Is Laser Eye Surgery Safe?
Author: Dr James Genge, Founder and Medical Director at Freedom Eye Laser
Estimated Reading Time: 3 minutes
Laser vision correction has demonstrated its safety and efficacy over a 23-year period. There have been around 100 million cases performed over the world and no-one has ever lost their eye from having the procedure. The risk profile for LASIK is safer than that incurred in using contact lenses and, in regards to infection, represents a tiny one-off risk as opposed to the ongoing infection risk with contacts.
The safety of LASIK has been exhaustively assessed by such governmental organisations such as NASA, the Australian armed forces and the US Navy. The result of their investigations is that LASIK performed with a femtosecond Laser creating the corneal flap (Blade-free LASIK) is approved for NASA Astronauts, the Special Air Service (SAS) and ‘Top Gun’ US Navy Pilots.
Professional sports people regularly have LASIK to optimise their performance, their number includes David Beckham, LeBron James, Barry Hall, and numerous first-grade rugby league players. Celebrities who have had LASIK include people like Richard Branson, Jessica Simpson, Dennis Quaid, Brooke Shields, Nicole Kidman and Brad Pitt.
The procedure, despite having the best safety profile of any operation, still has the potential for complications, however. I will discuss these and their management.
Laser Eye Surgery is performed on organic tissue. Although very accurate, there is on average a 2% possibility the correction will be good but not absolutely spot-on. If this is the case, I wait 3 months to ensure the residual glasses prescription is stable and then lift the same flap created to fine-tune the outcome. As enhancements are small corrections they are correspondingly more accurate. One of the beauties of LASIK is that although generally very stable in the long term, should a patient experience a shift in their refraction, this enhancement can be done almost anytime in the future.
The infection rate for LASIK is incredibly low, far less than for contact lenses. The possibility of scarring of the cornea resulting from an infection eventuating is rarer still, probably less than 1: 20 000. If this occurs, I can correct this with a corneal transplant. That being said, while I am a corneal sub-specialist and perform a lot of corneal transplants, I have never performed one for this reason as it is so incredibly rare.
The chance of getting an abnormal flap such as a buttonhole flap, a possibility with blade LASIK, is by and large eliminated with Femtosecond Laser (Blade Free) LASIK. Due to the enhanced safety this entails, this is the only form of LASIK I will perform.
Inflammation under the flap can occasionally occur (diffuse lamellar keratitis) and responds to a transient increase in the frequency of the anti-inflammatory drops.
Cells from the corneal surface (epithelium) can very rarely grow into the flap interface. Generally, if this occurs these cells absorb and disappear, however, should they proliferate, the flap is lifted and the cells are removed.
When the corneal flap is created, the nerves of the cornea are cut which creates a transient dry eye phenomenon. The nerves all regenerate over 3 months, during which time it is advisable to replenish the tear film with lubricating drops then everything generally returns to normal.
This is a very rare situation where the cornea becomes too pliable following laser vision correction and bulges forward over a period of time. Extreme cases have resulted in corneal transplantation to fix the problem. Fortunately, the screening of patients pre-operatively has become more and more accurate and unsuitable candidates for LASIK are almost always identified. The new technique of collagen cross-linking can stop the progression of this rare complication and if performed early allows the patient to maintain their vision and avoid corneal transplantation. I am one of a handful of ophthalmologists in Australia who is experienced in this technique and perform it in my rooms for patients with other problems such as keratoconus although fortunately, I have never needed to perform this on my own LASIK patients.
Halos and Glare:
Patients can occasionally experience some haloing or starburst around lights at night. Generally, this is due to the flap stabilising and dehydrating and is very rare to persist longer than a week or so.
Most patients following LASIK see as well or better than their vision with glasses and contact lenses. There will always be a very small minority that may feel their visual quality is not as crisp as what it was pre-operatively. Mostly this situation is rectified with a LASIK enhancement and rarely persists.
As other refractive surgery techniques come and go, LASIK’s proven track record of safety and accuracy make it the treatment of choice for achieving independence from glasses. The advance of Blade Free Femtosecond Laser LASIK has taken this safety and efficacy to new levels and truly represents the state of the art in eye surgery.