Sunday, March 15, 2015

Laser Eye Surgery: Is it Worth it?



The number of people who have problems with their eyesight has been significantly increasing over the years. As such the extent of research in this area has been on the rise and recently there have been significant advancements made in this field.8 The idea of getting eye surgery to remove all the hassle of continually updating and wearing contacts or glasses seems to be more and more appealing. When the concept of laser eye surgery first started becoming possible scientists had no real proof of what the long-term effects could be. Now that it has become increasingly popular around the world I was wondering to what extent patients thought it was worth it, what the process is like and what, if any, risky side effects there might be. I myself don’t need to wear eyeglasses or contacts but there is a shockingly large amount of my friends and family who do. I know someone personally who has gotten the surgery a total of three times in one eye and two times in the other and yet still uses glasses to read. I also know someone who must continuously put eye drops in to prevent the dry eye symptom that came after the surgery. These two outcomes made me wonder how effective laser eye surgery really is.


Laser eye surgery is also called vision correction surgery and is a surgical procedure used to correct a range of vision problems. These procedures often work by reshaping the clear front part of the eye, called the cornea, in order for light to be able to travel through it properly and focus correctly onto the retina, the light sensitive surface located in the back of the eye.6 However there are actually a variety of different types of surgery for vision improvement, which one you need all depends on what the problem is. I would like to focus on one of the more common surgeries known as LASIK, which was developed in the early 1990s. LASIK is short for laser in-situ keratomileusis and is used to correct vision in people who are nearsighted, farsighted and/or have astigmatism.5 Astigmatism is a vision condition that many people have to some degree; it can cause blurred vision at any distance due to either the irregular shape of the cornea or a curvature of the lens inside the eye.1


                                                    Digital Image from Fairview Health Services


During LASIK surgery, vision is corrected by reshaping underlying corneal tissue so that it can properly focus light into the eye and onto the retina. LASIK eye surgery differs from others in that a flap is made in the outer topmost layer of the cornea so that the underlying tissue can be accessed.7 There are 2 different ways to create a corneal flap in LASIK, either with a blade or the all-laser method.  Bladed LASIK is performed using a microkeratome, which is an oscillating blade however the most advanced method is the all-laser LASIK method. This method uses a specialized femtosecond laser to create the corneal flap and it is more expensive. The cost of getting LASIK surgery in the United States usually generally varies between 1000$-3000$. Once the flap is created it is carefully peeled back.  The laser then accurately re-profiles the corneal bed underneath the flap to correct any visual abnormality.  The specific type of re-profiling is customized for each patient’s unique case.  The flap is then gently placed back to its original place.  Since the inner layer of the cornea acts like a natural pump there is no need for stitches.  This surgery happens fairly quickly taking around 5 minutes per eye.7 The thickness of patients’ corneas must be large enough so they have enough corneal tissue to undergo this procedure.6  

A study was done last December by Bethke in association with results from the FDA, NIE and DoD was done in order to see what patients thought of LASIK.  They collaborated their results in order to give insight into p­atient satisfaction after the procedure as well as how LASIK’s outcomes compared to wearing glasses or contact lenses. They found that 98 percent of all LASIK patients and 97 percent of the contact lens patients “agree” or “strongly agree” that they’d recommend their vision correction method to a friend or family mem­ber.2

Obviously LASIK eye surgery has many benefits such as the immediate return of vision and minimal discomfort after the operations that make the process appealing to many. Before getting the surgery one must consider the risk of side effects, which may include a weakened cornea due to the creation of the flap; you do not want to lost or damage the flap. This can be especially dangerous for those participating in contact sports that do not protect themselves adequately.6 Another risk may be experiencing infection that delays healing however this happens in less than one percent of LASIK patients.2 Dry eye, which is associated with corneal denervation, is the most common complication after LASIK procedure. Patients usually however only experience compromised tear function for 1-3 months after surgery and may simply use artificial tears to prevent this unwanted symptom from causing damage.4 The second most common side effect is the development of halos. The halo effect occurs in dim light, as the pupil gets bigger, the untreated area on the outside of the cornea produces a second image. This can affect and interfere with night driving, especially in patients who have big pupils in dark conditions.2  Lastly, the procedure done to the cornea cannot be undone so often surgeries may result in undercorrections, which can be fixed with a second laser eye surgery.6 This is usually called laser enhancement. Often an enhancement will help get rid of the halos’ effect.

Although the surgery isn’t right for everyone and there may be some inconvenient short-term side effects such as dry eye or needing enhancement (repeat surgery), overall the complication rate for LASIK surgery is very low and patients end up being happy with the results.
           


           



Reference List

1- Astigmatism. American Optometric Association. 2014.http://www.aoa.org/patients-and-public/eye-and-vision-problems/glossary-of-eye-and-vision-conditions/astigmatism?sso=y

2-Bethke W. What Patients Think of LASIK. Review Of Ophthalmology [serial online]. December 2014;21(12):53-55. Available from: Academic Search Premier, Ipswich, MA. Accessed March 8, 2015.

3-How the Eye Works. Fairviews. 2015. Web 8 March 2015. Digital Image. http://www.fairview.org/healthlibrary/Article/85459

4-I. Toda, N. Asano-Kato, Y. Komai-Hori, K. Tsubota. Dry eye after laser in situ keratomileusis. Am J Ophthalmol. 2001 July; 132(1): 1–7.

5-LASIK. (2015). In Encyclopaedia Britannica. Retrieved from http://academic.eb.com/EBchecked/topic/1335849/LASIK

6-LASIK Laser Eye Surgery: Procedure, Recovery, and Side Effects. Web MD. 2015. http://www.webmd.com/eye-health/lasik-laser-eye-surgery

7- Mandel. The Laser Eye Surgery Message:  Clearing Up the Confusion. Mandel Vision. http://mandelvision.com/blog/laser-eye-surgery-message-clearing-confusion-blog-2

8-New Vision Problems in the U.S. Report. Prevent Blindness National. June 20 2012. Accessed March 8 2015. http://www.preventblindness.org/new-vision-problems-us-report

16 comments:

  1. If LASIK is only around 20 years old, I wonder how likely it is that more side effects will develop in people who have had the surgery after more than two decades? I would want to know more about that if I was seriously considering the procedure.

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  2. I think this is interesting, especially as someone who relies on contacts on a daily basis. I have thought about the surgery, but I would never go through with it without more concrete studies on the long term side effects. One thing I am wondering about is another side effect I have heard about: migraines. I have two different family members who experience severe migraines that only began after LASIK surgery and have continued many years afterwards. I wonder if there was some sort of predisposition for these migraines that were triggered from the surgery or if this is a type of complication of the surgery that can occur to anyone.

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  3. I wear glasses and contacts and their not all that frustrating. The only time I find them to ever be an issue is when I'm swimming or when I'm playing sports. You mention that contact sports may pose a high risk of damaging or losing the corneal flap. What aspect of the contact sport is of concern for such damage or loss?
    Also, would itching my eyes also pose a risk for damaging or losing my corneal flap? And what happens if you lose that flap? A lot of questions, but this is a procedure that I've strongly considered.

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  4. When talking about LASIK surgery, I know there is more of a push to do it as someone gets older since the eyes do not stop changing. And as people get older their eyesight tends to deteriorate. I wonder then if this method of vision correction is really a long term fix or actually just something that will help relatively short term. Though it does cut out some of the hassle of going yearly to get new contacts or glasses, there is also the consideration that there are fluctuations in the eye and perhaps the surgery, which you mentioned usually undercorrects, LASIK is not accounting for that change that happens over time.
    It would also be interesting to look at what percentage of people experience all of the side effects, especially the more dangerous ones having to do with the cornea. Even if they are small, seeing what went wrong in those situations could help to make the surgery more effective in the future.

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  5. My dad underwent laser eye surgery and it has changed his life as he no longer needs to use eye glasses or contacts. However, with the youth of LASIK surgery, I also wonder what long term effects are involved. My dad got the surgery almost 20 years ago, and is now having trouble reading -- is this a factor of age, or an effect of the surgery? Although it will only need time to see the extent of the side effects, laser eye surgery has allowed people to go without needing to buy contacts, which in the long run, is possibly more expensive than the surgery itself. Until new studies come out on negative effects of LASIK that outweigh the benefits, I think laser eye surgery is worth it.

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  6. One thing missing (or something that I missed reading) in this post is that laser eye surgery is reshaping the cornea usually due to a stiffening of tissue caused by age. Unfortunately, the aging process continues after the cornea is reshaped, and vision can continue to slowly degenerate after surgery. Patients who get laser surgery must consider how long the effects of the surgery last, because after the procedure, it cannot be done again to reap the same benefits. This is the one glaring negative to laser eye surgery I see, and is probably the reason Samantha Crowe's father is having trouble seeing 20 years after the surgery.

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  7. It seems like LASIK is a very positive new surgery with few serious side effects. I think that after long term studies are conducted to ensure that there are no longer term detrimental effects of the procedure, even more people will undergo LASIK. Perhaps in the future, when LASIK becomes cheaper, glasses will become obsolete!

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  8. My cousin is an eye doctor and was describing me the different types of LASIK procedures and advised me that if I wanted to undergo LASIK, that I should wait until I was older. With that being said, I assume that age plays an important factor when undergoing LASIK. As you get older, your vision deteriorates so that means that people have to undergo multiple LASIK surgeries, which can get costly over time. LASIK is a good short-term procedure, but I feel like more research and studies are necessary to produce a longer-term solution.

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  9. Being someone who wears both contacts and glasses and lives in a family where both parents and all siblings wear contacts and glasses this information was great to learn. In fact my brother has been thinking of getting LASIK and he has overall heard good things about it, but now reading that people who are active should be careful because of the flap created. This concerns me because not only me, but also the rest of my family is very active and we play a lot of sports, so the chance of losing or damaging the flap is higher than other people. Overall, LASIK is generally good, but overtime like many things, it loses its original strength.

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  10. This is an interesting post! When I think of surgical risks, typically eye surgeries don't come to mind. I think one of the biggest risks of LASIK surgery, along with with every other surgery, is the risk for the need of more surgery. Since LASIK can lose its effectiveness over time, this is a particularly relevant risk that must be considered.

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  11. The medical field has seemed to have finally figured out LASIK eye surgery and based on this article, the side effects seem relatively limited. Now that this is essentially mastered, I am curious to know if this can be applied to more serious vision problems such as blindness, lack of depth perception, or other further impairments.

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  12. This was fascinating to me as someone who wears glasses and has not every really looked into LASIK before. I had no idea that there were such prominent side effects I just always assumed you went in for a quick procedure and a few days later you were totally fine. Also having an eye flap to cut under to fix your vision is an ingenious way to correct vision and sounds really cool.

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  13. Based on the information in your post, it seems that the benefits far outweigh the risks. I rely on contacts/glasses daily to see far away, and it is definitely a hassle. With such a high patient satisfaction rate and low risks, this technology is really a cool advancement in eye surgery.

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  14. Patients should be fully aware of any risks that are present when getting any type of surgery done, including LASIK. If they feel comfortable with the possible side effects and can afford it, I don't think people should be too worried about it. Glasses and contacts can be a hassle to use, and the fact that there is a surgery with few risks available to the public can really help make peoples lives easier. I'd like to see more long term studies done studying the effects LASIK has on the cornea in people who have gotten the surgery, but as of now it seems only a small percentage of people are dissatisfied with it.

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  15. Very well written. I had heard of LASIK before but I didn't know anything of the procedure. I am amazed at how quickly it takes for the surgery to be completed! I wonder what percentage of those who reported 'very happy' responses to surgery had very poor eyesight before the procedure. Perhaps drastic improvements in eyesight make them very happy to have had it done, whereas those who didn't have terrible eyesight to begin with are less content.

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  16. I wear contacts every day, but I have never considered LASIK mainly because I don't find contacts that much of a hassle. I didn't really understand how the surgery was performed until after reading this post. The idea that they cut part of the cornea scares me, so I don't think I'll ever get it, even if people say they're happy with it. I'm interested to see the long term side effects of this surgery since it's pretty new. I have a feeling that in the long run, the risks will far outweigh the benefits.

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