Jan. 17, 2023 — Two years ago, Benjamin Wilbur had LASIK surgery to correct his vision. “I have three young children and I feel like I’ve been punched in the face a lot and my glasses have been knocked askew,” he said. He also doesn’t like his glasses “fogging up” while wearing a mask during the pandemic.
After a 10-minute consultation with an ophthalmologist, Wilbur, a 37-year-old New Jersey pharmacy investigator, was deemed a good candidate. For weeks after surgery, his eyes remained dry, which he treated with artificial tears. Within 6 weeks, he no longer needed them.
“I can drive within 24 hours and I have good eyesight,” he said. “I’ve gone back for regular checkups, the last one was 3 months ago – my vision is 20/15.”
Wilbur was pleased with the results. “I wish I had done it sooner,” he said.
LASIK, which stands for laser-assisted in situ keratomileusis, aims to permanently change the shape of the cornea (the transparent covering at the front of the eye) using a specific type of laser technology. LASIK is so popular that more than 500,000 American adults have had the procedure. But the FDA has recently begun to clarify its risks.
While most LASIK patients have experiences like Wilbur’s, the FDA last year Publish draft guidelines Seek advice from physician to warn patient of risks. The agency has solicited input from patients and doctors but has not released a final report. The proposed guidelines push for warnings about double vision, dry eyes, persistent pain and other problems. It even says people may still need glasses after surgery.
Lorrie Shank Tevebaugh of Texas-Aged 53, works in HR, was a LASIK patient, had a bad LASIK experience. Tevebaugh decided to have the surgery because she’s an “avid hiker and runner and spends a lot of time on boats” and wanted to do those activities without glasses.
She went to a reputable ophthalmologist and was told she was an ideal candidate for LASIK. “The surgery itself went very well,” she said.
But the next day her vision was still blurry and she started to experience eye pain. At her 24-hour post-op visit, she was assured her eyes would continue to improve over the next 3 days. Instead, her vision continued to deteriorate.
By the next week, she could only see shapes and colors. One of her eyes was swollen shut and she was in pain.She was diagnosed with central toxic keratopathya rare complication.
Nearly a year after the surgery, Tevebaugh is still battling the damage. Her cornea flattened. She wears special contact lenses that require a special liquid solution and bifocal lenses. She regrets having the surgery. “If I had heard about it in advance, I wouldn’t have done it.”
The impact of the FDA
According to Peter Hersh, MD, director of the Hersh Vision Group, director of the Teaneck Cornea and Laser Eye Institute in Teaneck, New Jersey, most people have no lasting side effects and the procedure works well.
“Technology has come a long way since LASIK was invented,” he says. “My concern is [the FDA’s guidance] Probably based on old data, there is currently little peer-reviewed literature to support it, and it shows a lack of balance. “
For example, what the FDA doesn’t mention is that more complex techniques have replaced the simpler procedures used in the past, said Hersh, who is clinical research This led to the FDA’s first approval of laser therapy to treat myopia in the United States in 1995.
How does LASIK work?
There are different types of laser procedures.
“In LASIK, the first step is to create a flap of skin using a device called a microkeratome, and then a laser is used to reshape the cornea, like the clear dome of a watch. After that, the flap is replaced and the patient takes antibiotics and antibiotics. inflammatory drugs,” Hersh said.
In another procedure, PRK (photorefractive keratectomy), Hersh explains, the top layer of the cornea (epithelium) is removed, like tiles are removed from a floor. It is done directly on the surface of the cornea. Afterwards, “a therapeutic contact lens (a type of bandage) is placed on the cornea to support the epithelial surface in healing and provide greater comfort.”
Sometimes, the SMILE (Small Incision Microlens Extraction) technique may be used. This involves reshaping the cornea by removing a microlens (lenslet) from the central corneal layer.
“Today, about 75 percent of procedures are LASIK and about 25 percent are PRK, depending on what’s best for the patient,” said Hersh, a Clinical Professor of Ophthalmology and Director of the Division of Corneal and Refractive Surgery at Rutgers Medical School.
Data from the patient’s exam is programmed into the laser, so the process is highly personalized — a huge improvement over the programs used to guide the process decades ago.
Who is a good candidate?
According to Hersh, the people who are likely to benefit most from LASIK surgery are:
- People with healthy eyes who want to reduce their reliance on glasses and contact lenses (possibly because of an active or exercise-oriented lifestyle)
- People who have intolerance to glasses or contact lenses
- People who wear prescription glasses but still don’t have optimal vision
“Some of the things we look for are making sure the cornea is smooth, not lesions, scars or infections, and making sure the patient doesn’t have severe dry eye,” he said. He also looks at the patient’s family history for other possible health problems.
Daniel Laroche, MD, Assistant Professor of Ophthalmology at Mount Sinai School of Medicine in New York Citysays people with certain immune disorders, diabetes, eye conditions (such as glaucoma or cataracts), or other medical conditions may not be good candidates for LASIK surgery.
Your ophthalmologist should have a complete picture of your overall health, he suggests.
Risks and Side Effects
Side effects of LASIK include eye redness, blurred vision, dry eyes, and sometimes vision loss, Laroche said. “The vast majority — about 95 percent — are fine, but about 1 percent to 5 percent have complications,” mostly short-term, but sometimes long-term.
Long-term complications include the possibility that the flap created during LASIK may not heal properly and a possible loss of corneal strength, Laroche said. If you need LASIK in the future, it can complicate cataract surgery.
Laroche, who is also Director of Glaucoma Services and President of Advanced Eyecare New York, no longer performs LASIK surgery and focuses primarily on glaucoma treatment, including surgery. He warns that using the LASIK procedure can “artificially provide a low pressure reading” during an eye exam.
Since high pressure in the eye is a major warning sign of glaucoma, an eye disease that can cause vision loss or blindness, it’s important to let your eye doctor know you’ve had LASIK surgery. “I’ve had patients go blind with glaucoma because they missed the diagnosis,” he said.
Hersh notes that in a small percentage of people, vision doesn’t improve as much as they’d like after surgery, so they may need another treatment, usually 3 to 6 months later, to “adjust the vision, so to speak, Take it from the 6-yard line to the 3-yard line.”
Hersh noted that dry eye and irritation symptoms improve over time in most patients, but a minority develop long-term dry eye. Often, vision effects such as glare, halos, and night driving problems subside shortly after surgery; in fact, many patients see better at night than they do with glasses or contact lenses. And LASIK won’t stop the need for reading glasses.
“It’s important to have realistic expectations,” he said.
Hersh and Laroche emphasize that the best chance for successful LASIK surgery is to find an ophthalmologist who specializes in this type of procedure, to conduct thorough and proper testing, and to go through the proper informed consent process so that you understand the risks and benefits of the procedure , and what to expect.
