Is Complete Loss of Vision a Matter of Concern in Lasik Surgery?
Lasik or laser-assisted in-situ keratomileusis employs a laser beam to correct nearsightedness, farsightedness and astigmatism. These are refractive errors that result from distortions in the curvature of the cornea of the eye. Lasik selectively peels away layers of stromal cells that constitute the thicker middle portion of the cornea. The result is a thinner cornea with corrected curvature that enables light to deviate correctly to bestow clear vision. Prima facie, any person would be anxious about permitting a laser to work on their most precious organ- the eye, and may become fearful about the prospect of losing their vision completely. Are such fears justified? Is Lasik surgery really dangerous? Read on to get a holistic view about the issues surrounding the laser eye surgery.
Lasik surgery, since the nineties when it was approved by the FDA, has attained rarified heights of success but its accomplishments have also attracted a great deal of criticism that questions the procedure’s motivation and the end result.
It cannot be denied that Lasik in its core form as an FDA approved technique has been very successful with 98 percent of individuals undergoing the process successfully. In the majority of cases, vision is restored to at least 20/40 which is equivalent to the vision that was assisted earlier by eye-wear. The people who undergo the procedure lead successful lives after giving up their dependence on eye-wear.
Moreover, no cases of blindness have been reported after Lasik operations, barring rare instances where major loss of visual acuity has been experienced. Even in extreme instances, there may have been health risks that were overlooked when the candidacy was considered.
The Factors that Eliminate the Danger of Lasik as a Surgical Procedure
- The excimer laser has been perfected over the years delivering a higher degree of procedural accuracy than ever before. In Wavefront Lasik, the surgeon gets a 3D rendering of the eye which is useful in programming the laser with greater perfection and for drastically reducing the risk of complications.
- The laser beam that is employed is a cold beam that does not work by generating heat. It vaporizes the tissues by weakening the molecular bonds that hold the connective tissues together. It removes only the corneal tissue and nothing else. The laser does not pose a threat to any other part of the eye.
- The laser beam is a series of pre-programed pulses designed to hit only the corneal surface and nothing beyond, hence the fear of the laser burning a hole in the eye does not arise.
- The outer epithelial layer above the stroma of the cornea is not removed as in the traditional surgery. In Lasik, the epithelium remains attached to the tissue as a hinged flap which is simply restored back to its normal position after the laser treatment. The natural suction force in the cornea keeps the flap in place allowing it to heal naturally. A protective eye shield prevents the flap from getting unhinged by accidental external pressure or touch. For the same reason, people involved in contact sports are usually discouraged from undergoing Lasik treatment.
- Lasik is attempted only if the cornea is thick enough to withstand reshaping. People with thin corneas and bulging corneas that occur due to a hereditary condition called keratoconus (corneal ectasia) are disqualified from attempting Lasik surgery.
- Candidates below the age of 21 years or those with a history of eye diseases or eye disorders or individuals suffering from ailments such as diabetes, rheumatoid arthritis, HIV infection, hormonal imbalance and autoimmune syndromes are automatically disqualified from attempting Lasik surgery. The motivation behind such detailed screening precautions is to cut the extent of risks as far as possible. This makes the procedure safer and error free to a large extent.
- The rigorous pre-operation checks ensure that the risk factors which increase the likelihood of an unsuccessful Lasik outcomes are thoroughly eliminated. This leaves the technique itself open to audit and the most advanced versions of Lasik surgery such as the Wavefront Lasik (also called as Custom Lasik) have reduced the margin of surgical error to negligible levels. In this technique, the surgeon studies and pre-programs a three-dimensional model of the entire eye to precisely identify the exact locations on the corneal surface that need removal.
In short, Lasik as a surgical procedure is only “dangerous” or “safe” as any other kind of surgery attempted anywhere else in the body. The human error component of Lasik is lower than ever before because of the complexity of pre-operation screening tests, sophistication and the reliability of excimer laser. The best precaution one could exercise is to consult a top ophthalmologist who has a vast experience dealing with hundreds of surgeries and is fully aware of the risks and knows the remedies inside out.
Unavoidable Post-Surgical Risks that May Cause Anxiety to Lasik Candidates
Just like any other kind of invasive surgery, Lasik also carries a certain degree of risk. These vision risks are explained in detail to candidates at the time of obtaining their written consent. But these risks do not threaten the vision to the extent of causing blindness or total loss of vision. These are risks that are immensely controllable and can be remedied through prescription eye-wear or a repeat surgery.
Lasik may disturb the nerves that control tear production by the tear glands and this may result in a temporary dryness of the eyes and associated discomfort for a few hours following the treatment. Artificial tears may need to be administered or moisturizing eye drops must be continued till the eye normalizes. To rule out complications, candidates suffering from chronic dryness prior to the surgery are disqualified.
Blurriness, Double Vision, Glare and Halos
These are prominent side effects of Lasik treatment but the symptoms are by no means permanent as the eye normalizes within a week of surgery. Patients are counseled to use eye drops and oral meds till these symptoms clear and to wear protective shields or sunglasses to reduce the discomfort. Driving mostly at nights may become problematic and would require to be curtailed for some time.
Scarring of Corneal Surface
Fears of laser surgery scarring the corneal surface are rare as advancements in surgical techniques have eliminated such risks. It should be noted that individuals with thin corneas, bulging misshapen corneas and those who suffer from hereditary corneal degeneration which is in the high-risk category are disqualified from undergoing Lasik surgery.
Need for Eye-Wear to Correct Vision Disturbances
In rare instances, Lasik surgery does not rectify refractive errors in the way it was planned. For such individuals, doctors may recommend additional corrective glasses or contacts. The important thing to remember is that Lasik does not guarantee complete independence from eye-wear because it may be required in later stages when eye muscles and lenses weaken and create fresh refractive errors.
The Bottom Line
Lasik is not by any yardstick a dangerous or vision threatening surgical procedure, but patients opting for laser surgery must understand its limitations clearly to avoid disappointments or frustration. Any decision to undergo Lasik surgery must be preceded by a comprehensive session with a qualified and highly experienced ophthalmologist to better understand the risks and drawbacks of the surgical procedure before committing to it. If a person is in sound health without a history of serious eye disease and if refractive errors are minor and controllable, corrective eye-wear must remain as the first resort before Lasik surgery.
- Losing an eye completely to Lasik surgery is a worst case scenario which cannot be ruled out.
- The pre-op screening, the skill of the surgeon and sophistication of the excimer laser remove all doubts regarding the safety of the procedure.
- Remedial action is possible for any risk or vision complication that may arise after Lasik surgery.