WHAT COMPLICATIONS ARE THERE WITH LASIK?

LASIK is a popular procedure to correct certain vision problems such as short sight, long sight and astigmatism. In the United States, doctors perform around 600,000 LASIK surgeries annually, with over 19 million procedures done since it was FDA approved in 1999. However, a recent New York Times article highlighted research on the potential complications of LASIK, including issues such as eye pain, dry eyes, double vision, and problems with night vision. Read further to learn who are candidates for LASIK, when it is not recommended, and the possible complications.

How vision works

To understand how LASIK works, we first need to know how vision functions. Light initially enters the pupil, is bent or refracted by the cornea, then by the lens, and is focused on the back of the eye or the retina. A signal is then sent from special cells of the retina to the vision centers of the brain, where an image is formed.

What is LASIK?

LASIK stands for Laser-Assisted In Situ Keratomileusis. It is a form of surgery that involves altering the shape of the cornea utilizing a type of laser. This procedure was developed to treat certain problems in vision due to refractive errors of the cornea. The surgery makes a permanent alteration to the shape of the cornea in an attempt to improve how light rays pass through the cornea, lens, and onto the retina.

The basic LASIK procedure involves the surgeon cutting a piece of tissue (a flap) in the front part of the cornea. A laser is then used to carefully change the shape of the cornea. The flap is then placed back.

Who could get LASIK?

People who are 21 years and older and who have the following conditions can potentially qualify for LASIK:

• Astigmatism: This is when the cornea does not curve correctly, causing vision issues.
• Myopia: This is near-sightedness, which is when the light focuses before the retina. People with myopia may have an unusually long eyeball.
• Hyperopia: This is far-sightedness, which is when the light focuses beyond the retina. This could occur if the eyeball is not long enough.

Note: Patients need to be aware that certain additional conditions or factors may make the procedure risky. These are listed in the section below.

Who should not get LASIK?

If you have any of the following conditions, then it is recommended that you should not get LASIK:

• Severely dry eyes: In some cases, LASIK is known to cause dry eye symptoms after surgery. Hence, those with pre-existing dry eye may experience worsening symptoms.
• HIV: LASIK is contraindicated for patients with AIDS due to risks of infection brought on by immunodeficiency and viral transmission through the laser.
• Weak immune system: This can be due to a person taking immunosuppressant medications. The procedure is not recommended for those with compromised immunity due to the increased risks of infection, impaired healing, and complications.
• Autoimmune disorder: Rheumatoid arthritis and Lupus. These disorders result in a poor outcome with LASIK.
• Connective tissue disorders: Ehlers-Danlos syndrome (EDS) can result in a rare complication called corneal ectasia when LASIK is performed.
• Vision changes due to pregnancy or medicine: Such changes may be temporary and, thus, may not be an accurate reflection of a person’s normal vision.
• Cataracts: This is when the lens of the eye clouds over due to unusual deposits on the lens; this results in hazy vision. LASIK addresses the cornea, whereas cataracts affect the lens. Therefore, the procedure will not correct the blurriness caused by cataracts.
• Glaucoma: High eye pressure (intraocular pressure) is often linked to glaucoma. People with glaucoma are typically not recommended LASIK surgery because the suction device used on the eye to create the corneal flap can briefly cause a significant increase in intraocular pressure.
• Epithelial basement membrane dystrophy: EBMD is known to increase the risk for corneal epithelial defects, a common complication of LASIK surgery.
• Herpes simplex of the eye: Studies show that in rare cases, refractive excimer laser procedures can reactivate the virus in those with a history of HSV infection and cause flare-ups.
• Eyelid disorders: This is a contraindication for LASIK because it can increase your chances of developing an eye infection after the procedure.
• Eye injuries: Odds of infection and inflammation are increased if an injured eye is treated with LASIK. Vision problems due to an injured eye may also only be temporary, making it difficult for the doctor to know how best to shape the cornea.
• Cornea that is thin or bulging: The cornea has to have sufficient tissue and be thick enough for the procedure to work properly.
• Corneal inflammation: An inflamed cornea cannot be treated with LASIK because the inflammation could worsen and likely increase vision problems.
• Strabismus: Crossed-eyes are sometimes a contraindication for LASIK, but it depends on the type of strabismus. An ophthalmologist can advise you on the best options for your particular case.
• Certain medications: Specifically, Amiodarone hydrochloride and Sumatriptan, which cause eye problems or worsen LASIK results.
• Uncontrolled diabetes: If your blood sugar is poorly controlled, then LASIK should not be performed. However, people with type I diabetes may qualify for LASIK depending on how well their blood sugar is controlled.

Complications of LASIK

There are possible complications of LASIK, which may resolve over time. The FDA reports of depression in some patients due to LASIK-related complications. These complications include:

• Dry eyes: Dry eyes remained a problem for 30% of patients after LASIK. The FDA found that 17% of patients still struggled with this issue 5 years post-LASIK. To some extent, this problem of dry eyes can be treated with eye drops.
• Glare: This is when an excess amount of light enters your eyes making it hard to see properly.
• Halo: This is when you see a bright ring around objects in sight.
• Diplopia: Also known as double vision, which is when you see two of the same object.
• Astigmatism: The condition causes blurring of vision.
• Overcorrection: This is when a refractive error is altered more than needed.
• Under-correction: This is when the refractive error correction is inadequate.
• Flap infection: When LASIK is done, the surgeon cuts a flap in the cornea and then does the reshaping. It is possible that an infection could develop in this flap of tissue.
• Vision change: Vision may not improve in the way it is expected to, causing further issues.
• Problems with night vision: This is because, after LASIK, your eyes may be too sensitive to light.
• Vision loss: Loss of vision is a very rare complication, estimated at about 1%, but you should be aware that it is a possibility.
• Regression: The changes may not help long-term, and the person may end up with vision problems and need glasses and contact lenses again.

Is LASIK covered by health insurance?

It should be noted that LASIK is viewed as a cosmetic procedure since it corrects problems that can be addressed with glasses or contact lenses. Because of this, it is important to check with your health insurance provider if the treatment is covered or not.

Conclusions

There is much debate over how risky LASIK is, but 90% of people who have had it are satisfied with the outcome. Still, the FDA guidelines provide more detailed information and guidance for patients who are trying to decide if they should have LASIK.

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Sources:

• FDA (2022). FDA Seeks to Improve Patient Communication on LASIK Benefits and Risks Through Issuance of Draft Guidance. https://www.fda.gov/news-events/press-announcements/fda-seeks-improve-patient-communication-lasik-benefits-and-risks-through-issuance-draft-guidance
• Gauthier, A. C., Bower, K. S., & Singman, E. L. (2022). Outcomes and Complications in Patients With Hypermobile Ehlers–Danlos Syndrome Who Have Undergone Laser In Situ Keratomileusis Surgery. Cornea, 10-1097. https://journals.lww.com/corneajrnl/Abstract/9900/Outcomes_and_Complications_in_Patients_With.13.aspx
• Mayo Clinic (2022). LASIK eye surgery. https://www.mayoclinic.org/tests-procedures/lasik-eye-surgery/about/pac-20384774/
• Rabin, R.C. (2022). LASIK patients should be warned of complications F.D.A. draft says. New York Times. https://www.nytimes.com/2022/12/07/health/lasik-injuries-fda.html?smid=nytcore-ios-share&referringSource=articleShare

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