LASIK Risks vs. Reward
Comparing laser eye surgeries like LASIK, ASA or PRK? Prioritize long-term health and wellness, not instant gratification.
So you're thinking about getting LASIK or another laser eye surgery – and you’re doing your research. That’s great. Restoring your sight to perfect (or near-perfect) vision can completely change your life.
It’s a transformative surgery with massive health and lifestyle benefits. But it’s a big decision that can also be a little scary.
Here’s the good news: no matter what type of laser vision correction you decide on, you really shouldn’t have any fear about the surgery itself. Let’s look at LASIK specifically since it’s still the most popular laser eye surgery in New York City and nationally.
The instant gratification of LASIK is intoxicating.
The truth is, dangerous or debilitating mistakes during LASIK surgery almost never occur (like with any surgery, though, they are possible). With LASIK, most patients will see quite well right after surgery. Along with this sudden improvement, LASIK also claims the fastest and easiest recovery period of any laser eye surgery.
Instantaneous results and minimal recovery… these are the core reasons why LASIK is the #1 laser eye surgery in America, especially with young adults.
But unnecessary complications aren’t far behind.
In my honest personal experience as a board-certified ophthalmologist, however – and in the experience of many LASIK patients I have helped – that feeling can be extremely misleading. Many report that their vision was most improved right after the surgery but only got worse with time.
As I wrote in our guide comparing LASIK, PRK and ASA, rather than seeing continuous improvement, LASIK patients are far likelier to experience long-term side effects from the surgery.
This is why I urge anyone making a decision about laser eye surgery to base their decision on their satisfaction and comfort 2 months, 2 years, and 20 years down the road instead of 2 hours or 2 days after the surgery.
Common LASIK Eye Surgery Risks:
Instead of the surgery itself, it’s the months and years after those first 24 hours that you should have some concern about.
LASIK patients commonly suffer from unpleasant post-op problems, especially dry eye and night vision issues. And, while rare, there are much more serious potential consequences from going “under the knife” instead of choosing a no-cut laser eye surgery method.
Here’s a closer look at the long-term risks and complications of LASIK.
Considering LASIK?
Give me a chance to talk you out of it. I performed LASIK for years before permanently switching to a safer and more effective alternative.
Why does LASIK sometimes cause these complications?
To understand potential risks with LASIK, we need to revisit what happens during the surgery itself.
First – background basics. Many people who are interested in corrective laser vision surgery have a misshapen cornea that prevents the eye from properly focusing light. Consequently, these people are nearsighted, farsighted, and/or have astigmatism. Laser eye surgeries like LASIK correct these vision problems by reshaping the cornea so it correctly focuses light on the back of the eye.
During conventional LASIK, the surgeon cuts a circular flap on the cornea that is folded away to expose the target tissue. After the laser reshapes the cornea to its ideal form, the flap is rolled back into place.
With LASIK, the surgeon creates a flap in the cornea (A) — the transparent, dome-shaped surface of the eye that accounts for a large part of the eye’s bending or refracting power. Then the surgeon uses a laser (B) to reshape the cornea, which corrects the refraction problems in the eye (C).
After LASIK surgery is complete, the eye does a pretty good job healing those cuts on its surface.
But not a perfect job.
And that's where complications can happen. Not from the laser, but from cutting the flap.
The “Flap About the Flap” is 100% Justified.
The thing is, cutting that flap can bring as many as 10 new troubles to the patient. Here are just three of them. Remember LASIK by definition involves cutting the flap. Whether they call it bladeless, all-laser LASIK, a flap is (unnecessarily) cut.
LASIK Problem #1: Dry Eyes
We all know how irritating it is to have a fleck of dust or an eyelash in our eye. We feel it a lot more than if that were on our skin. The cornea is full of nerves and they’re all important. It’s these nerves that tell you when to blink when they sense your eye is getting dry.
Well, when the corneal flap is cut, corneal nerves are cut as well. Corneal nerves do not grow back, so fewer nerves mean you blink less often. Studies show that LASIK patients blink every 5-10 seconds pre-op, and every 10-15 seconds afterward. For people whose careers involve so much computer use, this can be a real issue.
The result? You blink less often and live with uncomfortable, annoying dry eyes.
LASIK Problem #2: Glare and halos
In LASIK, after the laser is done, the flap is placed back on the remaining cornea. A major issue is that the two parts never properly fuse together. Your cornea from then on is in two parts instead of the one solid part that it is supposed to be.
So after LASIK, the cornea has a sandwich configuration, an interface between the two parts. Consequently, the way you’ll see is that light rays enter the eye, starting at the tear film and entering the cornea and eventually focusing on the retina. But when light encounters the interface or sandwich configuration, the light rays scatter.
The result? Glares and halos – visual disturbances that you’re more aware of at night.
LASIK Problem #3: Dislodged flap
MedicineNet says “there is a lifelong risk of LASIK flap dislocation if there is significant trauma to the eye.”
The likelihood of a dislodged flap is higher for people who engage in contact sports. People with pets or small children can always get a surprise poke in the eye. And of course anyone can get smacked in the face by a branch while out walking or working in the yard. Any of these events can push the flap out of place.
The result? Back to the surgeon to fix the flap.
But don't give up on laser eye surgery yet. There's a GREAT alternative to LASIK.
What's the Safer Option?
Advanced Surface Ablation (ASA) is a much safer corrective laser eye surgery. You don’t really hear a lot about it in the media, because reporting on solid, consistent results with satisfied customers doesn’t really sell newspapers.
Now, you may have heard of Photo-Refractive Keratectomy (PRK) laser eye surgery. PRK was the first generation of laser eye surgery, preceding LASIK by three years. ASA is a safer, more advanced version of PRK.
ASA loosens the outer layer of the cornea (epithelium) to allow an excimer laser to reshape the cornea — all without having to cut a flap, like in LASIK. Since ASA leaves the cornea intact, it prevents the three LASIK troubles we just discussed.
LASIK Problem #1: Dry Eyes - SOLVED by ASA
ASA doesn't cut into the cornea, so nerves aren’t cut like they are in LASIK. Your eye will know when it needs to blink, and your tear film remains strong. No uncomfortable, annoying dry eyes.
LASIK Problem #2: Glare and halos - SOLVED by ASA
Since ASA doesn't require a flap on your cornea, light rays are not incorrectly redirected when they enter the eye. No LASIK glare and halos.
LASIK Problem #3: Dislodged flap – SOLVED by ASA
ASA doesn't cut a flap, so there's zero risk of dislodging it. In fact, the same MedicineNet article that cautions people against LASIK if they participate in contact sports says, “other refractive procedures, especially surface ablation, may be more appropriate choices.”
Four other reasons ASA is superior to LASIK.
If you're still thinking of getting LASIK, here are three more reasons Advanced Surface Ablation is a better laser eye surgery choice.
1. More people can get it.
Not everyone is eligible to get LASIK. The American Academy of Ophthalmology (AAO) lists the following requirements for LASIK patients:
Your eye prescription should not have changed much in the last year
Your corneas need to be healthy and thick enough
Your overall eye health must be generally good
The pool of candidates for ASA is significantly larger than the pool for LASIK. The explanation for this is a lesson in mathematics.
The average cornea is 550 microns (around a half a millimeter).
For safety reasons, surgeons leave 300 microns untouched, so we have 250 microns to work with.
For each diopter corrected with a custom ablation, around 15 microns of tissue is used up, i.e., if you were a -4.00D myope, 60 microns of tissue would be used up.
Now the important thing about LASIK is the flap that is cut is usually around 110 microns, and 20% of your cornea is cut and lifted. So instead of having 250 microns of tissue to use, you only have 140. That 110-micron flap cannot be used. With more tissue that can be used, many patients with higher prescriptions can be good candidates for ASA.
2. ASA preserves the structural integrity of your eye.
The cornea is meant to have a single, unbroken surface. A solid sheet of collagen. LASIK breaks up that surface, permanently weakening the tissue.
Think of the structural integrity of the roof where you live. If you want to add insulation to your attic, you don't cut a hole in the roof and then replace the roofing materials when you're done. No amount of silicone caulk will permanently stop weather from doing what it does, and you'll eventually have water damage and a completely avoidable repair job.
Same thing with your cornea. By slicing into the cornea, LASIK compromises the structural integrity of your eye. Not so with ASA.
3. ASA results in a more precise correction than LASIK.
Before you’re deemed to be a good candidate for Laser Vision Correction, two tests are done.
One is called topography, and it analyzes the thickness and steepness of your cornea.
The second is a wavefront analysis of your cornea. This is like your unique fingerprint of your cornea. Your cornea is different from everybody else’s cornea.
The analysis of these two tests is plugged into the laser to come up with your treatment.
Now with ASA, we are treating the same surface as the one you’ve been tested on. But with LASIK, it’s a different story. Since they are cutting a 110-micron flap, they’re working at a much deeper level than the one you’ve been tested on. Hence, it’s not as precise a correction.
4. Most importantly, ASA is the right long-term decision.
Yes, LASIK patients get excellent short-term results. Clear vision just hours after surgery. A quick healing period. Back to normal activities within a few days.
This is all good if you’re going to live only a couple more years.
Now, it’s true that ASA patients wait a few extra weeks for the nirvana of crisp, clear vision. And yes, ASA patients experience a bit more post-op discomfort than LASIK patients.
But if you expect your eyes to bring you 10, 20, or even 50 years of clear vision without the side effects common with LASIK, what’s an extra two weeks of healing time?
And let’s talk more about the risks of a flap malfunction. You may believe LASIK is your best option because you don't currently participate in activities that pose a risk to the LASIK flap. But can you be certain you'll never decide to take up martial arts, soccer, or ultimate frisbee? Or have children who may accidentally poke you in the eye with a finger (or toy or spoon or ...)? Any activity that could result in a poke in the eye or a blow to the head can dislodge your LASIK flap and interrupt your busy life for a trip back to the surgeon.
With ASA, there's never a risk of an urgent surgical repair to a flap, no matter what activities are in your future.
So if you’re thinking long-term, ASA is simply the better choice.
Final considerations.
Here are other important facts about ASA that strengthen the case for ASA vs. LASIK:
ASA patients get 80 to 85% of total vision improvement within the first four days after surgery.
Regarding pain, my patients report a pain level max of 3 on a scale of 1 (no pain) to 10. The pain typically lasts two to three days.
ASA loosens the outer layer of the cornea (epithelium), and it heals completely within four days. There may still be some inflammation after those four days, but it typically resolves after a month. The patient is fully functional during that time. Any negative long-term effects of LASIK are just not present with ASA.
If you look at a post-op ASA patient, you can’t tell they’ve had anything done on a microscopic level. But with LASIK, you can see that it’s been done.
Bottom line? In general, patients who choose ASA achieve better vision results than with LASIK. While LASIK patients often experience improved vision immediately following surgery, they’re more likely to experience complications over the coming months, years, and decades.
I invite you to make an appointment now for your free no-obligation, no-cars-salesmanship consultation. I WON’T hard sell you on something you don’t need. I WON’T press you for an immediate decision. I WILL examine your vision honestly and give you a truthful assessment about what ASA laser eye surgery can do for you. Use the form below or check the contact page for my email.