The Risks of Lasik Surgery

It’s attractive to ditch the glasses and contact lenses, but surgery has a down side. Know the risks of Lasik and whether you might experience side effects before scheduling surgery.

About seven years ago I had surgery to correct my vision. If I could go back in time, I wouldn’t do it again. In fact, I’m embarrassed I took such chances with my eyes.

I’d been wearing glasses or contact lenses for almost 30 years. I had never really adjusted to contact lenses because I often had allergic symptoms in my eyes. I also tended to fall asleep in contacts at night. So I wore glasses. But people often complimented me on my green eyes, and I was in a period of intense dating, meeting lots of new people, and wanted to look and feel more attractive. 

Also, after decades of poor vision, the idea of waking up in the morning with a clear view out the window sounded blissful. 

Bottom line: I was middle-aged and wanted a new start in life.  

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So I took a tip from the super in my apartment building, who said he and several of his friends had had Lasik for a price I could afford. The doctor had reasonable credentials and I liked and trusted him during my consultation. Even though I was in my 40s, and I’d likely soon be entering the presbyopia zone when middle-aged vision changes, he said the surgery should adequately correct my sight for 10 years. 

His office was packed with clients coming for Lasik. It was clear he was making his living on volume. I considered the fact that he might be doing the surgery indiscriminately, to poor candidates — but it was undeniable that he had plenty of experience. 

The general wisdom is to choose a surgeon who specializes and has lots of experience doing your surgery. The decision came down to trust, and I felt good about him, so I went ahead.

Immediately after the surgery, I was delighted and recommended Lasik to my friends. I had each eye done separately, which is the safest procedure. My vision in the corrected eye was slightly blurry, but not for long. Soon I had 20/20 vision with my bare eyes and woke up able to see. I could go on dates feeling attractive without dealing with contact lenses. 

The problem arose about five years later, when my eyesight changed. The surgery had not corrected my vision for 10 years, as promised. 

This time, I chose a doctor who treated several of the brainiest, most meticulous people I knew, including other doctors. He had a quiet office and, not surprisingly, charged a fortune. 

He told me that it wasn’t possible to predict the course of presbyopia and that he would not have recommended surgery at my age at the time. He also said it now wasn’t possible to completely correct my vision. I ended up buying customized contact lenses for $1,200. They were never comfortable and I didn’t wear them. I didn’t feel I saw particularly well in them, either. Do I blame the doctor? No, but I can’t say I’d recommend contact lenses this expensive to anyone who doesn’t have a long history of loving contact lenses.  

I ended up wearing glasses. For about two years, I was aware of poor vision. I avoided driving (this was much easier for me than for most people since I live in a city with public transportation) and compensated in a variety of ways. I enlarged the font size on documents on my computer screen or captions while watching a movie on the television. I put colorful bands around my yoga mat so I could pick it out on the shelves at the yoga studio. To avoid the stress of looking for things that were often right under my nose, I learned to be more diligent about putting objects in designated spots.        

Thankfully, my vision has now finally shifted into a better zone, and my latest pair of glasses work fine.

In 2009, the U.S. Food and Drug Administration (FDA), the National Eye Institute, and the Department of Defense launched a series of studies to see the outcome of Lasik surgeries. The two initial studies found that up to 45 percent of participants, who had no visual symptoms before surgery, reported at least one visual symptom at three months after surgery. But less than 1 percent of patients had experienced “a lot of” difficulty or inability to do their usual activities without corrective lenses because of these symptoms. 

These are the risks of Lasik you should consider:

• Some patients lose vision forever. No glasses, contact lenses, or further surgery can enable them to see lower lines on the vision chart.
• Some people lose night vision. They see a glare, halos, or double images. Up to 35 percent of participants with no halos before Lasik saw halos three months following surgery, according to the FDA.
• You may be under treated or over treated, and need glasses or contacts to achieve 20/20 vision. According to a 2013 Consumer Reports survey, of 793 adults who had laser vision-correction surgery in the previous eight years, more than half the respondents still needed to wear glasses some of the time, and side effects were common. 
• The surgery may interfere with your ability to produce tears, and your eye may become dry, which can be uncomfortable and cause blurring.  The FDA found that up to 30 percent of participants who didn’t have dry eyes before Lasik complained of it three months after. 
• The results may diminish with age, as they did for me. One tip: you are more likely to experience a decline in vision if you are far-sighted at the time of the surgery and your “manifest refraction,” a vision exam with lenses before dilating drops, is very different from your “cycloplegic refraction,” an exam with lenses after dilating drops.

Some doctors recommend correcting one eye for distance viewing and the other for near vision — a technique called “monovision” because you then see only with one eye on a given task. In the other eye, your vision will be blurry. The FDA warns candidates to go through a trial period with contact lenses corrected in this way to see if they can tolerate it, and to check whether they’ll still be able to drive, which means you must pass your state’s licensing requirements.  

The FDA urges prospective patients not to base their decision simply on cost, to visit more than one doctor or eye center, and to weigh the risks of Lasik and possible side effects. Be wary of eye centers that advertise "20/20 vision or your money back" or "package deals," the agency warns. “There are never any guarantees in medicine.”

Even with the best-trained doctor and the best candidates, problems can arise during surgery that lead to irreversible damage. Some complications, such as “migration of the flap,” inflammation, or infection, may require another procedure or intensive treatment with drops, and even so, lead to temporary loss of vision or permanent blindness.

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