Laser Eye Surgery is considered by experts as one of the safest and most effective forms of elective surgery. But what are the actual risks and if something does go wrong, can it be fixed?

Let’s talk about the elephant in the room: “Is Laser Eye Surgery safe?”

While you are researching the internet, reading reviews of clinics, talking to friends, family and colleagues who have had LASIK and deciding whether to take that leap yourself to undergo laser eye surgery, it is natural to feel anxious or afraid. After all, you are trusting a surgeon and technology with your eyes.

You’ll have read the statistics - laser eye surgery was first performed in 1987, over 27 million people worldwide have had the procedure with high patient satisfaction rates, 99% of people can drive without the need for glasses the day after surgery.

But what are the actual risks and if something does go wrong, can it be fixed?

Laser Eye Surgery is considered by experts as one of the safest and most effective forms of elective surgery. As Laser eye surgery is a surgical procedure, like all other surgical procedures there is a very small risk of infection and scarring. The risk of a serious complication is around 0.1%.

Let’s start by understanding what the surgery involves.

Laser Eye Surgery Described:

All laser eye surgery procedures (LASIK, SMILE or PRK) involve permanently changing the shape of the cornea allowing light entering the eye to be properly focused onto the retina. The surgery is performed under a topical anaesthetic (drops on the eye).

At Bowen Eye Clinic we offer LASIK (Laser-Assisted-In-Situ Keratomileusis) as our preferred surgical procedure. This is because LASIK is still the gold standard in Laser Eye Surgery due to its precision, safety record, range of treatments, ease of re-treatments, and minimal side effects.

The Intra-LASIK procedure involves the surgeon using the femtosecond laser to create a small flap on the surface of the cornea (corneal flap) with laser energy. The IntraLase laser is capable of creating extremely precise flaps by producing tiny bubbles inside the cornea that are 1/20,000 of a cm in diameter. The laser beam cannot penetrate into the eye beyond the cornea. After the flap has been made it is lifted and a second laser, the excimer laser, is used to reshape the eye by removing ultra-thin layers of the cornea. This laser has precise eye tracking features and can be adjusted for astigmatism which currently SMILE can not. The corneal flap is then repositioned and bonds back into place without the need for stitches. The removal of the thin layer of corneal tissue causes the centre of the cornea to flatten in the case of nearsightedness, steepen in the case of farsightedness, or become more rounded in the case of astigmatism, thereby changing the focusing power of the cornea.

You will be prescribed medications as part of the treatment. In a few cases, a soft contact lens may be placed on the cornea during the healing process, which your doctor will remove after healing is completed.

If you have presbyopia (a separate prescription for reading glasses) Dr Reece Hall can discuss the option of having Presbyond, Laser Blended Vision, at Bowen Eye Clinic. This corrects one eye focused for distance and at the other eye focused for near vision. The brain then processes these two images together and enables you to see objects at a distance and close up without effort.

What visual result should I expect after the surgery?

The goal of Intra-LASIK is to achieve the best visual result using the safest method reducing your dependency on glasses or contact lenses. FDA (Food and Drug Administration USA) studies have reported that 95% of people who have laser eye surgery achieve 20/20 vision or higher.

All surgery stimulates the body’s natural healing response and is different for everyone as our bodies heal at their own rate. Your recovery time may vary from a few hours to several weeks or a couple of months before your vision completely stabilises. Patient differences in healing can affect both the visual recovery process and the final visual outcome and are impossible to predict. After the initial procedure and even if further procedures are performed, you may have some remaining nearsightedness, farsightedness or astigmatism. If so, glasses or contact lenses may still be needed for some or all of the time e.g night driving glasses and/or reading glasses.

Is Laser Eye Surgery safe? 

LASIK has been performed for over two decades and proven to be an exceedingly safe, effective and long-lasting procedure. LASIK has been fine-tuned over the years to provide the surgeon with automated tracking of the pupil, automated pupil centration and wavefront analysis and guidance during the procedure.  

Despite the best of care, complications and side effects may occur. This procedure, like all laser eye surgery procedures, presents some risks.

There may be redness, pain or a foreign body sensation, particularly during the first 48 hours after surgery. You will be given a regime of eye drops to take and it is important to keep to the routine as the drops will reduce pain, inflammation and the risk of developing an infection.

There may be increased sensitivity to light, glare, and fluctuations in the sharpness of vision. These symptoms usually occur during the normal stabilisation period from one to three months but they may rarely be permanent.

Dry eyes are very common in the first few months following laser eye surgery and in most cases this resolves in 6 months. There is an increased risk of eye irritation related to drying of the corneal surface following the LASIK procedure. This is due to a temporary decrease in tear production as a result of the surgery. These symptoms may require frequent application of artificial tears and/or closure of the tear duct openings in the eyelid if it doesn’t correct itself.

An over correction or under correction could occur (3% of patients), causing farsightedness or nearsightedness or an increase in astigmatism. In most cases this can be treated but in rare cases this could be permanent. Enhancement (retreatment) surgeries can be performed when your vision is stable and your surgeon will reassess your eyes and discuss this with you as your healing from the surgery progresses. Enhancement surgery can be performed normally around 3 months after the original surgery.

After refractive surgery, a small number of patients experience glare, a “starbursting” or halo effect around lights, or other low-light vision problems that may interfere with the ability to drive at night or see well in dim light. Although there are several possible causes for these difficulties, the risk may be increased in patients with high degrees of correction. For most patients, this is a temporary condition that diminishes with time or is correctable by wearing glasses at night or taking eye drops.

There may be a “balance” problem between the two eyes after LASIK has been performed on one eye, but not the other. This phenomenon is called anisometropia and can cause eyestrain and make judging distance or depth perception more difficult.

After LASIK, the eye may be more fragile to trauma from impact. As with any scar, the corneal incision will not be as strong as the cornea originally was at that site making the eye more vulnerable to injuries, at least for the 3 months following LASIK. It is advisable to wear protective eyewear when taking part in sports or other activities in which the possibility of a ball, projectile, elbow, fist, or other traumatising object contacting the eye may be high.

Other serious complications such infections are extremely rare (<0.1%) and we suggest that you discuss these with your doctor if you have any concerns.

There may sometimes be complications with the formation of the flap; an incomplete flap (<0.5%). If this happens, it is likely that the laser part of the procedure will have to be postponed until the cornea has a chance to heal sufficiently to then create the flap again.

These serious complications could lead to scarring and reduced vision. It is possible to remove scarring with further surgery. No one at Bowen Eye Clinic has had a serious complication from Laser Eye Surgery and no one has required surgery to remove scarring.

It is important to not rub your eye after laser eye surgery as this can cause the corneal flap to displace or wrinkle. If this does happen your eye will become uncomfortable and your vision will get worse. Your surgeon will check for this as part of monitoring your healing progress. Flaps can usually be repositioned with full recovery of your vision if it is seen quickly. Irregular healing of the flap could result in a distorted cornea. If this distortion in vision is severe, a partial or complete corneal transplant might be necessary to repair the cornea.

Other very rare complications threatening vision include: infection, corneal swelling, corneal thinning (ectasia), perforation of the cornea, appearance of “floaters”, retinal detachment, haemorrhage, venous and arterial blockage and keratoconus.

 

Are my eyes suitable to have laser eye surgery?

First of all, you need to be a suitable candidate for having laser eye surgery. At your suitability assessment Dr Reece Hall will do a number of eye scans using different technology - measuring the exact geometry of your cornea as well as its thickness in 3D and the tiny, unique imperfections in the way that your eye focuses light. You will have an extensive eye exam, sometimes with anaesthetic numbing eye drops to gather more details about your eyes. Dr Hall will help you identify any concerns, answer any questions and put your mind at ease.

Laser eye surgery is most suitable for people who have a moderate degree of refractive error and no unusual visual problems.

Generally, the treatment should not be performed on people with the following conditions: uncontrolled collagen-vascular disease, autoimmune disease, immune-compromised or on drugs or therapy which suppress the immune system, signs of keratoconus (steepening of the cornea), pregnant, residual, recurrent, or active ocular disease(s) or abnormality, active or residual disease(s) likely to affect wound healing capability, unstable or uncontrolled diabetes, progressive myopia or hyperopia, moderate to severe amblyopia (lazy eye), uncontrolled or severe glaucoma, or severe dry eye, or are at risk for this by taking Accutane or other high-risk medications.


How can I avoid these complications happening to me?

Many of the complications and symptoms mentioned can be either avoided or managed by:

wearing sunglasses for the first 24 hours after surgery

never rub your eye

follow the prescribed eye drop regime that you are given

use the artificial tear drops to lubricate your eyes to reduce the dry eye feeling

attend your follow up appointments.

We understand that this list of risks can be scary which is why at Bowen Eye Clinic we believe it is important to get to know your surgeon so you are comfortable discussing any concerns you may have before, during and after your surgery. Dr Reece Hall has had over 14 years of performing eye surgery and will see you at your first pre-assessment, surgery and all of your follow up visits. He will give you his personal mobile number to call him if you have any concerns after the surgery. Our knowledgable ophthalmic technicians will guide you through each step should you have any questions at any time.

Knowledge dispels fear, now that you’ve addressed that elephant in the room, if you’re ready to take that leap to have laser eye surgery or wish to understand more on any part of the process, call 0800 69 2020 or email info@boweneye.co.nz