Controversies with LASIK in 2024
Explore this chart on Google Trends
“Big LASIK” has big problems.
Even here in New York City, LASIK case volumes have dropped significantly from 2022 to 2024 after a surge in procedures in 2021 (which we now know was common for elective health procedures in the later stages of the Covid-19 pandemic).
2025 will be a pivotal year for the industry. I think it’s likely that many LASIK Mills – no longer producing reliable profits – will shutter altogether, while others will spin off and transition away from LASIK to safer, non-cutting laser eye surgeries.
According to Google Trends data, fewer people than ever are actually seeking out the procedure online (at least via Google Search!). Outside of one of the most brutal months of the pandemic – April 2020 – the last time LASIK search interest was this low was December 2010!
Even though we’ve been predicting a rough patch like this for years, it’s still startling to witness the speed of the erosion in consumer interest in LASIK.
So, what’s responsible for this? Usually a slowdown of this magnitude would be a result of a recession or large-scale technological disruption – but that’s really not the case here in Manhattan, even as inflation and consumer confidence has restrained some spending this year. Watch or read my theory below.
Before getting into this, I want to assure you that if you are interested in laser vision correction, there are far safer options that can deliver the same benefits of LASIK without the same risks and long-term complications! That includes Advanced Surface Ablation and other procedures which do not cut your cornea or create a flap!
Controversy #1:
The Procedure Itself!
With LASIK, a surgeon cuts and lifts a “flap” of tissue in the cornea prior to performing the laser correction. That flap – which is usually 20% of your cornea – never fuses with the rest of your cornea eye after the cut. So from that point on, it’s actually in two parts, not the one whole part it should be.
The flap itself is the fundamental problem with LASIK and the thing that leads to both short term and long-term complications. Cutting the flap is also hard on the corneal nerves, the ones that tell you when to blink. The nerve damage tends to result in a lower blink rate, and dry eyes are not far behind.
Now, you may see LASIK advertised as “bladeless” or “all-laser.” Then there’s SMILE – SMALL Incision Lenticular Extraction. Don’t be fooled, though – at the end of the day, cutting is cutting. There is a reason why they’re using semantics to draw attention away from that!
LASIK has one advantage, though – and that’s the instant healing. Often when a LASIK patient gets up off the laser bed, at that moment, that’s as sharp as their vision will ever be.
But all told, 46% of patients report one or more visual issues after LASIK according to a major 2009 FDA study.
I think this percentage is much, much higher now. Remember – 2009 predates social media and the rise of streaming… The dry eye issue is only getting worse because of all the time we spend staring at screens, and I think this is another reason to avoid LASIK.
Look at it this way. Imagine there was any other elective procedure on your body, and there were two ways of doing it. The first way entailed cutting that changes the structural integrity of that body part forever and has a much higher risk factor – but it offers an instant recovery. The second way entails no cutting and equal or superior results, but a five-day functional recovery. Why would anyone choose to cut?!
Controversy #2:
The Industry
Here’s the thing… even though there are better options, LASIK can be okay for some people. There are quality LASIK surgeons out there.
But the LASIK Industry is actively hurting LASIK and the entire conversation around laser vision correction.
Here’s why: LASIK is an expensive out-of-pocket procedure. So naturally there’s a big corporate interest in selling it to more and more people – even when they aren’t great candidates and despite mounting evidence that there are safer alternatives.
I call this the “LASIK-Industrial Complex.” Quantity is often the main priority at “LASIK Mills” owned by large corporations, not quality.
This means a much higher risk threshold for who they are willing to operate on. It means one surgeon performing dozens of surgeries per day. It means never hearing from your surgeon again after the operation. It means patient care being routinely subordinated to non-MD employees in the interest of growth and greed.
Not all LASIK clinics fit the criteria of being a LASIK Mill. But considering the corporate takeover of so many LASIK clinics in New York City and the United States, it can be easy to fall into the trap without even knowing it.
Controversy #3:
Government and Media Scrutiny
In December 2022, the FDA shocked the ophthalmology world by announcing it would consider slapping a warning label on LASIK.
Which is to say, NYC LASIK surgeons would be urged to walk patients through a checklist of potential complications prior to surgery.
Even though the FDA’s proposed guidelines are still under consideration, this announcement shined the media’s spotlight onto LASIK risks and complications and handed a megaphone to critics of LASIK. Many of these critics are well-respected doctors who have been warning consumers about LASIK for many years.
Less than a year after the FDA news, the FTC fined a major national LASIK chain for bait-and-switch advertising. This fine was just the tip of the iceberg when it comes to the LASIK industry’s aggressive marketing and sales tactics.
You can see how these two major news stories would whip up a wave of negative sentiment and potentially turn the tide against LASIK.
Controversy #4:
Gen Z
But beyond the pending FDA action, beyond the FTC fine, beyond the media scrutiny, beyond everything else – the biggest reason LASIK is losing its edge as the most popular form of laser vision correction may actually be Gen Z.
Hear me out. The vast majority of people get laser eye surgery in their twenties and early thirties. At my practice, the average patient age is about 26.
So, this means LASIK practices and their ad agencies are now really trying to convince Zoomers and younger millennials to get LASIK.
And I think that’s proving a hard sell. Remember… Gen Z grew up on the internet and social media. They don’t trust traditional marketing and they don’t trust corporations. Above all, they seek out and value social proof in the form of verified reviews and feedback from their peers online on social media, on Google, and in online forums.
Typical advertising and even word-of-mouth from a family member isn’t going to cut it for them. They’re going to do the research themselves.
I think this new paradigm represents a major threat to LASIK in general and especially to LASIK Mills, who tend to have bad reviews. The LASIK sub on Reddit, for example, is often bombarded by negative reviews of LASIK. Of course this is a bit skewed by the fact that successful cases often don’t run to the internet to proclaim their satisfaction, but this is still a real headache for many LASIK practices.
And now, influencers who had a negative experience with LASIK are starting to jump on video and live streams to share their story in vivid detail.
These videos can have a powerful persuasive effect – both negative and positive – since they get boosted by algorithms and are obviously not critically reviewed or fact-checked
So, where does this leave someone who’s sick of contacts and glasses?
The good news is that there is a safe, modern alternative to LASIK called Advanced Surface Ablation.
ASA is laser surgery technique that involves loosening the outer layer of the cornea – the epithelium – to allow the laser to reshape the deeper corneal tissue layers. ASA treats the cornea in the gentlest way possible. There’s no cutting. And there’s no flap. This is why ASA Surgery results in far fewer long-term complications than LASIK.
In addition to not using a blade, ASA also doesn’t require an alcohol solution. So, patients typically have a shorter recovery period and less post-op discomfort compared to PRK Surgery. Bottom line, this is a much safer procedure with better long-term outcomes. The only downside is a slower recovery period compared to LASIK, but I think that’s a small price to pay to avoid the lifelong complications that can occur with LASIK and other cutting procedures.
And if you live in the New York City area, use the button below to book a free consultation!