Thursday, January 10, 2013

What are the long terms side effects of laser eye surgery?

Q. I am interested in having laser eye surgery to correct short sight but I am concerned about the longer term side effects as I get older. I can't find much information about this subject on the web so I would be really interested to find out.

A. The risks outlined below apply to both PRK and LASIK procedures. The chances of having a serious vision-threatening complication are minimal, and there have been no reported cases of blindness following either PRK or LASIK, says James Salz, M.D., clinical professor of ophthalmology. However, FDA is aware of a few instances of severe eye injury requiring corneal transplant.
Infection and delayed healing: There is about a 0.1 percent chance of the cornea becoming infected after PRK, and a somewhat smaller chance after LASIK. Generally, this means added discomfort and a delay in healing, with no long-term effects within a period of four years.

Undercorrection/Overcorrection: It is not possible to predict perfectly how your eye will respond to laser surgery. As a result, you may still need corrective lenses after the procedure to obtain good vision. In some cases, a second procedure can be done to improve the result.

Decrease in Best-Corrected Vision: After refractive surgery, some patients find that their best obtainable vision with corrective lenses is worse than it was before the surgery. This can occur as a result of irregular tissue removal or the development of corneal haze.

Excessive Corneal Haze: Corneal haze occurs as part of the normal healing process after PRK. In most cases, it has little or no effect on the final vision and can only be seen by an eye doctor with a microscope. However, there are some cases of excessive haze that interferes with vision. As with undercorrections, this can often be dealt with by means of an additional laser treatment. The risk of significant haze is much less with LASIK than with PRK.

Regression: In some patients the effect of refractive surgery is gradually lost over several months. This is like an undercorrection, and a re-treatment is often feasible.

Halo Effect: The halo effect is an optical effect that is noticed in dim light. As the pupil enlarges, a second faded image is produced by the untreated peripheral cornea. For some patients who have undergone PRK or LASIK, this effect can interfere with night driving.

Flap Damage or Loss (LASIK only): Instead of creating a hinged flap of tissue on the central cornea, the entire flap could come off. If this were to occur it could be replaced after the laser treatment. However, there is a risk that the flap could be damaged or lost.

Distorted Flap (LASIK only): Irregular healing of the corneal flap could create a distorted corneal shape, resulting in a decrease of best-corrected vision.

Incomplete Procedure: Equipment malfunction may require the procedure to be stopped before completion. This is a more significant factor in LASIK, with its higher degree of complexity, than in PRK.

Problems with a Perfect Procedure: Even when everything goes perfectly, there are effects that might cause some dissatisfaction. Older patients should be aware that they can't have both good distance vision and good near vision in the same eye without corrective lenses. Some myopic patients rely on their myopia (by taking off their glasses, or by wearing a weaker prescription) to allow them to read. Such a patient may need reading glasses after the myopia is surgically corrected. Another consideration is the delay between eye treatments. If one eye is being done at a time, then the eyes may not work well together during the time between treatments. If a contact lens is not tolerated on the unoperated eye, work and driving may be awkward or impossible until the second eye has been treated.


What has been your experience with Lasik Surgery?
Q. I am spending $400+ a year on contacts/glasses and can get LASIK done for less than 2k. I am strongly considering it. What are the success/horror stories you've heard of?

A. My experience has been awesome!

I had my surgery done when I was 20 (I'm now 23), I had a relatively strong prescription (very nearsighted with quite a bit of astigmatism). My prescription was strong enough that I didn't like wearing glasses because the lenses make everything look really small (and my eyes looked really small to people that looked at me with them on). I wore contact lenses during the day, only taking them out an hour before I went to bed and put them back in with 30-40 minutes of waking up in the morning. I couldn't see anything without a correction. I had to hold the alarm clock a couple inches in front of my face if I ever woke up and wanted to know the time. Even in the dorms, we had to mount a shelf by my lofted bunk so the clock could be within arm's reach.

I remember when I sat up after the Lasik procedure...and I could see the clock on the wall. I wasn't at perfect vision yet (20/20), I was seeing about half that at 20/40. But after wearing glasses or contacts for the last 9-10 years, I forgot what it was like to look at a clock without any correction and be able to see it. I also remember when I walked out of the building (under assistance from my mother, of course. They gave me Valium beforehand, and I was a little loopy), I remember looking around the parking lot and being able to SEE. It was like I had been blind and was seeing for the first time, it was an amazing experience. I also remember waking up the next morning and could look over to see the alarm clock for the first time in 10 years.

I now have 20/15 vision (a little better than normal) and no longer wear any glasses, other than sunglasses.

Now that was the good part, but there are a few drawbacks. The procedure I had is called epi Lasik, where they actually shave the top layer of the cornea off to perform the procedure and allow it to grow back (can take a few weeks). So the day of the surgery was fine, and most of the day after. But then, I went through 2 days of a lot of pain which is very much expected with this procedure. It also took me about 2 weeks to get to 20/20 vision, which was quite a bit faster than what I was told. It took me about another year to get to 20/15 vision. So some people aren't happy with this method because it takes time for your eye and vision to recover. The other common version of Lasik is where they make a flap on your eye and put it back in place when the procedure is done. In that procedure, you see 20/20 immediately. But the epi version is much safer, because there is no flap (which there is always a danger of opening it back up).

Longer term effects, I have a little trouble with car headlights/brake lights at night. Nothing severe, but they kind of look like a star, with those streaks radiating out from the light. I also have some dry eye issues. Both of those are expected, but I absolutely will put up with both of those issues to see an alarm clock in the morning!

Oh, and you'll end up needing reading glasses sooner than you would without Lasik. But there again, you only need glasses for reading and not for full-time wear.

I hope this helps!


Is lasik eye surgery more of a risk for someone that has very small asian eyes or does it make a difference?
Q. I read this some where in an article , can anyone elaborate why, pls.

A. ... I've never heard that before. I tried looking it up and I found this:

http://www.docshop.com/2006/07/20/hastings

From reading this I don't really think it matters. Since everyone does have different shaped and size of eyes, I don't think it matters if you're asian.


What si the price f having laser eye surgery and what are the risks?
Q. I am thinking about getting the eye surgery when i turn eighteen because i hear of all these complications of wearing contacts that it might get stuck inside my eye.

A. About 2 to 3 K. Your power must be stable. Risk is small as Singapore has the highest success rate in lasik.





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Title Post: What are the long terms side effects of laser eye surgery?
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