LASIK is one of the most popular elective surgeries in the world, delivering millions of patients clear vision and freedom from glasses and contact lenses. However, many people considering this procedure often wonder, “Is LASIK safe?” 

This article is a comprehensive look into the safety of LASIK by exploring its history, potential risks, and common concerns.

What is LASIK?

LASIK is a procedure that uses a laser to correct refractive vision problems such as myopia (nearsightedness), hyperopia (farsightedness), and astigmatism. The process involves reshaping the cornea—the clear front part of the eye—so that light entering the eye is properly focused onto the retina for clearer vision.

How Does LASIK Work?

  1. Preparation: The eye is numbed with anesthetic drops, and a lid speculum is used to keep the eyelids open.
  2. Flap Creation: A thin flap is created in the cornea, most commonly nowadays with a femtosecond laser.
  3. Corneal Reshaping: An excimer laser is used to reshape the underlying corneal tissue.
  4. Flap Replacement: The flap is gently repositioned back onto the cornea without stitches.

LASIK History

The concept of reshaping the cornea to improve vision dates back to the mid-20th century. However, LASIK as we know it today began to take shape in the late 1980s and early 1990s.

Early Developments

  • 1960s: The groundwork for modern LASIK was laid by Dr. Jose Barraquer, who developed the first techniques for corneal reshaping.
  • 1980s: Dr. Rangaswamy Srinivasan discovered the excimer laser’s potential for precise corneal reshaping.
  • 1990: The first LASIK procedure was performed by Dr. Ioannis Pallikaris in Greece.

Technological Advances

Since its inception, LASIK technology has continually improved, with advances in laser precision, eye-tracking systems, and patient safety protocols enhancing the procedure’s effectiveness and safety.

How Safe Is LASIK?

LASIK is one of the most popular and well-studied procedures in all of healthcare. It was approved as safe & effective by the FDA back in 1998. Laser and diagnostic technology has continually advanced to make it safer than ever before. 

The rate of complications from LASIK is estimated to be well below 1 percent. Moreover, the vast majority of complications are treatable. 

Success Rates

Success is generally assessed by studying patients’ vision after the procedure. LASIK has advanced dramatically over the past 30 years. Let’s look at FDA data for one of the current lasers on the market. 

The following outcomes are available from the FDA data for the Visx S4 laser with iDesign system:

  • 100% of patients had 20/20 vision (or better) without glasses at 12 months after their treatment
  • 100% of patients had 20/20 binocular vision (or better) without glasses at 3 months after their treatment
  • 99% of patients reported being satisfied with their vision at 12 months after the procedure

What Are The Risks Of LASIK?

While LASIK is generally safe, like any surgical procedure, it carries risks. Understanding these risks can help patients make informed decisions.

Infection

Although rare, infections can occur after LASIK. Symptoms include redness, pain, and blurred vision. Prompt treatment with antibiotics usually resolves the issue without long-term effects.

The long-term risk of infection from soft contact lenses has been found to be many times higher than LASIK.  

Diffuse Lamellar Keratitis (DLK)

Diffuse Lamellar Keratitis (DLK), also known as “sands of the Sahara,” is an inflammatory response that can occur after LASIK. It is usually treatable with steroid eye drops but requires careful monitoring to prevent complications.

Epithelial Ingrowth

Epithelial ingrowth occurs when surface cells grow under the corneal flap. It is typically mild and asymptomatic, but severe cases may require surgical intervention to lift the flap and remove the ingrown cells.

Epithelial ingrowth is rare with modern lasers. The flap architecture of modern lasers has decreased the incidence of epithelial ingrowth compared to older microkeratome flaps. 

In fact, in a study of 3,866 LASIK treatments there were zero cases of epithelial ingrowth. The risk does go up for enhancements, or re-treatments. In this same study, the incidence of ingrowth for enhancements was 2.3%.

Decentered Ablations

Decentered ablations happen when the laser treatment is not perfectly centered, potentially causing vision issues such as glare and halos. Modern lasers use eye-tracking systems to prevent this, and have minimized this risk significantly.

Buttonholes

A buttonhole is an incomplete or irregular corneal flap. This rare complication usually necessitates stopping the procedure and allowing the cornea to heal before attempting surgery again. Modern laser systems have made this complication extremely rare. 

Ectasia

Ectasia is a long-term risk of any laser vision correction procedure that has become much more rare with modern technology, and is now treatable. Ectasia refers to the progressive thinning and warping of the surface of the cornea. This is most common in patients with keratoconus. 

If a patient with keratoconus has LASIK, their cornea may not be stable after LASIK which can lead to a change in prescription, and extreme thinning of the cornea requiring surgery. 

Modern diagnostic tools are better than ever at identifying which patients are at risk for ectasia to avoid having LASIK on them. In these patients EVO ICL or Custom Lens Replacement are typically a much better option.

For patients who have ectasia or keratoconus, treatment called corneal cross-linking is available to strengthen the cornea which prevents progressive shape changes. 

LASIK Safety Compared to Alternatives

When considering vision correction, it’s essential to compare LASIK to other common alternatives like contact lenses and glasses.

LASIK versus Contact Lenses

  1. Infection Risk: Contact lenses carry a risk of eye infections, particularly with poor hygiene. LASIK, by contrast, has a lower infection risk post-surgery with proper care.
  2. Convenience: LASIK eliminates the need for daily lens maintenance and replacement, offering a permanent solution to vision correction.
  3. Cost: Although LASIK has a higher upfront cost, it is more cost-effective over time compared to the ongoing expenses of contact lenses and solutions.

LASIK versus Glasses

  1. Visual Quality: LASIK provides a higher quality of vision correction compared to glasses, eliminating issues like peripheral distortion and frame-related limitations.
  2. No More Losing Your Glasses: Glasses get lost and broken all the time. For many patients with borderline vision, they will still drive and do other activities despite lost or broken glasses putting themselves and others at risk.
  3. Lifestyle Benefits: LASIK offers freedom from glasses, benefiting active lifestyles and enhancing convenience in various activities.
  4. No More Fogging Up Your Glasses: You won’t have to worry about fogging your glasses after LASIK. 

Conclusion

LASIK is a safe and effective procedure for correcting vision problems, with a high success rate and low risk of complications. While there are potential risks associated with the surgery, advancements in technology and rigorous safety protocols have made LASIK safer than ever. 

By choosing a qualified surgeon and adhering to pre- and post-operative care guidelines, patients can minimize their risks and enjoy the benefits of improved vision.

If you’re considering LASIK, consult with an experienced ophthalmologist to determine if you’re a good candidate and to discuss any concerns you may have about the procedure. With the right information and professional guidance, you can make an informed decision about your vision correction options.