Case
A 28 year-old male was referred because of sterile infiltrates and peripheral pannus formation of 1-2 mm of both corneas. He was a long-term soft contact lens wearer, frequently slept in his lenses, and did not use a disinfectant. We instructed him to discontinue his contact lenses and prescribed a course of a topical steroid. The corneal infiltrates gradually resolved.
He was advised not to wear his contacts on an extended-wear basis and was given instructions on proper care. We also discussed the option of LASIK, but the patient was reluctant and made the following comment: “I understand the results are not proven, and the risk of halos and dry eyes are common.” We reviewed the LASIK procedure in detail with him and told him that his thoughts were contrary to the scientific literature as well as our experience over the past 30 years.
Dispelling the Myths of LASIK
#1: Eye surgeons don’t take advantage of the benefits of LASIK.
Not true. Over 60% of ophthalmologists eligible for LASIK have undergone the procedure. Laser eye surgeons are four times more likely to have had refractive surgery than the general population.
#2: LASIK is still a new and unproven procedure.
Actually, LASIK has been around for over 30 years and is proven technology. The current LASIK technologies provide better outcomes than ever before. There is a 10-year trend of continual improvement in visual acuity and in safety. New technologies introduced in the future may make LASIK available to a wider group of potential patients whose vision cannot currently be corrected with the procedure.
#3: LASIK results wear off.
Not true. Patients can obtain years of satisfaction without glasses or contacts lenses following LASIK. All patients with good distance vision, will require reading glasses in their mid-forties. If the eyes stay healthy without cataract formation, then distance can be excellent for years.
#3: Having vision corrected with LASIK is risky and can lead to vision problems in the future.
The vision risk with LASIK is low and has been shown to be similar to the long-term wearing of contact lenses. LASIK is considered one of the safest and effective procedures ever done.
#4: LASIK is only recommended for people within a narrow age range and a moderate level of myopia, hyperopia, and/or astigmatism.
The truth is that LASIK can be performed on patients from the age of 18 and up. There is no upper age limit provided the eyes are healthy. LASIK corrects the most common levels of myopia, hyperopia, and astigmatism. Patients with extreme refractive errors can be offered other options including a refractive lens exchange or an Implantable Contact Lens.
#5: Undergoing LASIK can compromise the results of cataract surgery in the future.
Cataract surgery outcomes are not affected by LASIK – in general, outcomes are excellent but there is a greater chance of requiring further laser enhancement after the cataract surgery if patients want to remain spectacle independent.
#6: LASIK is likely to affect night vision, causing halos and glare.
Long-term halos and glare after LASIK have been shown to be less than wearing contact lenses or glasses. In fact, LASIK can enhance night vision. In a study of pilots who land on aircraft carriers at night, 88% found their night vision to be better with no glasses after LASIK than with their glasses before surgery.
#7: Vision can be compromised if the eye moves during the LASIK procedure.
Laser technology has sophisticated space-age tracking ability, that senses eye movement and adjusts the treatment.
#8. Dry eyes are a common long-term complication after LASIK.
In fact, dry eyes are not a common long-term effect from LASIK. In two FDA-sponsored studies, only 3% or fewer patients reported moderate dry eye 3 months postoperatively, and 23% reported mild dry eye. By 6 months, however, dry eye signs and symptoms usually return to normal.
#9 A high percentage of patients say they regret having LASIK
This is false. Satisfaction levels are extremely high. Over 98% of patients said they would choose the procedure again. This evidence comes from a world literature review of LASIK, in which 2,915 abstracts and 97 peer-reviewed articles were reviewed, which included 68,000 eyes.
#10 The LASIK flap can become easily dislodged.
The LASIK flap is tough and is extremely difficult to displace except for during the first 24 hours postoperative. This is the time period that patients should refrain from rubbing their eyes and activities should be limited.
#11 The LASIK procedure is painful.
Patients are typically comfortable during the LASIK procedure. Anesthetic drops are very effective at controlling any significant discomfort. Patients may feel some brief pressure during the flap creation, but the excimer corneal reshaping is usually painless.
#12 Activities after LASIK must be limited.
This is untrue. There are no limitations in activity after LASIK. In fact, patients can resume normal activities within 24 hours. High altitude activities, like mountain climbing, can be safely performed after LASIK. It is safe to scuba dive following LASIK. Flying immediately after LASIK is fine. Professionals, sports, military and special forces have all benefited from LASIK.
#13 If the LASIK outcome is not satisfactory then nothing can be done.
This is false. 98% of patients do not require any additional treatment. 2% of patients may require a laser enhancement procedure to refine the refractive outcome. This is relatively easy to accomplish and has an excellent prognosis.
#14 LASIK outcomes are not dependent on the skill of the surgeon or equipment.
This is false. LASIK results are dependent on the skill of the surgeon and high quality, well calibrated lasers (excimer and femtosecond). These are essential elements in the success of any surgical procedure. The laser is one of the tools that the surgeon uses to perform the procedure. The surgeon must also create and manipulate the corneal flap, which is considered a delicate surgical procedure.
#15 LASIK outcomes utilizing a blade with a mechanical microkeratome are similar to that performed with a femtosecond laser.
This is incorrect. Modern day clinical studies have confirmed that the LASIK flap created with a laser offers superior results. Advantages include a more precise flap thickness, less long-term myopic or hyperopic regression, and a lower incidence of flap related complications. So called “cheap or discount LASIK” with a metal blade is not considered modern technology.
Case Continued….
The benefits and risks of LASIK were discussed with the patient, and he consented to have the procedure. The Intralase femtosecond laser was used to create a thin flap of 110 microns. A custom ablation was performed with the Allegretto 500 KHz excimer laser. There were no operative complications. Postoperatively, he achieved an uncorrected visual acuity of 20/20 + in each eye on the first postoperative day, which was maintained at one year. There was some minor dryness during the first month that was managed with preservative-free artificial tears. He was very pleased with his quality of vision during the day and night.
References
- Price MO, Price DA, Bucci Jr FA, Durrie DS, Bond WI, Price Jr FW. Three-year longitudinal survey comparing visual satisfaction with LASIK and contact lenses. Ophthalmology. 2016 Aug 1;123(8):1659-66.
- Sandoval HP, Donnenfeld ED, Kohnen T, Lindstrom RL, Potvin R, Tremblay DM, Solomon KD. Modern laser in situ keratomileusis outcomes. Journal of Cataract & Refractive Surgery. 2016 Aug 1;42(8):1224-34.
- Manche E, Roe J. Recent advances in wavefront-guided LASIK. Current opinion in ophthalmology. 2018 Jul 1;29(4):286-91.
- Chua D, Htoon HM, Lim L, Chan CM, Mehta JS, Tan DT, Rosman M. Eighteen-year prospective audit of LASIK outcomes for myopia in 53 731 eyes. British Journal of Ophthalmology. 2019 Sep 1;103(9):1228-34.
- Moshirfar M, Shah TJ, Skanchy DF, Linn SH, Durrie DS. Meta-analysis of the FDA reports on patient-reported outcomes using the three latest platforms for LASIK. Journal of Refractive Surgery. 2017 Jun 6;33(6):362-8.
- Sugar A, Hood CT, Mian SI. Patient-reported outcomes following LASIK: quality of life in the PROWL studies. Jama. 2017 Jan 10;317(2):204-5.
- Price MO, Price DA, Bucci Jr FA, Durrie DS, Bond WI, Price Jr FW. Three-year longitudinal survey comparing visual satisfaction with LASIK and contact lenses. Ophthalmology. 2016 Aug 1;123(8):1659-66.
- Zhou J, Gu W, Li S, Wu L, Gao Y, Guo X. Predictors affecting myopic regression in− 6.0 D to− 10.0 D myopia after laser-assisted subepithelial keratomileusis and laser in situ keratomileusis flap creation with femtosecond laser-assisted or mechanical microkeratome-assisted. International Ophthalmology. 2019 Sep 30:1-3.
- Zhou J, Gao Y, Li S, Gu W, Wu L, Guo X. Predictors of Myopic Regression for Laser-assisted Subepithelial Keratomileusis and Laser-assisted in Situ Keratomileusis Flap Creation with Mechanical Microkeratome and Femtosecond Laser in Low and Moderate Myopia. Ophthalmic Epidemiology. 2019 Dec 28:1-9.
- Qian ZG. Comparison of femtosecond laser or a mechanical microkeratome to create corneal flaps in LASIK for myopia. International Eye Science. 2019 Jan 8;19(1):121-4.