal.

I am not going to risk it at this point. Both involve cutting through the epithilium to get at the cornea underneath, and in my case some of the cells that pump moisture through the epithilium were damaged or destroyed, so it's even more of a risk than for most people.

This is the _one_ thing I miss about getting my eyesight fixed. Within a month of getting laser surgery, it was so natural that I'd essentially forgotten the experience of glasses and contacts, as though I'd never experienced the previous 20 years with them.

One of my very favorite things to do before then was sit in Central Park, or at the Diversey Rocks in Chicago, or anywhere with lots of color, remove my glasses, and just enjoy the blur of it all. It was very calming. An escape from all the details around me, which immediately translated to an inner calm.

I still prefer my perfect vision, and I paid a lot more than I could afford when I had it done to make sure it was done well. But I do very much miss that old shortcut to a quick and simple calm.

Why not just buy some glasses that blur up your vision? And then go put them on in Central Park?

As a glasses-wearer who understands the parent commenter: the all-encompassing vision granted by taking off the glasses (which cover ~60% of our regular view) is what makes for the wholesome, nice feeling OP is talking about.

make sure they're rose-tinted too

You can train your eye muscles to focus at whatever distance without needing something to fixate on. This allows you to blur your vision at will simply by focusing close.

Only until presbyopia sets in, starting in your 40s and completing in the early 50s (usually).

You could force your eyes to blur and achieve the same effect.

It's easier to do if you are tired, if you've never done it before. Crossing your eyes slightly also helps (then hold the blurry focus and uncross them).

The continuous effort required to force blurring pretty much negates the calming effect, I think.

I tell people I could walk through a room of naked people and not see anything private.

I have the same situation. When I take my glasses off and move stuff close to my eyes (really close, like around ~4cm) it's like looking through a microscope.

I wrote a huge comment in reply to someone else, but I had this "superpower", too, and wasn't told that I'd lose it after having my vision corrected. I miss it.

Bah, my eye Rx is -8.5 diopters. Taking off my glasses/contacts doesn't "soften" the external world - it makes me unable to function. If I forget where I put my glasses after taking out my contacts at night before going to bed, I have to call my wife to find them for me. If I try moving around too much, I'm liable to hurt myself.

I'll probably want to get LASIK at some point :)

I was at that point when I had it done. The only problem with having that bad of an eyesight, they have to use the laser for longer. It helped I had extra thick corneas, but the surgeon I went to said some folks can't have the surgery with eyes that bad.

Of course, that was 15 years ago, so maybe different guidelines now.

I am -7.5 and agree w/ GP, especially for identifying SMD components and other details.

But, yes, sometimes I need help finding my glasses, too.

Both eyes worse than -6.

I use special always-on contacts since 5 years ago or so, change them once a month. This reduces the hassle a lot.

I do the same when I feel disillusioned with superficial beauty. Really pretentious, I know. Either way, it feels good to reduce people to blobs every once and a while. I sometimes get too distracted by looks, so being able to turn that off is nice.

You are under 40 I assume? That's not gonna last forever

Nearsightedness does not go away after 40 (presbiopia does not cancel out myopia).

I meant "viewing something as close to my nose as I comfortably can" won't last long.

People like myself with both presbiopia and myopia can still comfortably view something close to the nose (without glasses).

I don't think near sightedness means better than 20/20 up close...

Personal anecdote...depends on your age. I'm near sighted (blind as a bat since my teens) and up until I was ~45'ish still had perfect 20/20 near sight vision. Up close I could read the tiniest of print and perform tasks and repairs on very small assemblies (I'm talking sub-millimetre PCB work and modelling). As I've gotten older this has gotten harder and these sorts of tasks now demand the use of a magnifying glass. This could probably be corrected with the use of varifocal lenses but for now I get on fine with a magnifier.

Apropos the Lasik treatment, in my early 20's vanity got the better of me and I wore contact lenses for a time. There were also practicality reasons because I'm a biker and ruined several pairs of glasses trying to stuff the legs into my helmet. Anyway, I contracted an eye infection which over the period of a month affected both eyes and could have resulted in loss of sight in one eye. The doc reckoned I'd picked this up from the lenses despite me being totally anal about keeping them clean. I never wore contacts again. Despite the annoyance sometimes of having to wear eyeglasses, my eyesight even with its less than perfect capabilities, is too valuable a sense to lose. Despite all the Lasik success stories it bothered me enough that I might just be that unlucky sod it doesn't work on and could end up worse just for the sake of convenience and vanity.

It depends on the cause but if the only thing wrong is your eyes are focused to closely, then you will have better vision up close because you have better magnification from the shorter focused lens.

Heh, I do this too. It’s great after I’ve been staring at a screen for hours, although I also take my glasses off when using a computer because I really only need them For distance. I definitely feel like it helps my eyes relax a bit more to have my glasses off.

YMMV of course.

But I got LASIK done just over a year ago. I'd worn glasses since I was a kid and don't remember a time without them. Things I love after having done LASIK: - Being in the rain - Boxing - Not fumbling for my glasses after a shower, waking up - Being able to just rub my eyes - Wearing 3D glasses

Things I don't like after having done LASIK - night vision is really quite bad. Low lit streets, driveways can be hazardous. - light sensitivity. Not sure if this is a byproduct of LASIK but I feel disoriented in rooms with low fluorescent lighting. - dry eyes aren't as common as in the first 6 months but I do take more screen breaks to moisten my eyes - blurred vision. Doesn't happen often and I can't say this is purely related to LASIK as I often get this after a long day of coding.

I got my LASIK done at the Eye Institute in Auckland and they sat me down for close to an hour to talk through it. Will I need glasses in the future? yep, they mentioned that. Dry eyes and blurred vision? Yep. For the first 6 months after the operation I had regular checkups.

It's been a freeing experience overall.

My night vision is also significantly deteriorated. I can drive fine at night, as I can see lights and reflective surfaces just fine, but walking around at night is definitely more difficult, and sometimes concerning.

I'd had issues with dry eyes for most of my adult life. When I was still wearing contacts, I had a doctor tell me it was likely that I wasn't blinking enough. It seemed silly to me at first, but then I paid more attention (I did tend to stare at screens for 18-20 hours at a time back then), and realized the doctor was spot on.

I learned to blink more while working and it's made an enormous difference. On occasion, I'll still find myself completely submerged into whatever I'm doing, eyes wide open, dry as dust, and I'll sit back, squeeze my eyes shut a few times until they water again, and then take a break.

Did you use any tricks to make yourselfs blink more? I'm going through the same, getting used to contacts, but I can't think of a way to learn myself this without setting a timer every 2 minutes or so - which is obviously not really an option.

Of course there's a software solution to this: http://eyedoc2020.blogspot.com/2017/03/best-apps-to-remind-y...

Unfortunately, I've no tricks to share. I've just been trying to stay more mindful of my blinking in general, and when I notice my eyes are completely dried out, I take a break.

Boxing? As in punches thrown at your head? Can't imagine that's safe for someone who had LASIK since the chance of corneal flap damage would be quite high.

It's not safe, and the FDA actually warns people against participating in combat sports or other activities potentially involving eye trauma after the particular LASIK that opens your flaps because of what you said.

Though PRK, which does not open the flap, is fine, and is the procedure athletes typically go through.

Definitely not sparring. Mostly hitting pads. Something I could do with glasses on but I found it annoying as it got in the way of training.

I also had LASIK surgery and feel that my light sensitivity has increased, especially to sunlight. I used to never wear sunglasses before, and now I feel I need to in some situations.

Someone pointed out an interesting perspective. Perhaps it was that my glasses and contact lenses had a UV filter on them that sunlight did not bother me. Maybe it is not the brightness, but the amount of UV light hitting the eye that is responsible for some of the light sensitivity. It could be UV sensitivity, and not light sensitivity.

I have not taken the time to try to test this hypothesis out in any meaningful way, but it is an interesting thought.

Could it also be the case that the sharper focus due to LASIK itself causes increased sensitivity? Is there a general inverse correlation between bad eyesight and light sensitivity?

Yeah, don't rub your eyes.

Why is that?

Because it might dislocate the flap

This is what worries me the most about taking the plunge, not the videos I've seen of it being done, not the potential side effects, just the fact that I could seriously screw my eyes up by rubbing them after the fact.

My doctor said there was a case of a lady who removed her flap when she woke up at night and tried to remove her contacts out of habit :|

Good luck with that. That’s really quite hard to do, ask your surgeon how hard it is to find the original cut when they’re looking for it to do a touch-up.

You don't need to find the flap, finger to the center of the eye sideways will suffice.

But after months, the flap does settle back. So while it never heals the risk of rubbing your eyes dislocating the flap is rare.

Nevertheless, I do worry about this a lot.

Infections and foreign objects, is the usual answer.

We should also "focus" on preventable myopia, which is so common, especially in Asia (For example, in Korea, 96% of younger population suffered from myopia, which is insane). If I have kids, I will make sure to let them play outside in the sun daily, in order to get enough exposure to the bright sunlight. As for me, I didn't get a lot of exposure to sun when I was in my early teens, when I developed myopia. I should've had more balanced lifestyle, instead of spending all my time playing with C64 in my room. I don't think it was hereditary because both of my parents and my siblings had normal vision. I was the only one in my family to wear glasses.

* [The myopia boom : Nature.com](https://www.nature.com/news/the-myopia-boom-1.17120)

* https://www.youtube.com/watch?v=DjdkbcOx05A

I played tennis competitively as a teen. So that was about 1 to 2 hours a day, every day in the Florida sun. Still developed myopia by the end of high school though. . .

That's why studies look at aggregate data and not individual anecdotes. Individuals vary from the trend.

Based on the Nature article it looks like the conclusions within the research community are still pretty unsettled.

Very interesting article. Do you also by any chance know of studies about adult myopia? I wonder if it light exposure. makes a difference there.

That's really interesting!

I had Lasik done at a university teaching hospital by a surgeon who had done thousands of surgeries. This was in 2003. Every follow-up was by a resident and then the full surgeon. I had significant dry eyes and blepharitis (probably from the dry eyes) for about 12-18 months.

15 years later, I can still see 20/20 in one eye and 20/25-30 in the other. I still occasionally have dry eyes and blepharitis. I wear glasses at night while driving to feel comfortable and I do get halos at night. My left eye, when it is dry, I get slight double vision.

Ultimately, I'm OK with having had it done and don't really regret it. However, folks who ask me about it, I tell them if they can still wear contacts, not to have it done.

I could only wear rigid gas permeable contacts. Being a computer programmer who doesn't blink often looking at the computer (like everyone), I wore ulcers on my eye. So, could only wear glasses. I was legally blind without them, so I feel like I'm in a much better situation now, albeit with some downsides.

With how bad my eyesight was, I will definitely need reading glasses. I'm in my early 40s now, and am starting to show signs of it.

I had mine done when I was in my late 20s. I'm now in my late 40s. I need reading glasses for any small print but otherwise I'm fine. The doctor who did my lasik told me it would happen in my 40s and he was right.

I never had dry eye issues - just starbursts and halos at night. I have always been thrilled with the whole outcome. Though I think soon I may need to look at wearing glasses again - but the 20 years without them was worth it.

Ditto for me. I had it done in 2006 and have had 20/20 vision ever since. It took about a year before the halos became unnoticeable but I've never had any other issues. My wife, either. It was absolutely life changing for me and I'd do it again even if I had worse side effects.

>>However, folks who ask me about it, I tell them if they can still wear contacts, not to have it done.

Contacts carry their own risks. Even if you have excellent hygiene habits, they can cause eye infections. And if you accidentally fall asleep in them...

Just want to stress this point. An infection sounds benign but the eyes are naturally immunosuppressed. An infection can spread rapidly and lead to permanent damage to your eyesight within days.

I use daily-wear contact lenses (you throw them out in the evening), but usually wear glasses unless there is a specific reason to wear them (usually a sports-related activity).

I also purchased a 2nd pair of prescription sunglasses, so that has also helped.

FWIW I'm 58 and still have 20/15 vision with corrective lenses (yes I typically eat bushels of veggies and carrots too), but the fear of only having 20/20 vision or worse is why I never opted for LASIK.

I consider my night vision poor--but I thought that even when I was in my teens. My eyes have always been a bit light sensitive... IDK if the two are related.

Contact lenses? Nope. All the wetting solutions I tried blurred my vision, sure it was only for 15 or 20 minutes but that doesn't work with my lifestyle.

For me the risk was never worth it.

I always was corrected to 20/15 when I wore glasses and could actually be corrected in the office setting to 20/5 (fairly rare). I was very particular about my vision, similar to you. I haven't had issues with it being 20/20 now, but I do wear glasses for driving because I like the clarity.

This, and other summaries of trials / research in here, do indeed imply dramatically more complications than I've ever heard. Gonna have to dive in deeper, I suppose, but the fuzziness around this kind of stuff has been part of the reason I haven't done it already :|

>A recent clinical trial by the F.D.A.[1] 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.

[1]: https://jamanetwork.com/journals/jamaophthalmology/fullartic...

Or this one:

>even after [5] years, nearly half had dry eyes at least some of the time. Twenty percent had painful or sore eyes, 40 percent were sensitive to light, and one-third had difficulty driving at night or doing work that required seeing well up close.

Like... one third have difficulties after 5 years? That's potentially insane if representative.

I suspect a lot of people who have these procedures and don't like the results don't make a big fuss about it, because it's not like they can undo it. And they usually spent a bunch of money on it. You might as well try to be happy with the results.

For me, it never seemed worth it to deal with the permanent change leading to potential side effects for a temporary benefit. If my corrective lenses were big and heavy, I might reconsider.

It helps to understand the benefits of the procedure to understand why folks would undertake the risk... I had correction at -6 diopters, which is equivalent to about 20/500 vision. My near vision uncorrected was bad enough that the focal distance was closer than the distance needed to resolve 3D vision. This means that to read my phone without correction, I had to close one eye and hold it in front of my face. Further, I was developing an astigmatism, which results in double vision, even when optically corrected (glasses can fix this, contacts do so poorly).

I got PRK in Vancouver, BC for less than $2K USD. Recovery took about 5 days to functional vision, and maybe 1-2 months for complete recovery. It is a world of difference. I wake up and can see the world immediately. I can go hiking/camping without gear that requires a sanitary environment just to wake up and go to sleep. Cheap sunglasses work. I can participate in sport with no notice or prep. I can swim without eye protection. My day-to-day experience is dramatically improved.

If you don't perceive the benefits, LASIK/PRK may not be for you. For some people, though, life with glasses or contacts is a noticeable burden, and correction can provide measurable upside. In these cases, it can be well worth the perceived risk.

Hows your night vision?

My night vision has been completely fine since the surgery, with no major haloing or aberrations. I do not know whether this is a function of PRK vs LASIK, a good doctor/procedure, or luck. (Maybe a bit of all 3?)

Did you get the TransPRK (SmartsurfACE) procedure? I ask because people from the US typically go to Canada to get it since its not available here. Seems like the much better bet for long term results vs Lasik.

I got LASIK in February for my -6.75 vision, and my night vision now seems the same as before the surgery. I've had no complications at all.

1) If you're a civilian pilot, then you should read this carefully beforehand: https://www.faa.gov/about/office_org/headquarters_offices/av...

2) If you want to be a military pilot, then research the correct military branch. Historically, some allow eye surgery and some don't.

3) All surgery is major surgery, with the risk of infection or other complications.

FWIW, I got PRK laser eye surgery and had 20/15 vision for maybe 6 months. Dry eyes took a few years to go away. Back to wearing glasses again in ~8 years. Stars and lights are now permanently fuzzy at night because my pupils dilation is larger than the surface area of the PRK. YMMV but for me, it wasn't worth it.

Interesting. One of the disqualifying factors for my LASIK surgery would have been if my pupils dialated too much. Luckily, mine did not.

PRK is a different procedure. The main advantage is that there is no incision and less chances of error which is why pilots opt for it. The main disadvantage of PRK over lasik is the much longer recovery time which is a decent trade off for less risk. That said, I still suffer from dry eye years after the procedure though it’s improved compared to before

Thankfully others have already pointed out this article's lack of journalistic merit or rigor. As a follow-up, I'd like to state:

I don't wear glasses or contacts anymore thanks to LASIK. After 30 years of squinting, jamming fingers in eyes, staring through fogging/scratched/dirty/broken lenses... I have better than perfect vision each morning when I wake, "naturally", thanks to a quick and near painless surgery. Forget flying cars, THAT is the future, now. It is absolutely life altering. Amazingly good.

Certainly, there is risk. Certainly, not everyone is a good candidate. Selecting a surgeon who is credible and who will say "no" to you is critical. You need to do your homework! How many surgeries have they performed, what is their reputation, are there complaints(how many?), how long have they been established. Price, that is the last, dead last factor. Why save a buck for something you'll do only once and whose outcome is permanent?

I'm not a LASIK shill. I wasn't paid to type this out. I am just really, really happy to be able to see. I can't imagine not getting this procedure done. Having some asshat tell you lies to rile you up or confuse you about the risks or outcomes is a disservice. Both myself and my partner went to the same surgeon, and had both eyes corrected. Both of us have perfect vision and no complications. I'd absolutely do it again.

After ICL and Lasik, my vision isn't as good as when I wore glasses. I've taken to wearing glasses that my eye doctor has told me I don't actually need so that I can read signs in the distance.

In addition, I used to have amazing near vision. When I'd work on small projects, I could see them amazing well. Now I have to hold things almost at arm's length to focus on them well. I was told that it would get better as my eyes strengthen, but it hasn't really changed much in the years since the surgery.

To compound things, I'm about 40 years old and my near vision is now deteriorating anyhow. I was warned about this and fully expected it, but the other problem wasn't something I was warned about.

I also knew that my vision was bad enough that Lasik wasn't good enough and would weaken my eyes too much, and so ICL was used with Lasik to fine-tune it. I did know to expect my vision might not be 100% perfect.

In short, I now get to wear much lighter, cheaper glasses when I want to see far in the distance, and wear no glasses at all for most day-to-day things. But I have trouble reading at less than 2/3 arm's length.

If I were given the opportunity to choose differently, I might choose to keep my money instead and continue to wear glasses. I'm not angry, but I'm certainly not fully satisfied with the procedure.

I had Lasik done in India to both my eyes in 2009. The total cost came out to Rs. 25000 (~500 USD) for both eyes. I went from a 20/600 to 20/20 in 15 minutes. Best decision of my life. I made sure to get the surgery done from a highly reputed ophthalmic surgeon who had performed 1000s of surgeries with success. As in every surgery, there are side effects. For me, there was temporary mild dryness that lasted a few months, and eye drops were recommended. Besides that, there are no halos, no blurred vision, or any other visual aberrations that others report.

One thing I'm really concerned about is the flap itself. I always have the flap and eyes at the back of my mind when I play any sport. Since the flap never heals, a blow to the eyes can possibly detach the flap. I've also read instances where people who have had surgeries and swam in pools/sea water have had their flap edges infected resulting in complications. But, I am not really a swimmer, so no worries there. I went into it with as complete a knowledge as possible, and it has been worth it.

The flap heals. Where did you hear that it doesn't?


Is that true for surgeries that use the microkeratome as well? I remember researching quite a bit and reading a few well sourced studies about the effects of trauma on the flap, but I don’t remember where.

Where in India did you undergo the surgery? Can you recommend any LASIK surgeons in Mumbai? I'm planning to get LASIK done and would appreciate your help.

Happy to recommend, but like everything on the Web, make sure to do your own research and check reviews etc. unfortunately, this isn’t in Mumbai.


No mention here of SMILE which seems to be gaining ground in much of the world, but pretty rare in the US.


Seems interesting, no flap like with LASIK and it may result in fewer cases of dry eyes. Has anyone here had it?

I have. I had the SMILE procedure done just under 2 months ago now so I can't speak on the long-term effects yet.

The procedure was really quick (+- 5 minutes) and painless. I was told that it might feel like I have sand in my eyes for the rest of the day after the numbing eyedrops wore off but I only experienced very minor discomfort, not anywhere near as close as having sand in your eyes.

The first hour after the surgery it looks as if you are looking underwater (slight white haze) due to the eye drops they put in your eye during the procedure but that quickly fades. My vision was improved directly after the surgery and it only took around 2-3 hours to reach 100% (or close). I watched some TV that night and even answered some emails although it took 1-2 seconds to really focus on my small laptop screen.

Next day my vision was perfect and I could see everything close and far away without issues and even went back to work. I had slight starburst at night (there is a picture with an example in the article) on small and direct light sources like a street post but that I was told that would disappear in a few months and so far it has been improving every week. I now only see it slightly on tiny light sources like the stand-by LED of a TV or monitor. With the rate of improvement after the surgery I expect that the starburst is soon going to disappear completely but even if it would stay like this I would 100% choose to get the surgery again.

They gave me eye drops for eye dryness. You take them every half hour for the first week, every hour for the week after that and then switch to 6-12 times a day depending on your needs and stop completely after 3 months. In the beginning I really felt like I needed to follow that schedule closely but now I sometimes forget because my eyes don't feel dry anymore.

Everything considered this has been one of the best decisions of my life and the quality of life improvement is huge.

Although SMILE was significantly more expensive (3300 vs 2300 for Lasik) I don't think you should try to cheap out on eye surgery. Not having a flap like LASIK makes a huge difference in terms of recovery speed and risk of complications.

If anyone has any other questions I would be happy to answer them.

Similar story here. I had SMILE 1.5 months ago with great results so far. No noticeable change in night vision, although definitely noticeable dry eye.

SMILE is available in the US, but not if you have astigmatism. I had to go to Canada to get my surgery because of this. SMILE with astigmatism correction is undergoing FDA review currently, with approval expected sometime this year (according to the US optometrist I spoke to).

There's also a third option which is non-destructive - Visian ICL https://us.discovericl.com/

It's worth mentioning that a single drop of Alphagan (brimonidine) in each eye an hour before dark will often eliminate halos in people who've had Lasik. The effect lasts an entire night and there aren't any real dangers in the way of side effects or interactions.

I've worn glasses for almost forty years now, and I'll probably wear them for the rest of my life. I actually like having something between my eyes and flying objects, in spite of the annoyance of always having to clean my glasses (or having to wear bifocals for that matter).

I never liked the idea of undergoing a very new surgical procedure on eyes that are otherwise healthy. Not to mention, I'm old enough now that cataracts may be in my future, though they may be years off.

I've worn glasses since I was 6. 3 times over the years, the glasses have prevented damage to my eyes from flying objects. They aren't true safety glasses (I have a separate pair for that) but I like the extra protection, as well as the protection from UV.

But at my age everyone needs glasses anyway, so there's little upside to lasik and even a small risk is too much for me to accept.

The glasses make for terrible eye-hand coordination, as they warp the trajectory of balls in unpredictable ways. I cannot hit nor catch baseballs worth spit. Fortunately, I couldn't care less about having an athletic career.

> I actually like having something between my eyes and flying objects

When I got contacts, walking through bushland suddenly terrified me. My eyes felt so exposed and vulnerable! Growing up with glasses I'd never realised how protected they made my eyes feel.

Wearing glasses also lets me safely ride with my visor open most of the time and I like the wind on my face. Well, there was that one time I ran into a bee so it's not 100% safe but my eyes were still fine...

Same here. Unfortunately I can not read a thing on my phone anymore if I don't have my glasses on. That can be a serious hazard in some situations. But, since I've been wearing them so long I feel naked without them so, it's rare I'm glassesless.

Why's that a serious hazard? I can't (and could never) read anything off my phone without my glasses, but I never considered it any sort of hazard.

Likewise, I'd have to carry safety glasses if I didn't wear regular glasses. And with bifocals, I never have to search for my reading glasses, because they're always on my nose.

I distinctly remember a high school gym class where they made all the kids without glasses wear safety goggles during some sport. My friend and I were the only ones who didn’t look ridiculous because we got to keep our glasses. ;) Luckily nothing happened then, but one time in university I was playing racquetball with a friend and the ball hit me right in the eye. I still worr glasses at the time and all it did was pop the lens out.

every time I go into my shop I spend 30 minutes trying to find my safety glasses...then go do something else.

For me, the flying objects are usually bugs, when I'm out cycling. More than once I've had yellow jackets bounce off my glasses. :O

Late last summer, I took a ride one evening when, in any wooded area, the air was absolutely thick with gnats. I wound up tying a extra bandana over my mouth (flying protein supplements do NOT taste good!) and adjusting the one around my forehead to close the gap over my glasses for good measure.

The trick is to have multiple pairs, to the point where you find them at the same rate you lose them.

I'm not ruling Lasik out personally, but I'm just giving it another decade or two to see the long term effects. My eyes are the highest bandwidth input by far, it's not a decision to take lightly

In the mean time, I have these contacts that you can leave in for a month or more, the brand is 'purevision' but there are others. They're completely liberating, almost as good as Lasik it sounds like, but with none of the downsides like loss of night vision or halo's. You wake up and don't even think about the fact that you sometimes have glasses

The only issue is remembering not to rub your eyes too much (just wash your face instead) and change them over every month or so

I had completely shit vision. I couldn't swim safely for long distances because of how bad it was. Got Lasik in Lithuania (same complication rate; 1/6th the price of Toronto) and it was completely, totally worth it.

That beings said, my eyes are itchy sometimes. Just because there is a complication doesn't mean that the tradeoff wasn't worth it. I was under no illusions that I wasn't risking permanent damage, but the way I looked at it was that I was also risking permanent damage by relying on always having access to my glasses.

Wow, looks like I could fly to Lithuania and have Lasik done, while spending less money than getting Lasik done at home. How does that work with follow up appointments? Did you just stick around for a few weeks?

I did my LASIK in Poland. You can do a 3 week vacation with the surgery and three doctor followups for the price of just the surgery in the US. This is on state-of-the-art equipment in a top-rated clinic in Warsaw, not a budget option at a second-grade clinic.

If you want to contact me privately by email I'll send you detailed instructions, including who I hired to communicate / bring me back to the Airbnb. Because I work remotely I just rented a beautiful place in Vilnius for a month and worked from there.

Did you try corrective goggles?

I don't mean that as a suggestion, I'm wondering what your experience with them might have been.

I didn't, no. I don't really like how most goggles make my eyes feel.

"LASIK has a remarkable success rate, with 96%" This implies that 4% of LASIK surgeries are failures. Odds of dying in a skydiving accident: 0.0007% Odds of dying in a car accident: 0.0167%

You probably aren't going to die from a bad lasik surgery but for someone who's livelihood depends on their eyes, developing bad eye problems and actually dying should be adjusted for the same level of risk. In which case, 4% is absurdly high.

Also that 96% is taken from a LA$IK site, so the real failure rate is quite likely to be higher than 4%.

Failure doesn't mean "bad eye problems", it means any result other than 20/20 vision. So you could have better sight than before, but still be a failed case.

I had PRK about a year ago, and I'm very happy to have done so. I wore contacts / glassses for about 35 years prior, and I don't miss them at all. I have experienced some of the post-op complications mentioned in the article, but I'm not a good data point there because of many confounding factors: my age means that I'm starting to experience things (allergies, presbyopia) that would have happened regardless of the surgery.

I wanted to mention something else that I experienced post-op, which is more relevant to HN: anger at websites that don't support zooming! My temporary foray into the world of low-vision web browsing gave me a new appreciation for people who have to experience the web like that every day. If your website's header grows to fill my entire screen as I zoom, I'm not buying anything from you.

Thanks for bringing up the accessibility point. I had some issues in the past where I needed to use some accessibility features and it gave me massive appreciation for the people/platforms that worked hard to make them usable for everyone.

> None of the surgeons he consulted ever warned him he could sustain permanent damage following Lasik, he added.

I had LASIK ~18 years ago, and was warned many times by everyone I discussed the procedure with that there were possible side effects, including the ones in the article. I also signed a bunch of stuff saying the same.

About 12 years ago I had a ‘touch up’ and same deal - warnings everywhere from everyone...

Yea, I got a ton of warnings and had to straight up sign a paper saying I knew it could cause permanent damage. This makes me wonder if he just didn't pay any attention, or if he went to really dodgy surgeons.

I find it extremely hard to believe he wasn't warned. I had PRK (in San Francisco) and had to sign my life away, was told over and over and over again about the dangers. Plus, 30 seconds on google and you get plenty of information.

I see these sort of operations as like buying safety gear. You don't skimp on price... or doctor quality. I went to several places first and got evaluated and then made an informed choice.

It took about 6 months for my eyes to totally recover due to the PRK, but oh wow, I'm so glad I did it.

Mind sharing where in SF? I live in SF too. (my HN username @ gmail)


The thing that sold me was that Dr. Faktorovich is well known in the industry and they use a newer version of the machine than other providers in SF.

Note: I get no referral credit, I also no longer live in the US.

Has anyone tried refractive lensectomy for astigmatism and/or myopia? Think cataract surgery, but for improving near/far sightedness, etc. So you end up with artificial intraocular lenses.

It costs about double what LASIK does, but doesn't seem to have the side effects.

My father had it done due to cataracts, and was satisfied with the artificial lenses and resulting vision.

I had PRK done instead of LASIK (the top layer of the cornea is discarded [it regenerates] instead of being cut and lifted prior to abalation; recovery time is longer, but corneal integrity is preserved) 8 years ago. The recovery time was a few weeks, but I had no LASIK side effects. I highly recommend it versus LASIK.

Did the same. I really think it’s a pay now or pay later affair. PRK was a more painful recovery for sure, but I’ve had no issues and no restrictions.

I healed very quickly. I did a review of medical research and did a few things to make PRK better for me:

1. Vitamin C supplements leading up to and after treatment. Reduces risk of corneal haze (though risk is very low with modern PRK which uses Mitomycin off-label for prevention)

2. Extra omega 3 supplements before and during recovery. Keeps the tear coatingon your eye from evaporating / breaking up as quickly which supposedly shortens re-epithelialization time (the epithelium is what is removed on the surface of your cornea).

3. Wetting drops way more frequently than the minimum that the doctor prescribes. You basically can’t use these fast enough for the first few days. The wetter the surface of your eye, the faster the regrowth of your epithelium (fun fact: this is the fastest growing tissue in the body—at least according to the surgeon who did my eyes).

Also, pick a surgeon with the latest and greatest laser. I believe the latest ablation tech had some benefits from an optics / recovery perspective.

All great points!

I had cataract surgery done. For cataracts. At age 42.

The doctor was able to correct out something like -12D myopia in both eyes with a precision that was mainly limited by the fact that lens implants only come in 0.5D increments. She was also able to use a laser to ablate the cornea in a way that corrected out astigmatism. In the span of two relatively brief surgeries, I went from >35 years of needing to use glasses to now, where I'm typing this post without any external correction at all. It's an amazing result, particularly considering the risks involved with such a high degree of myopia.

That said, I'd never do it just for the purpose of correcting nearsightedness. The implants work, but you mostly lose the ability to focus. There are ways around this, but the technology is still relatively new, and carries with it risks of visual artifacts. There are also the literally 500 eye drops you have to take and risks of various complications during surgery. (One noteworthy risk is that if the lens's bag ruptures during the phacoemulsification, the lens drops into the posterior chamber of the eye and requires a vitrectomy to retrieve.)

It's an amazing procedure, I'm thankful to have had the option to have it done, but I wouldn't recommend it unless and until you absolutely need it.

My mother had it done. Side effects are mostly limited to eyes so dry she needed her ducts plugged to retain fluid and no/ limited night driving due to halos.

With all of that said, compared to the coke bottle glasses she had before, I don't think she would have done anything differently.

Me, I can still comfortably wear contacts (astigmatism is mild enough) so she suggested that I not get it.


I had LASIK and PRK.

Dry eyes? Check Can’t see shit in low light? Check Weird itchy feeling? Rare, but check

It’s still a huge improvement over glasses or contacts. I probably ha e 5-10 years left before I need glasses again due to old age but I’ll enjoy it until then.

Maybe it's because I've been wearing glasses for literally as long as I can remember, but wearing glasses sounds much better than dry eyes and loss of night vision.

I feel the same. Glasses are such a minor inconvenience that I don't think I'd risk even a 1% chance of complications.

What kind of glasses are people wearing that makes it worth the substantial risk that they'll end up with chronically dry eyes. Especially when you'll he wearing them again anyway in a decade or two.

The inconvenience of glasses are relative. Before I had LASEK/PRK done, I had a very strong astigmatism and mild case of nearsightedness. Combined, I basically couldn't make out much of anything more than ~6 inches from my face.

I didn't mind wearing glasses at all, or even contacts (although they caused dry eyes). What I minded the most about glasses was my dependency on them, and the fact that I'd be dead in the water if anything happened to them. Having a contingency plan was a part of everything I did; having a second pair on me, avoiding activities that risked my glasses if I didn't, dealing with them at the beach/pool/water activities, etc. I went through a lot of glasses growing up, and also had several ruined vacations and social situations due to something happening and becoming a lame duck reliant on other people to get me squared away. Although not consciously, I very definitively became more risk averse over time to avoid those situations.

The most profound impact of getting eye surgery was the complete and utter removal of that dependency, and the cognitive overhead that came along with it. Not that it seemed like a big deal at the time, as I spent decades accounting for it. But now I just don't think about my eye sight anymore. It's a small and subtle thing, but profoundly impactful on my quality of life in a way that I didn't even realize prior to surgery.

And when I have to start wearing glasses again, it'll be contextual need due to gradual degradation of my eyesight rather than an absolute dependency on them for every aspect of my waking hours.

I'm not sure I'd have made the same decision if eye surgery would have only been an incremental improvement in vision for me, but wanted to provide some insight into why some people would choose eye surgery, even with a high potential of side effects.

My vision is also bad enough that I basically can't function without glasses.

I always have a backup pair with me in the car, and I take 2 backup pairs on vacation, usually packed in 2 separate bags.

I also take spare shoes (even for day trips) because I can't buy another pair easily if something happens to mine--they don't sell shoes big enough in normal stores.

You obviously evaluated the risks differently, but to me not needing to pack an extra pair of glasses isn't worth the substantial, potentially life altering risk of severe dry eyes (not to mention blindness).

A few weeks ago I had an eye exam, and was starting to consider getting some kind of corrective eye surgery done, but this article gave me pause. What's really so bad about wearing glasses? I've worn either glasses or rigid contact lenses all of my adult life and most of my childhood so I'm used to it. I've adapted to whatever inconveniences and difficulties come from needing vision correction.

I know some people who've had the surgery, and who are happy with it, but it's not for me. I find disturbing the casualness that patients and medical practices have approached this kind of eye surgery. The rapidity of the procedure and the short recovery times, makes it easy to forget that this is major elective surgery on a vital organ. There's just too much that can go wrong. Glasses are a bit annoying, but that's the limit of it. I don't want to be reminded everyday how good I had it back when I wore glasses, as I put in eye drops every 15 minutes for the rest of my life, or have to have someone drive me around at night, or whatever else could go wrong. Medical procedures become more refined, safer and less invasive all the time. I'll wait until surgery is a necessity and enjoy the benefits of years of medical advancements between now and when that time comes.

I actually like my glasses! I like wearing them, and only rarely do I dislike having them. Maybe it is because my vision is not that bad without them. I can imagine that if it was worse I might hate them more.

You don't have to take them out and put them back in, clean them, etc. You don't have to worry about having the correct lens in each eye.

You don't have to buy them. Regular disposables are very cheap, but toric lenses are not cheap.

I am now at the point where I do need basic reader type glasses.

In most other ways, my vision is good, and I don't have night artifacts. Would take a lot for those to be worth it.

After using them for a while, I agree.

I had ICL done about 4 or 5 years ago. Wasn't a good candidate for either LASIK or PRK due to severe astigmatism. ICL is a lot like cataract surgery, but instead of replacing the lens, they implant what amounts to a permanent contact lens behind the iris and in front of the natural lens.

Ive had really good results from it. 20/15 after 5+ years. I still have effects from the astigmatism, but less than I was wearing glasses/contacts, really only a problem when fatigued. I'll need reading glasses as I get older, but for now, its beautiful.

They did mine in 2 stages, one eye at a time over 4 weeks. Normally recovery is pretty quick, but I had a lot of swelling in my first eye done (anesthesia wore off in the middle of the procedure), I was blind for 3 weeks in that eye as the swelling came downm. Second eye I had nearly perfect vision straight out of the OR. The preop work is pretty painful as they use a laser to zap blood vessels in the iris to allow it to dialate enough to insert the implant.

There are side benefits, too, such as full UV A & B protection for the retina.

It's expensive, like $4500 per eye, but still probably the best money I've ever spent on myself.

I’m curious, what’s better compared to contacts? I idly considered surgery for a long time, but then I tried contacts and they’ve been great. I realize they’re not great for everyone, is it just that?

I've been mildly curious about this question as well. I appreciate that not all people can or are comfortable wearing contacts. And glasses are a pain for a lot of active pursuits, at least for me.

But I've been wearing contacts for decades and they're still improving. (The type I was wearing for ages stopped being manufactured a couple years back and I switched to new highly permeable lens. What I had been wearing was fine but the new ones were even more comfortable.)

The only downside for me is that I now need reading glasses when I'm wearing contacts--which I don't when I'm not wearing them. May look into multi-focals next time I'm getting checked.

Why doing both? I was considering PRK as it seems safer than LASIK.

After a couple years, I started to have astigmatism in just one eye, so I had PRK done on that eye.

I had PRK done at Stanford about 10 years ago, right around. I wasn't a candidate for Lasik for a reason that I can't quite remember (thin corneas? large pupils?)

For me, it was a complete success. Healing took about a week (PRK takes longer than Lasik). It was painful during the healing, but afterwards there have been no issues at all. No night halos, no dry eyes. Everything has been great.

I "couldn't" wear contacts, which affected my decision to get the procedure done. I had astigmatism in my left eye that was "half and half" right across my cornea. Spherical astigmatism on one side, cylindrical on the other. Given this description, I'm still kind of surprised that glasses worked well for me, but they did. Because of this strange shape, even though contacts worked to correct my vision, I just couldn't stand to have one in my left eye. It always felt like I had something stuck in my eye.

> 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.

If that's actually the case across the full population of Lasik patients that's insane.

Could be a misleading statistic. What if the discomfort goes away after a week in 95% of patients?

Instead of LASIK I got Visian ICLs and am pretty happy with them. Going on 3 years now.

My eyes feel dry occasionally and for the first year or so I had night halos, but things have mostly settled down now.

I think most of the light distortions came from the iridotomy procedure rather than insertion of the lens itself.

Anyone here wear the contact lenses that reshape your eyes at night and then during the day you have corrected vision and no lenses? Mostly I don't mind glasses and contacts, but there are some activities I'd rather not have to rely on them.

I wore them for about 10 years, from 11 to 23. They were great and stopped my eyes from getting any worse, but I ended up getting PRK ~5 years ago which has been worth it overall (exacerbated my dry eye and led to an one eye ulcer from reading too much).

The main issue is the paranoia of sleeping with them on and knowing that if you rub your eyes, it's possible for them to break and cause serious damage. I'm not sure how likely it is, but was a recurring worry and source of nightmares.

It's also something you have to do every day, otherwise it takes a few weeks for your eyes to return to the normal shape.

I tried corneal shaping (contact prescription was about -6.0 for both eyes), and stopped it after roughly six months and three different prescribed lenses. I wore the rigid lenses at night while I slept, and took them out in the morning when getting ready for work (6:30-7am).

I experienced some undesirable effects daily: vision sharpness was perfect in the morning, but would noticeably regress starting around 3pm; I saw halos at night; and the combination of progressively more blurry vision and halos made my night vision really suck. I wasn't comfortable driving at night, and seeing stars in the sky was impossible (maybe sounds silly, but I found that to be a quality-of-life issue). Also, I think the area that could be treated was narrower than my field of vision, similar to how glasses treat a narrower field than regular contact lenses.

Turns out my pupils naturally dilate far more than the average person's (so the halos were partially treatable with brimonidine daily), and my cornea either isn't thick enough or reshapes itself too quickly -- or both, can't remember exactly. Whatever it was, I remember my doctor saying that I would probably experience similar undesirable side effects were I to get Lasik.

This sounded pretty cool so I googled it. The proper name is Orthokeratology.

I know it as Corneal molding.

Yes. It works great. It doesn't have all those complications, it's much cheaper, and it's trivially reversible — just stop wearing the contacts.

Most people here would probably be better off with ortho-k than with LASIK, so long as their myopia isn't severe.

My understanding is that LASIK is sometimes held up as an example of the triumph of the free market, and that costs fell more dramatically, and serious complications fell more dramatically, than just about any other procedure that you can name.

Sure, glare and halos sound awful, but compared to the most serious early risks such as blindness, it sounds like the situation is indeed much improved.

However, given what we know about markets, I wonder if there's been any attempt to figure out if, for instance, poorer patients going to cheaper clinics with older machines are the ones faring the worst. I suspect that is the case.

So I spent top dollar on my LASIK and I have night time glare.

That said - completely worth it. It's a tradeoff I'll make every single time.

At my last job, there was a girl who had probably the worse case scenario: She got LASIK then 5 years later here eyes reverted back and she needed glasses again.

What does she say? Best 5 years of her life, would do it again in a heartbeat if she could.

Worst case? Did you read the article? That’s absolutely not the worst case.


Scott Petty, 36, a 3D artist from Houston who developed video games for a living, was diagnosed with corneal ectasia six months after having Lasik surgery.

His sight has continued to deteriorate, even after he underwent a new procedure called corneal cross-linking to strengthen his cornea. He is in so much pain that he is “almost suicidal,” he said. “It’s like hot grease is in my eyes, 24-7. I pretty much have to admit my career is over.”

That is awful, but so are car accidents, and most people still think automobiles are worth it.

The question is the relative risks and the relative benefits. This procedure appears to have more benefits and less risks than most comparable procedures.

That’s fine, but irrelevant. The parent described a “worst case” scenario which was clearly not even in the ballpark.

The obvious difference is you have to drive a car but you dont have to do Lasik - you can just wear glasses.

Modern civilization is a triumph of the free market.

An elective procedure which very likely adds lifelong negative side-effects?

Doctors do no harm unless absolutely necessary. Lasik surgeons know of these life-altering negative symptoms and still happily take your money to give you your dream realized. As their industry exists right now, they serve consumers, not sick patients. Lasik surgeons must not consider themselves a doctor, so don't trust them like they are one.

It doesn't matter which eye surgery is used, ocular surgery destroys nerves in the surface of the eye which are essential for communicating to the rest of the body the needs of the eye, like adjustments to tear composition to ensure tear quality necessary for maintaining ocular health.

Negative side-effects may be just an inconvenience for a few decades, but they can easily turn into terrible complications should your body's general health degrade such that slightly inconvenient eye symptoms becomes chronic eye pain.

For dry eye pain, there is no known cure. Dry eye pain can only be mitigated, but never cured. Dry eye pain causes tension in the muscles in the head and neck which can be triggered to form severe headaches. The muscle tension caused by dry eye pain can trigger psychological changes such as anxiety, chronic bouts of drowsiness, decreased stress tolerance, and heart palpitations. Chronic pain, such as from dry eyes, can cause chronic physical exhaustion.

The Lasik/elective eye surgery industry is terribly wealthy, and its side-effects is not well understood and suspicious. More research is necessary to determine exactly the scope and severity of its long-term side effects -- there really is very little data here and that should be terribly concerning for a procedure which is sold as incredibly safe.

Be skeptical of it and support predicating its growth on further research of the scale, scope, and severity of its side-effects.

If you're considering having a Lasik-like procedure performed on your eyes, first join a Lasik complications group/forum on the internet. In addition seek third-party research which attempts to assess the true scale of complications and how to cure those complications should they arise in you. It's far more than 1-2% which have complications, think closer to 10-30%.

Bad news travels around the world before good news even has its shoes on... Except for Lasik. Anyone who's had a friend who had the surgery knows what I'm talking about. They can't stop expressing about how awesome it is, and why haven't you gotten it done yet! I'm honestly surprised there's less than a million operations a year with all the evangelical patients out there. Personally, I'll wait a few more years until the lasers are so good and automated they install them at your local pharmacy next to the blood pressure machines.

My pupils are very large. I held off on LASIK for a long time because it seemed like it wasn't well understood. Then I considered getting it about 10 years ago and there was ample evidence that large pupils were associated with negative results (halos, stars, night blindness, etc -- all the stuff mentioned in this article and elsewhere). I'm very glad I didn't get it. It still surprises me that they wouldn't simply increase the area of the operation, but perhaps there are technical reasons why this isn't possible.

Many years ago when I was thinking of getting it done I was told by the sales rep/doctor (I forget) the machines are limited in range. Women tend to have larger pupils than men apparently this wasn't thought of during the design phase. Kind of weird to go through all that trouble of designing and building a machine that needed just a few more millimeters of range. I passed on the procedure.

Tangentially - there was something I heard on the radio recently that drug testing was restricted by the FDA about 30 years ago to men only due to unforseen side effects possible in pregnant women, and medical companies took the shortcut of just limiting testing to men wherever possible and lifting that thought process is still an ongoing effort. It even impacts animal testing where they might test something mostly in male mice.

I'd like to see some more statistics backing this article, as well as real evidence. Who are the doctors that these people are seeing? Is the survey only finding the population of dissatisfied people?

I got PRK a year ago and have zero issues, and I've also never been sent a survey from NYT asking if I have problems. I know 11 people who got LASIK/PRK and no one has reported issues yet.

There's no way a procedure that causes issues in 50% of cases would be legal in the States.

My eye doctor basically told me that I should never do lasik and should do PRK instead. The risk of complications is WAY lower, even if the recovery is a pain.

The biggest problem for me was that one of the temporary protective contact lenses that they give you after the surgery came out after a couple of days.

It was the most painful experiences of my life, absolutely execrutiating. A friend rushed me back to the clinic where they replaced it, and put me on some painkillers that pretty much knocked me out for a couple of days.

Other than that, no regrets, my quality of life is much better since I had it done.

I'm considering eye surgery. I'm mildly farsighted and have strong astigmatism, so I'm not suitable for LASIK and have been recommended Implantable Collamer Lenses (ICLs, sometimes known as contact lens implants).

I'm very interested to hear from people that have had positive LASIK experiences or even an ICL procedure done. So far on this thread it's mostly negative.

I feel like I’ve heard similar statistics before and they completely dissuaded me from ever desiring lasik. Minor eye issues would definitely cause me great stress - I developed a somewhat prominent vitreous floater three years ago and it still sometimes bothers me intensely.

I have no evidence to back this up, but I'm guessing many of the these complications come from the discount LASIK centers that offer very cheap surgery prices.

I can't understand why anyone would have eye surgery at some place that advertises $600/eye on the radio.

I paid $4200 for my LASIK surgery after researching it thoroughly, verifying that it was appropriate for my vision problems and deciding to go with a research hospital that had the latest technology at the time. After my eyes healed in the first few days, I've had zero side-effects and it's been almost 10 years now.

I highly recommend the surgery, but I always tell people not to go for the cheapest option.

> I have no evidence to back this up, but I'm guessing...

I don't understand. You have admittedly have zero evidence that paying less for a LASIK procedure results in more complications, yet you seem to have a very strong opinion about it. What does the cost of the procedure or advertising techniques of the practitioner have to do with the quality of outcome? If you get a great deal on a new car, do you think that car is going to break down more often than one that cost the sticker price?

I think it's pretty obvious that on the whole, quality is generally proportional to cost.

There are plenty of times when I choose the cheapest option, but surgery that permanently affects the rest of my life is not one of them.

Additionally, I would say that buying a used car is a more apt analogy since new cars don't usually differ in any way. Different surgeons use a variety of different equipment and have widely varying levels of experience. If I saw a used car that was well below market price, I would be suspicious that something was wrong with it.

> I think it's pretty obvious that on the whole, quality is generally proportional to cost.

There are numerous examples that this is not true, and is a very common consumer misconception. If you found a LASIK place that charged $50,000 for the procedure, doesn't that make it a better quality procedure by your own definition? What about $500,000? Expensive wine comes to mind. It's easy to find examples of consumer perceived value in the wine industry. I can get a $20 bottle of wine at Costco that costs $40 at a nice restaurant. I'll still pay the $40 because it adds to the dining experience, but at the end of the day I'm drinking the same $20 wine. Natural diamonds have massive perceived value but you can get a lab produced, flawless version for a fraction of the price. Consumers put a higher value on natural diamonds because of clever marketing and decades of supply chain manipulation to make them seem rare.

> Different surgeons use a variety of different equipment and have widely varying levels of experience.

That's true and definitely something to consider other than just the cost. The cost of something shouldn't be the sole indicator of the quality, so telling people to stay away from cheap LASIK centers solely on cost is not giving a complete picture. It's going to vary from center to center often times regardless of cost. Here's a good read on perceived value: https://moneyandvalues.blogspot.com/2008/03/psychology-of-mo...

I'm surprised that the Bates method alternatives haven't been mentioned yet. I picked up a book called "Better Vision Now" several years ago and started practicing what looked like the more practical exercises in the book, very infrequently, and all the while still abusing my eyes with excessive reading and computer work.

I went from needing a -2.25 prescription to a -1.00 when I went back to the optometrist a few years later, but I think the most important decision was to stop wearing eyewear altogether during the day, except for driving.

Let's get more balanced view on Bates' method... https://www.quora.com/Does-Bates-Method-work

I remember reading about a procedure where you surgically insert a lens into the eye to correct the vision, and one huge benefit was the process is completely reversible compared to Lasik.

Seems like a much better option?

refractive lens exchange ? no idea if it's better https://www.google.com/search?q=surgical+lens+implants&oq=su...

I had PRK almost exactly a year ago. I choose it over LASIK for less chance of dry eyes since I live in a very dry climate (Colorado). My vision is passable 20/15 and solid 20/20 which is great but my night vision is terrible. While I don't outright regret the surgery I don't know if I'd make the same choice knowing what I know now of my outcome. I just ordered some glasses with the hopes that they'll increase the sharpness at night just enough to make driving feel safe again.

I looked into LASIK a long time ago, but I wasn't a candidate at the time because of my large pupils. Even then, the starring and glare-sensitivity issues were well known, and the recommendation for PRK instead almost as much so. I know several people who've had LASIK and love the results, but not for me thanks. At my age (53) the only option I'd even consider is ICL, because it's easily redone as eyes continue to change, but even that doesn't really seem worth the risks.

So, this poorly written article at least sparkled a good discussion here on HN.

I have an "Ask HN" for you here: it's the year 2018, I am 41, live in Bay Area, have myopia (~2 sx and ~3 dx), and have pondered doing surgery.

What's the absolute best option I have? Is it LASIK? Are there different types of LASIK? I spoke with two eye doctors in the past 5 years, and none of them managed to either convince me, or to clarify the various pros and cons of different approaches. (p.s. I really hate the US healthcare system).

Thanks for any help!

There is an alternative to Lasik. It is a new generation of PRK. the difference is you dont get a flap in the surgery and instead they burn and take away a layer from the eye.

The type of surgery I had done was TransPRK.

The benefits are less halos, extreme acuity and perfect dark sight.

I have no halos, no dryness and see better in the dark than before.

The healing process takes a bit longer than Lasik. You need to wear a contact lens for two weeks to protect the new layer growing over your eye. During this time your eyesight fluctuates and there is some nausea associated. This was thoroughly explained to me and I had no problems since every day it got better.

On some days I can count leaves on far away trees. Read license plates on cars way ahead of me. I would do it again even if it cost triple.

The best option available when I started looking into this a year ago was ReLEx SMILE(Trans PRK being second, LASIK third). I have since had the procedure done (see my other comment in this thread for my experience but TL;DR is I highly recommend it).

From what I remember LASIK is the oldest method with the highest chance of complications and side-effects and longest recovery period.

Trans PRK is the least-intrusive procedure because they don't touch your eye during the procedure but is more painful after the procedure and you have to wear protective contacts for 2 weeks.

ReLEx SMILE is 'latest and greatest' and has the quickest recovery period but is the most expensive option.

Thanks to both for the info! Will do some more research now.

I have a very bad shortsightedness and this is the thing that always kept me from at least trying to pursue a career as a professional pilot. Now that I begin with my private pilote license, I decided to never to LASIK in order to avoid the risks. I have perfect vision now - as long as I wear glasses and I will be able to fly night and day with it. But I really fear about unforseen consequences of the LASIK treatment in my case.

I didn't read all the comments - but it should be pointed out that Lasik and PRK are 2 different things.

With PRK, the laser burns off the whole top of your eye. In Lasik, they just slice the top layer of your eye, peel it back, then laser underneath, then pull the flap back down.

I am wondering if this study only focused on lasik, or also looked at PRK.

Anecdotally, I had PRK and it was one of the best decisions of my life.

I've always been surprised that people are willing to do LASIK. Maybe I've just been very lucky with contacts, but I notice pretty much no life difference versus before I needed contacts or glasses, other than the need to find contact solution to store them in at night. Nowhere near inconvenient enough to get me to consider carving my eye up with lasers.

I had PRK, which is different but similar results. Two things I definitely noticed were worse night vision, and light sensitivity. I'm in my 30s and have developed floaters recently, but I can't say that's related at all. Would I do it again? ABSOLUTELY. The benefit of clear vision absolutely outweighs the minor annoyances.

If people would learn about how to reverse their myopia before doing crazy surgery like Lasik’s there would be less problems. It took me 1 year to reverse it and I know most people are too lazy to do the research so I try to ignore posts like that but it’s not that easy...

I sometimes wonder about Lasik. But you only have only one pair of eyes. It's weighing a small improvement in daily life vs an uncommon but serious deterioration in daily life. When one of the people who originally approved it at the FDA is saying he regrets it that says something.

Cost of LASIK Eye surgery in India can range around INR 10,000 to INR 1,50,000 approximately. https://www.medifee.com/treatment/lasik-cost/

Lasik is one the best decisions i've ever made for myself and honestly any person i've ever talked to feels the same way. This is totally anecdotal and a small sample size but i'll say as someone who's had lasik I would never go back.

had LASIK two years ago. dry eyes and starbursts quite a bit in the first 6 months, but the dryness is gone now and night time vision is good. I can live with very minor starbursts/halos at night that don't interfere with my vision vs having contacts or glasses. the procedure got me to 20/15 and I'm seeing more clarity than I ever did with glasses or contacts.

I was told about still requiring reading glasses when you hit a certain age because that's an entirely different condition and sometimes people confuse that with the procedure having failed them later.

I should add that I was an excellent candidate with plenty of corneal tissue and the procedure was using the latest equipment and techniques. The place I went to was reputable and turned a lot of people away because they were not good candidates. I wonder if any less reputable places are performing the procedure on higher risk people and this contributes to an increase in serious side effects?

Horror stories like these have scared me away from ever getting LASIK, even though I'm apparently an ideal candidate. Vision is such a important sense, I would never want to risk damaging it.

I had LASEK, it’s incredible. No side effects, and from what I can tell, LASEK has a much smaller risk profile vs LASIK as no flap is cut.

My nyc surgeon is the best. If you’d like an intro, email me. A@175g.com

I had LASEK in one eye. It was so painful that it took years to do the other one - I picked PRK the second time. LASEK was easily the most pain I ever experienced. But it worked very well.

How does it compare to PRK?

PRK is very similar to LASEK.

In PRK, the outer layer ("epithelium") of the cornea is removed chemically, and the laser ablates the surface of the eye. Over a few days the layer grows back.

For LASEK, the outer layer of the cornea is peeled away. The laser ablates the surface of the eye, and the skin is pushed back into place.

For both of these, there is no flap. The cornea retains its original structural integrity. PRK and LASEK are quite similar in process and outcome. PRK is a faster procedure and gives the patient less discomfort. LASEK has a slightly lower risk of corneal haze.

Having experienced both... I'd never choose LASEK again.

According to a text from my surgeon.

“LASEK is ASA or Advanced Surface Ablation. PRK is the old painful kind of surface ablation prone to scarring.”

It's the same thing with a different marketing name. PRK / LASEK is much more painful (1 week of pain over 36 hours), but has fewer complications, especially for martial artists.

I had LASIK two years ago, and it was the best money I have ever spent.

It was made clear that I will likely return to glasses as I age, but I’ll hopefully make it another 20 years.

> two years ago

Ok, so let us know how it goes in 20 years.

I had LASEK 13 years ago and it still goes smoothly. I'm now 52 so I have presbyopia but, beside that, I still have almost perfect vision. The only drawback is that, as other also said, the pain in the immediate after surgery was horrible.

I had PRK last year. It's awesome.

Dry eyes? Yes, rarely

Sensitive to light? Yes, constantly

Totally worth it

I experience the shitty night vision (bad glare, halos, and huge starbursts). But still am very happy with this over contacts/glasses

It's quite miraculous.

Can we ban propaganda sites from HN? They are almost never focused on technology and the headlines are clickbait.

All "news" sites should be banned. Or you should allow breitbart stories too. They are all the same thing, propaganda for the far left or the far right.

This is a public health risk that doesn't get a lot of attention, as I see it. It's good to occasionally post stuff like this.

If it was a well-known/often-posted topic, however, then it's ok to consider what you suggest.

Oh great, somebody at the NY Times wants to ruin Lasik for us all too.

This is clickbait FUD. I got lasik last year, and I was very clearly warned about the possibility and likelyhood of every single side effect in this article, aside from the "seeing triple" one. (It worked great for me, incidentally.)

I had Lasek/PRK 4 years ago with one of the UK's top surgeons. Happy with the results.

In my understanding, Lasek/PRK is the method whereby instead of cutting and lifting a 'flap' to laser beneath it before replacing the flap, the surgeon basically obliterates the surface of the eye, which then heals up over a week.

With Lasik (flap method), you're supposed to be back to normal within hours, which makes it a more popular method. Lasek/PRK had me in bed for a week and virtually blind for the first 3 days while the eyes were healing.

Nonetheless I have 20/20 vision, 4 years later, with no complications. I went from -9 (severely myopic) to perfect vision.

Best decision I ever made and I'm so happy I didn't go with the more popular Lasik option.

Caveat emptor Mr. Ramirez. Of course you shouldn't trust the seller of the product to tell you all about the product's downside with all the proper emphasis. The information in this article isn't "coming into sharper focus" just now. Stories like yours were already easy to find on the internet more than ten years ago when I investigated this for myself. I visited several gung-ho eye surgeons. Then read enough online to know that there are serious risks of not very uncommon results, especially for those who particularly value their fine vision. Then I spoke to the surgeons about these risks and they were quite open about them and not at all dismissive. I decided not to have Lasik. My brother went ahead with it and regrets it not at all.

No matter how much trustworthiness and gravitas your doctor exudes, and how much they dismiss pecuniary details, they see the evidence of risk through their own strong incentives. You have a duty to yourself to use their advice as just one part of the puzzle.

Guidelines | FAQ | Support | API | Security | Lists | Bookmarklet | Legal | Apply to YC | Contact