Lasik’s Risks Are Coming into Sharper Focus
nytimes.com
nytimes.com
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).
Wink wink.
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 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.
=================================== 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.
Also, did this trial use a microkeratome or the femtosecond laser for flap creation?
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.
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.
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.
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.
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.
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.
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.
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 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...
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.
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).
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 :)
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).
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.
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.
I'll probably want to get LASIK at some point :)
But, yes, sometimes I need help finding my glasses, too.
I use special always-on contacts since 5 years ago or so, change them once a month. This reduces the hassle a lot.
Of course, that was 15 years ago, so maybe different guidelines now.
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.
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.
Nevertheless, I do worry about this a lot.
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.
Though PRK, which does not open the flap, is fine, and is the procedure athletes typically go through.
* [The myopia boom : Nature.com](https://www.nature.com/news/the-myopia-boom-1.17120)
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 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.
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...
I also purchased a 2nd pair of prescription sunglasses, so that has also helped.
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.
>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.
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.
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.
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.
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.
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.
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.
https://www.allaboutvision.com/visionsurgery/smile.htm
Seems interesting, no flap like with LASIK and it may result in fewer cases of dry eyes. Has anyone here had it?
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.
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).
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.
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.
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.
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...
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
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.
I don't mean that as a suggestion, I'm wondering what your experience with them might have been.
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%.
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.
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...
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.
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.
It costs about double what LASIK does, but doesn't seem to have the side effects.
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.
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.
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.
YMMV
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.
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.
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.
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.
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).
You don't have to buy them. Regular disposables are very cheap, but toric lenses are not cheap.
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 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.
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.
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.
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.
If that's actually the case across the full population of Lasik patients that's insane.
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.
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.
Most people here would probably be better off with ortho-k than with LASIK, so long as their myopia isn't severe.
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.
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.
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.
—-
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.”
The question is the relative risks and the relative benefits. This procedure appears to have more benefits and less risks than most comparable procedures.
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%.
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.
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 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 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 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?
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.
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 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.
Seems like a much better option?
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!
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.
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.
https://www.aao.org/eye-health/treatments/lasik
http://eyewiki.aao.org/Category%3ARefractive_Management/Inte...
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 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.
My nyc surgeon is the best. If you’d like an intro, email me. A@175g.com
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.
“LASEK is ASA or Advanced Surface Ablation. PRK is the old painful kind of surface ablation prone to scarring.”
It was made clear that I will likely return to glasses as I age, but I’ll hopefully make it another 20 years.
Ok, so let us know how it goes in 20 years.
Dry eyes? Yes, rarely
Sensitive to light? Yes, constantly
Totally worth it
It's quite miraculous.
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.
If it was a well-known/often-posted topic, however, then it's ok to consider what you suggest.
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.
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.