LASIK eye surgery is known for being a quick, convenient medical procedure—and sometimes it is. The surgery only takes a few minutes, and can correct your vision immediately so that you no longer need glasses or contacts. But not everybody gets that best-case outcome, and the FDA wants potential patients to know about the risks and side effects.
What are the potential complications of LASIK surgery?
LASIK surgery is done to reshape the cornea of the eye, the clear dome over your pupil. The surgery involves cutting a flap in the cornea, removing tissue with a laser, and replacing the flap. In the process, nerves are damaged and need to heal. Most patients can see clearly within a day or two of the surgery, but healing takes longer. The most common issue in the early days is dry eyes; 85% of patients still have dry eyes a week later. Dry eyes can cause blurry vision and pain, but eyedrops help.
If the nerves that were cut don’t heal properly, symptoms like dry eye may continue for months or years. Other complications can also occur, and these are more common if you have certain health conditions, including diabetes or allergies, or if your cornea is already very thin before surgery.
The surgery also isn’t guaranteed to give you 20/20 vision; many people need to continue wearing glasses or contacts even after a surgery that improves their vision.
How common are complications from LASIK?
The FDA has been working on a draft document that discusses what these complications are, and who is most likely to get them.
Six months after the surgery, according to the FDA, 27% of patients still have dry eyes, and 41% have visual problems like glare, halos, starbursts, or double vision. These visual problems can make it difficult or impossible to do tasks like driving at night. At the six-month mark, 2% of people report “a lot of difficulty” or “so much difficulty that I can no longer do some of my usual activities” without glasses or contacts.
These symptoms usually get better, but not for everybody. The FDA wants patients to sign a form acknowledging that these are the statistics 5 years after surgery:
Around 17% of patients may still need to use eye drops daily for dry eye.
Less than 2% of patients notice some visual disturbance, such as glare, halos, 800 starbursts, and double vision.
A decreased ability to see under low light conditions; around 8% of patients may have moderate difficulty or a lot of difficulty driving at night.
Very rare reports (estimated rate of less than 0.8%) of severe, constant pain that may prevent normal activities.
Who is likely to have complications from LASIK?
The FDA’s document also includes a checklist of things that may affect your chances of having lasting complications. These include medical conditions, but also other considerations like whether you play contact sports and whether you rely on being able to see well in low light (for example, if you do a lot of night driving).
Contraindications, meaning that you should not have the surgery, include:
Already having dry eyes
A cornea that is “not thick enough” (your eye doctor can tell you about your corneal thickness)
Autoimmune disease
Glaucoma that is not under control
Diabetes that is not under control
And then there are conditions and activities that don’t prohibit you from getting the surgery, but that should probably give you pause. The draft document suggests talking to your doctor about your risks if you have milder versions of the conditions above, like if you take a medication that causes dry eyes as a side effect, or if you have glaucoma or diabetes that is well controlled with treatment. If you have crossed eyes or decreased vision in one eye, those are also classed as warnings. (For the full list, which includes more conditions than we’ve mentioned here, see the draft document.)
Not all clinics clearly explain the risks
If these complications of LASIK are so common, why aren’t they talked about more? Maybe I’m cynical, but one reason is likely to be marketing. The surgery is simple and efficient from the doctor’s point of view, so there are clinics that specialize in it and that have substantial advertising budgets. LASIK is usually not covered by insurance, and cost varies but averages over $2,000 per eye. Doctors can often perform the surgery in 15 minutes, making it very profitable, as this analysis in an ophthalmology journal points out.
That paper also mentions that LASIK clinics will offer discounts “to entice patients to schedule visits for preoperative evaluation and for subsequent treatment.” It’s not hard to imagine that some clinics may emphasize the benefits over the risks when they’re interested in making a sale.
As the New York Times reports, the FDA has been working on its draft document for years, and the current draft has gotten over 600 comments—many from surgeons suggesting that the draft is too negative, and might scare patients away unnecessarily.
In short, the FDA is concerned that surgeons don’t do enough to discuss the potential downsides of the surgery before people agree to get it done. It’s important to understand the risks and benefits of any medical procedure, especially an elective one that you could do without. Besides glasses and contacts, there are other eye surgeries that may be able to correct your vision; they each have their own list of risks and benefits.