How Safe Is Laser Eye Surgery Anyway?

By Dr James Genge






Laser eye surgery has been tried and tested over its 23 years of existence. Over 36,000,000 LASIK procedures have been performed throughout the world, and nobody has lost an eye from having the procedure. The risk associated with laser eye surgery is less than that associated with contact lenses, and as far as infection goes, it represents a small one-time risk, as opposed to the ongoing risk of infection with contacts.

Laser eye surgery's safety has been experimented with and assessed by government and military organisations such as the US Navy, the Australian Army, and NASA. Their investigations show that blade-free LASIK (ie. creating a corneal flap with a femtosecond laser) is safe and approved for the SAS, Top Gun pilots and NASA astronauts.

Professional sportspeople also have used laser eye surgery to ensure their best performance on the field. This includes sportspeople such as Tiger Woods and David Beckham, whose vision correction procedures undoubtedly allows them to perform at their peak.

Despite having such an exceptional safety profile however, laser eye surgery is still surgery, and therefore will always have the potential for complications. Such complications are generally rare and always manageable though, which I will discuss below.

Enhancement:
LASIK surgery is performed on the eye, an organic tissue. Though the procedure is extremely accurate, there is an average 3-4% risk the correction will be decent but not absolutely optimal. In these cases, I usually wait around 3 months to ensure the stability of the residual glasses prescription, then lift the same corneal flap created earlier to "fine tune" the procedure's outcome. These enhancements are minor corrections, and are therefore more accurate. A great advantage of laser eye surgery is that, although highly stable in the long term, should anyone experience any refraction shift in their vision, enhancements such as these can be at almost any time in the future.

Risk of infection:
As mentioned before, the rate of infection as a result of laser eye surgery procedures is extremely low, far less than infections resulting from contact lenses. Corneal scarring resulting from infection occurs even less than this, at a rate of less than 1 in 20,000. Even if this occurs, it is correctible with a corneal transplant. As a corneal subspecialist, I've performed a lot of corneal transplants, but have never had to perform one for this reason.

Corneal flap issues:
Blade LASIK introduced the risk of creating an abnormal flap (such as a buttonhole flap). However, blade-free (femtosecond laser) LASIK eliminates this risk altogether, and due to this enhanced safety, it is the only form of laser eye surgery I perform.

With blade-free laser eye surgery, inflammation under the flap can sometimes occur (this is called diffuse lamellar keratitis), and can be managed by an increase in anti-inflammatory eye drops. If cells on the cornea grow (epithelium - a very rare occurence), they will generally absorb and disappear. If they ever proliferate, the flap can be lifted and the offending cells removed.

Dry Eye:
Temporary dry eye phenomenon is created when the nerves of the cornea are cut, which occurs during laser eye surgery. It can take about 3 months for these nerves to regenerate. During this time I would advise replenishing the tear film with lubricating drops.

Ectasia:
Ectasia is fortunately a very rare occurrence in which laser vision correction causes the cornea to become too pliable, and therefore bulges forward over time. Extreme cases of ectasia have been corrected by corneal transplantation, however fortunately pre-operative screening of patients has increased in accuracy, meaning candidates unsuitable for laser eye surgery are almost always identified before the procedure. Recent advances in the technique of collagen cross-linking also allows us to stop this rare complication from progressing further, and lets the patient maintain their vision while avoiding a cornea transplant. I am one of few eye surgeons in Australia who is experienced in this and can perform it in my surgery, however I have never needed to perform it on my own patients.

Glaring and Halos:
After the procedure, patients sometimes see starbursts or halos around lights in the night. This is most often due to the corneal flap dehydrating and stabilising, and it is rare to see this phenomenon persist longer than about a week.

Quality of vision:
The majority of patients feel that their vision after laser eye surgery is better than their vision with glasses or contacts before the operation. There is always a very small minority who experience visual quality less crisp than their pre-operative vision, but this situation is generally rectified by laser enhancement.

Laser eye surgery's proven and maintained track record of safety, accuracy and efficiency make it the clear treatment for becoming independent from glasses or contact lenses. Recent advances in blade-free femtosecond LASIK takes this to new levels, and surely represents the height of eye surgery and vision correction.

Dr James Genge (M.B., B.S., B.Med.Sci. (Hons)., F.R.A.N.Z.C.O.) is an ophthalmic micro surgeon and internationally trained Laser Eye Surgery, Cataract and Corneal Surgery Subspecialist. Want to learn more about LASIK and Laser Vision Correction? Visit his site at Laser Eye Surgery Sydney.

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