Advances in technology have erradicated many of the old complications, but some potential problems remain.
Last year the FDA in the US embarked on a study of quality of life for the popular LASIK procedure. This has brought renewed attention to the negative publicity. This type of publicity seems to come in waves, which might lead the public to conclude that refractive surgery is a procedure beset with ongoing complications. Yet leading surgeons contend that the reality is almost the polar opposite: serious LASIK complications have become rare and are growing more so every year. Here, refractive surgeons separate fact from fiction.
Better Tools
Many of the worst horror stories on the “LASIKRuinedMyLife.com”-type Web sites are attributable to mistakes that occurred in the earlier days of refractive surgery. A big difference between then and now, surgeons note, is the superior technologies available.
Better Drugs
Medications have also played an important role in reducing the incidence and severity of various refractive surgery complications. For LASIK patients, preoperative treatment with hyperosmotics is associated with a significant reduction in epithelial disturbances in patients over the age of 35 . For patients at risk for dry eye, many surgeons will prescribe cyclosporine two to three weeks preoperatively.
Better Techniques
But better refractive surgery results aren't just the product of improved lasers and medications. Inevitably, there is the human element. Drawing an analogy with golf. “You can be the world's best golfer, but every year — since young people are coming along, since expectations are high — you might need to take a quarter stroke off your average. You need to be that little bit better. And every year, do a little bit better. Because the technology improves a little bit, and the techniques improve a little bit and the knowledge improves a little bit.”
What Remains
The side effects, that remain for patients and surgeons to deal with are the following:
Dry eye. “We expect that some patients will have transient dry eye symptoms after surgery,” “It's part of the healing process.” This transient dry eye is not something that is characterized as a significant complication. However, significant dry eye symptoms that persist longer than one would expect of the normal healing process could be alleviated with punctal plugs, artificial tears, cyclosporine and
However, we need to point out that what many think of as dry eye syndrome is really a mild inflammation of the cornea, caused by cutting the nerve endings during refractive procedures. This condition gets better, he says. “The nerves grow back.”
But careful preoperative screening is still key. “If you look carefully, you'll sometimes see the patients who struggle a bit after surgery are the ones we were not as vigilant in screening out the potential for these problems beforehand,”
“A very carefully look at the cornea is crucial. Patients who have signs and/or symptoms of dry eye are treated until resolution; if it doesn't resolve, they are not considered appropriate candidates for LASIK.
While the technology has improved the architecture of the surgery, making intraoperative complications rare, post-operative complications such as infections
Night vision problems.
Last year the FDA in the US embarked on a study of quality of life for the popular LASIK procedure. This has brought renewed attention to the negative publicity. This type of publicity seems to come in waves, which might lead the public to conclude that refractive surgery is a procedure beset with ongoing complications. Yet leading surgeons contend that the reality is almost the polar opposite: serious LASIK complications have become rare and are growing more so every year. Here, refractive surgeons separate fact from fiction.
Better Tools
Many of the worst horror stories on the “LASIKRuinedMyLife.com”-type Web sites are attributable to mistakes that occurred in the earlier days of refractive surgery. A big difference between then and now, surgeons note, is the superior technologies available.
Better Drugs
Medications have also played an important role in reducing the incidence and severity of various refractive surgery complications. For LASIK patients, preoperative treatment with hyperosmotics is associated with a significant reduction in epithelial disturbances in patients over the age of 35 . For patients at risk for dry eye, many surgeons will prescribe cyclosporine two to three weeks preoperatively.
Better Techniques
But better refractive surgery results aren't just the product of improved lasers and medications. Inevitably, there is the human element. Drawing an analogy with golf. “You can be the world's best golfer, but every year — since young people are coming along, since expectations are high — you might need to take a quarter stroke off your average. You need to be that little bit better. And every year, do a little bit better. Because the technology improves a little bit, and the techniques improve a little bit and the knowledge improves a little bit.”
What Remains
The side effects, that remain for patients and surgeons to deal with are the following:
Dry eye. “We expect that some patients will have transient dry eye symptoms after surgery,” “It's part of the healing process.” This transient dry eye is not something that is characterized as a significant complication. However, significant dry eye symptoms that persist longer than one would expect of the normal healing process could be alleviated with punctal plugs, artificial tears, cyclosporine and
However, we need to point out that what many think of as dry eye syndrome is really a mild inflammation of the cornea, caused by cutting the nerve endings during refractive procedures. This condition gets better, he says. “The nerves grow back.”
But careful preoperative screening is still key. “If you look carefully, you'll sometimes see the patients who struggle a bit after surgery are the ones we were not as vigilant in screening out the potential for these problems beforehand,”
“A very carefully look at the cornea is crucial. Patients who have signs and/or symptoms of dry eye are treated until resolution; if it doesn't resolve, they are not considered appropriate candidates for LASIK.
While the technology has improved the architecture of the surgery, making intraoperative complications rare, post-operative complications such as infections
Night vision problems.
Night glare and halos after LASIK are now a rare problem. The most common cause, says Dr. Schallhorn, is uncorrected refractive error. Such patients are managed with glasses, contact lenses or retreatment. “What a lot of people see, when they are out of focus, is halo around lights,” However, glare or halos despite correction for sphere and cylinder can occur.
Epithelial ingrowth.
Epithelial ingrowth.
Corneal epithelial ingrowth is seldom a problem in primary LASIK cases, in large part due to the laser and flap side cut architecture. Patient one day post LASIK presented with pain, decreased vision and focal clustered infiltrates, some extending beyond the flap margin. These are warning signs of early LASIK-associated corneal infections, requiring flap lift, culture and scraping, antibiotic irrigation of the interface and intensive antibiotic therapy.
Ectasia — Still the Wild Card
The ultimate complication that remains, and that is sight-threatening is, of course, ectasia. “It is the one that scares physicians the most“If you get an ectasia, you think, what am I going to do now? Now the patient has an unstable cornea, and in the worst-case scenario, he'll need a corneal transplant to fix it.”And while collagen cross-linking has real potential to help patients who develop ectasia after LASIK, it's still not TGA approved in the Australia.“
I always mention to my patients that I am a great fan of Laser Eye Surgery for the right candidate. That is for an example, for someone in their 20's and 30's with no preexisting dry eyes or corneal contraindications and who are going to get a good 10 to 20 years before needing glasses again in their 40's. If the descision is made to go for a monovision correction after your mid 40's, then a proper trial of the monovision world must be trialled for at least a few weeks before making that descision.
David Nicolas
