My LASIK

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On January 19, 2004 I underwent LASIK surgery on both eyes.  Before the surgery I was about 3.5 diopters near-sighted, with some significant astigmatism, in both eyes.  My vision was nearly perfectly corrected with hard lenses (adjusted for “monovision”).  After the surgery:

  • Both eyes are over-corrected by about 0.5 diopters.  This means that I need corrective lenses to see properly.
  • Both eyes have irregular astigmatism.  My left eye has significant irregular astigmatism.  This means that:
    • Reading is difficult because characters are “confused”.
    • Car tail lights at night look like star-bursts.
    • These effects cannot be corrected at all by spectacles or soft contact lenses, and only partially by hard contact lenses.
  • I have a partial vitreous detachment in both eyes.
    • This means that my field of vision is filled with floaters.  This is especially distracting when I am looking at a bright background (eg. the sky or a black-on-white computer window).
    • This is permanent and uncorrectable.

Here are some thoughts I have had about LASIK surgery.  I should note that I have no idea whether or not my surgeon was incompetent or negligent (although during most of the brief surgery he was discussing one of his staff member’s Florida vacation).  My personal opinion is that the LASIK procedure itself is fatally flawed.

Conflict of Interest

It seems to me that LASIK practitioners are guilty of a conflict of interest.  The same person who is trying to convince you of the benefits of LASIK surgery is also the one who will profit by it.  This goes as well for the optometrists who refer their patients to LASIK surgeons and do the followup work.  My optometrist received about a quarter of the fee my surgeon charged me.

The conflict of interest involved in LASIK surgery is largely a function of the fact that it is “elective” – no one really needs it, somebody has to convince you that you want it.  Therefore, your surgeon is strongly tempted to present a much more optimistic picture of the likely results.

Reporting and Accountability

Unlike most other surgery, LASIK is usually performed in a lab in the ophthalmologist’s office.  The ophthalmologist is often not associated with a particular hospital.  There is little peer accountability, and any outcome reporting is left to the surgeon.  Therefore, when your surgeon tells you that his incidence of “bad outcomes” is less than half a percent, there is no way to independently verify this.

Measuring Quality of Vision

One thing which has become clear to me is that it is extremely difficult to measure quality of vision objectively.  The obstacles include:

  • No one but you can see what you are seeing in the way you are seeing it – not even your ophthalmologist!
  • Since you also cannot see what anyone else is seeing in the way they are seeing it, you cannot determine how your vision compares with anyone else’s.
  • Since different aspects of vision are of different importance to different people, what “works” for someone else may not work for you.
  • The methods which ophthalmologists use to measure quality of vision are inadequate.
    • Eye charts are worthless.  Look at this “ghosted” eye chart.  You can read it, but would you like your world to look like that?
      • Ghosted Eye Chart
    • Corneal mapping is mainly useful for analyzing the damage done by LASIK surgery.
    • People who report damaged vision are often frustrated by the inability of their ophthalmologist to discover what is causing the visual distortions they are seeing.

The Flap

One of the most problematic aspects of LASIK (as opposed to PRK) surgery is the flap cutting procedure.  The supposedly nice thing about it is that there is a much shorter and less painful recovery period.  The not-so-nice things about it are:

  • The flap can be cut all the way through, resulting in a loose piece of cornea.
  • The suction of the microkeratome raises the pressure inside the eye, possibly resulting in vitreous detachment.  (This happened to me.)  See the article about Floaters at the CRSQA Web site.
  • Various types of debris can be left under the flap.
  • The flap can heal in a misplaced position.  (This happened to someone I know.)
  • You will be told that the flap heals quickly.  In a day or two it is difficult to displace.  In several weeks it is almost completely healed.  What you will not be told unless you ask is that if you require a later “adjustment”, it will not be necessary to cut another flap – the “healed” flap can be lifted after a period of up to a year and a half, and possibly longer.  Perhaps you have misunderstood the meaning of the word “healed”.
  • One of the possible side effects of LASIK surgery is known as “dry eye”.  This ranges from uncomfortable to disablingly painful.  If you ask your surgeon about “dry eye,” you will be told that some LASIK patients may experience dryness for up to a month after surgery, but this is temporary in most cases.  Another way of explaining this is that the flap cutting procedure severs nerves in the cornea which are part of the feedback loop which produces tears.  In most patients the nerves regenerate.

“Progress”

One victim of LASIK surgery has pointed out that no matter what the status of today’s refractive surgery is, yesterday’s is always “barbaric”.  An unfortunate corollary of this is that tomorrow, the refractive surgery you had today will also be “barbaric”.

Trail of Failures

The dirtiest secret of LASIK surgery is the trail of damaged eyes it leaves.  Your surgeon will undoubtedly tell you that his rate of “negative outcomes” is less than half a percent (funny how they all have the same failure rate).  The rate of “perceived” (as opposed to “measured by inadequate means”) negative outcomes in the clinical trials of the LASER device used for my surgery was about 10 percent.  I suspect that the actual failure rate hovers about 3 percent.  No matter what the number is, the fact remains that successful LASIK procedures would be completely impossible without a small, but steady stream of people whose vision is permanently ruined to at least some degree.

18 Years Later

Stars still look like Chinese characters. I still have floaters. However these problems hardly bother me. I have very good distance, and good reading, vision. I do not need corrective lenses to drive. I stopped wearing rigid contact lenses years ago. I need spectacles for reading, and a magnifying glass for reading prescription instructions (who doesn’t?). I am happy with my current vision. It could be much worse.