Ex-FDA Advisor Says of Lasik Eye Surgery: ‘It Should Have Never Been Approved’

https://pittsburgh.cbslocal.com/2019/06/17/lasik-eye-surgery-complications-fda-approval/

by bookofjoe • 7 years ago

242 260 7 years ago

pittsburgh.cbslocal.com

I had laser eye surgery, but I went with PRK. Less invasive, more durable, far less wasteful of cornea, and its end results are just as good as LASIK's. The only downside is it's a little less convenient because each eye takes a few weeks to heal, so people usually do one eye at a time.

The LASIK procedure is just utterly insane in comparison, especially given its extremely limited advantages.

https://en.wikipedia.org/wiki/Photorefractive_keratectomy

d23• 7 years ago

I did PRK and have had chronic dry eyes ever since. I can't recommend it. I would go back to contacts if I had the choice.

jniedrauer• 7 years ago

I also had dry eyes after PRK, for about 6 months. Been back to normal for a long time though and I consider the minor discomfort for 6 months well worth it.

saurik2• 7 years ago

Do you not have the choice? (I was under the impression that PRK couldn't correct very large prescriptions, but maybe it is larger than contacts? They claim it is very reversible, but the studies I read made it seem like maybe your eyes start to have permanent changes due to different growth rates, so are you saying you wish you had never done it? Or are you just saying "if I were you", but using phrasing that I am misparsing?)

CharlesColeman4• 7 years ago

I did PRK and have had chronic dry eyes ever since. I can't recommend it. I would go back to contacts if I had the choice.

IIRC, from my research, dry eyes are more common with Lasik than PRK. But you make a good point: PRK isn't side-effect free, either.

Reason077• 7 years ago

LASIK seems to work well for many people. My sister had it years ago, and I have several friends who've had it too. None of them, to my knowledge, have any regrets whatsoever.

toomuchtodo3• 7 years ago

For the people it works for, LASIK is great. For those who experience complications (the corneal flap needed for LASIK never heals entirely, therefore it can become displaced, causing much discomfort and possible permanent damage under the right circumstances), it can be long road of chronic issues because they wanted to save some recovery time over PRK. My recommendation (having had PRK done a decade ago) is to prefer PRK over LASIK, and take the recovery time needed. You're going to have your eyes for a lifetime. Take shortcuts elsewhere.

forgot-my-pw• 7 years ago

It comes with a lot of risks and side effects: https://en.wikipedia.org/wiki/LASIK#Risks

mschaef• 7 years ago

far less wasteful of cornea,

The argument years ago that convinced me NOT to have this procedure done was that they'd have to remove fully half my cornea. I'm assuming there are ways to recover from that with a corneal transplant, but that's a big risk and a lot of resources consumed just for the sake of not wanting to wear glasses.

Flash forward fifteen years and I'm diagnosed with early onset cataracts. Turns out they can pick a lens implant that corrects out the distortion caused by the shape of the eyeball. That was the procedure that got me to where I didn't need glasses, even though that wasn't remotely close to the primary motivation.

PhasmaFelis2• 7 years ago

I didn't know it was this bad, but I decided not to get LASIK for a different reason. It'd fix my near-sightedness, but also normalize my superior close-up vision. I can easily read ultra-fine print that most people need a magnifying glass for, and LASIK would destroy that. Absolutely not worth the small benefit of getting rid of my glasses.

artificialLimbs• 7 years ago

Ha! I thought I was the only one that loved being able to see any swimmers in my water bottle. I guess that's more of a drawback, but being able to have magnifying vision is pretty awesome. I use contacts sparingly when working, and glasses the rest of the time, and the maintenance thereof is not really a big deal.

mirimir• 7 years ago

I'm very nearsighted. But as I've aged, my "best distance" has increased from ~20 cm to ~40 cm. So now it's perfect for computer work. And I only need glasses for driving, movies, etc.

I can still read fine print etc, however.

PhasmaFelis2• 7 years ago

Yeah, totally! It's great for working on small objects, tiny screws, and so forth. It's honestly like an everyday superpower.

I take my glasses off to read up close; I can't make out faces across a room without them, but at close range they actually make things blurrier. Contacts kill it, too, which is why I didn't use them for long. I've been thinking of getting a pair just for using in VR, since my glasses don't fit well, but I dunno.

rhinoceraptor• 7 years ago

I didn't even realize people with normal eyes couldn't see as closely as I could. Is it really true that normal eyes have a near point of almost 10 inches?

melling2• 7 years ago

Orthokeratology contact lenses to reshape the eyes while you sleep are the new thing for teenagers.

https://www.npr.org/sections/health-shots/2015/05/21/4065023...

davidzech2• 7 years ago

I've used Ortho-k for 16 years, and I've absolutely loved them. I still confuse the heck out of people when I show or tell them I wear rigid contact lenses while sleeping. I've used glasses and dailies, and I without a doubt prefer Ortho-k. I do find it really weird that insurance doesn't cover it though - probably explains why they haven't become too widespread.

Loughla• 7 years ago

How do those feel in your eye, though, while you're trying to sleep?

Also, how would you rate your personal pain and discomfort tolerance?

npongratz• 7 years ago

As an anecdote, it didn't work for me, unfortunately. Tried for 9 months, 3 different sets of lenses.

Apparently I don't have enough corneal tissue, which resulted in poor and increasingly bad vision starting every day around 3pm (~9 hours after removing lenses). My pupils also dilate surprisingly large, with no lenses being able to pull tissue over the entire dilated pupil, resulting in super nasty halos around light sources. The halos alone were bad enough that I wouldn't have been able to safely drive at night.

I am glad, though, that the attempt was completely, 100% side-effect free (except for my wallet). After a day or two, my vision returned to its terrible origin, with no halos or discomfort or anything.

causalmodels• 7 years ago

I participated in the clinical trials for this and used them regularly between 2008-ish (it's hard to remember since I was in middle school) and 2015.

The results were remarkable but the contacts themselves where insanely uncomfortable.

tedunangst• 7 years ago

It's really damning how they were unable to find a single patient happy with their outcome.

falcolas• 7 years ago

It's pretty unlikely they tried hard then. I know of 4 in my close family alone. Brother- and sister-inlaw, and two cousins.

There have also been a number of co-workers and distant friends who suddenly stopped wearing glasses, and seem quite happy with their Lasik.

scarejunba• 7 years ago

Damning of the quality of their survey perhaps? I could point them to loads of such people.

notacoward2• 7 years ago

I'm kind of glad that I wasn't a candidate for LASIK when I was most seriously considering it (pupils were too big). I know several people who've had it and been delighted, but I also keep reading these horror stories about it making a bad situation worse. At my current age (54) the benefits are likely to be temporary at best, so it's just not worth the risk. Eyesight is not something to gamble with.

madengr• 7 years ago

Same here. Been wearing contacts for 25 years and they work fine. I've had several occasions where something has hit my eye, and the contacts have protected it from probable severe scratching.

CharlesColeman4• 7 years ago

At my current age (54) the benefits are likely to be temporary at best, so it's just not worth the risk. Eyesight is not something to gamble with.

Also, if you're that old, it might mean an instant need for reading glasses (if you don't already have them).

Being nearsighed is like permanently wearing a pair of reading glasses. Given how much of my day is taken up reading vs. using distance vision, part of me regrets getting my eyes corrected to 20:20.

notacoward2• 7 years ago

Indeed that is the case. I've already been wearing progressives (+2.0 add) for several years. I think presbyopia is something a lot of folks don't consider when they opt for LASIK. It might make your vision better for one decade, but then worse for two or more. Maybe people just can't internalize that age will catch up with them too. Maybe they just hope that medical science will come up with something new by then, so they can have the best of both worlds. Didn't work out that way for me, though I do think we've passed Peak Eyeglass and glasses will seem as outdated as buggywhips some day.

daeken• 7 years ago

Holy observation bias, Batman! The only thing even resembling actual negative statistics in this article is the ballpark estimates by the ex-FDA advisor, and those are just guesses.

You can find negative experiences, sure, but what is the actual incidence of that? Without that data, this is utterly meaningless. It certainly isn't damning.

exhilaration• 7 years ago

Some data here [1]:

A recent clinical trial [2] by the F.D.A. suggests that the complications experienced by Mr. Ramirez are not uncommon.

Nearly half of all people who had healthy eyes before Lasik developed visual aberrations for the first time after the procedure, the trial found. Nearly one-third developed dry eyes, a complication that can cause serious discomfort, for the first time.

The authors wrote that “patients undergoing Lasik surgery should be adequately counseled about the possibility of developing new visual symptoms after surgery before undergoing this elective procedure.”

[1] https://www.nytimes.com/2018/06/11/well/lasik-complications-...

[2] https://jamanetwork.com/journals/jamaophthalmology/fullartic...

foobiekr3• 7 years ago

I wonder how people who got dry eye will age. As you age dry eye symptoms tend to increase and can be associated with recurrent corneal erosions which, aside from being painful, can get infected, which can be absolutely terrible and vision threatening in extreme cases.

Dry eye is hell especially if you work at a computer.

As an aside, Ocusoft Retaine drops are the best thing I’ve found for dry eye; I’ve never met anyone else with the problem who uses them but it’s like night and day.

mcguire2• 7 years ago

Specifically, "Visual symptoms and dissatisfaction with vision were common preoperatively. Overall, the prevalence of visual symptoms and dry eye symptoms decreased, although a substantial percentage of participants reported new visual symptoms after surgery (43% [95% CI, 31%-55%] from the PROWL-1 study and 46% [95% CI, 33%-58%] from the PROWL-2 study at 3 months)."

So, nearly 50% had new symptoms at 3 months.

raverbashing3• 7 years ago

Twelve months postoperatively, 5.0% of PRK and 0.8% of LASIK participants developed chronic dry eye.

https://www.ncbi.nlm.nih.gov/pubmed/26796443

arcticfox2• 7 years ago

Anecdotal, obviously, but the only person I know that has had Lasik now has terrible, chronic dry eyes. I took stats with her; she said it never even crossed her mind that it might actually be pretty risky.

commandlinefan• 7 years ago

Yeah, the headline scared the heck out of me, since I had lasik done about 10 years ago, but (at least in the article) there's no way to tell if the people who are having problems wouldn't have had problems if they hadn't gotten lasik in the first place.

fellowniusmonk• 7 years ago

Exactly. This is statistically a non-story.

MY STORY: I was recently interested in Lasik because I could no longer wear contacts. I ran into Dr. Oz's expose video right away, and realized that since at least 2013 there was a constant local/national news cycle promoting the lasikcomplications.com group.

This freaked me out quite a bit.

I read many of the negative posts, not all, but a large number said something like "Dr's told me my cornea wasn't thick enough but I had the procedure anyway."

THE NUMBERS: Google very heavily features https://lasikcomplications.com/ and its FB page when you do any basic search, their FB group https://www.facebook.com/groups/LasikComplicationsFaceBookGr... page has 6,400 members.

In the U.S. ~9 million people have had Lasik, internationally it's 30 million. There FB group has effectively no membership, their FDA petition has less than 2k signers.

The site mentions suicide rate prominently, but the baseline suicide rate from https://afsp.org/about-suicide/suicide-statistics/ is 14.0 per 100,000, and it didn't seem like that rate was higher for people who got Lasik, it seemed lower really.

Ok, so I was confident that people with real complications have an outlet, and that outlet seems to be concentrated in this single group, so english world complaints should be pretty reliably represented in this group... and there just aren't that many complaints.

so...... statistically outcomes look great.

RESULT:

I got Lasik 4 months ago, couldn't be happier with the outcome, due to my risk tolerances if I could have kept wearing contacts I wouldn't have gotten it but everything has been hunky dory. On the plus side because I can easily wear sunglasses again my light triggered migraines (transitioning to sunlight is a problem) have all but disappeared and I am back long distance cycling again because my vision isn't jostling on the bike any longer.

Also, this group definitely juices its numbers by focusing on the large percentage of people who have dry eyes and halos during the recovery period and they include those as "complications", I had those for the first month, I've since met a surprising number of people who got Lasik (they come out of the woodwork once you get it) and people have different lengths of recovery from dry eyes, the longest I've met was 7 months and they were still very happy with getting it.

joezydeco2• 7 years ago

A long time ago it was promised that the FDA would eventually approve intraocular lens replacement for vision correction as well. What ever happened to that?

raverbashing3• 7 years ago

It does exist but it's a much more invasive procedure, and I think it's used only for much higher prescriptions (+/-10d and above) - not sure it's approved by the FDA though.

oyashirochama• 7 years ago

It is also used for areas that require a certain color correction as well, usually aircraft or combat roles and is covered under tricare for combat and pilots.

ReidZB• 7 years ago

I think whether or not LASIK is suitable depends on corneal thickness, corneal steepness, and the level of correction needed, just as a baseline, or so it was explained to me. I was investigating intraocular lenses not too long ago as an alternative because my ophthalmologist advised that I'd probably have difficulty seeing in low-light conditions if I underwent LASIK.

(Apparently my "parameters" are such that I'm in a gray area where some surgeons will perform LASIK, but others won't. My prescription is pretty high in one eye (around -8). I ended up not being a great candidate for any corrective eye surgery, intraocular lenses included.)

Anyway, intraocular lenses are definitely more invasive, but from what I recall they sounded like a better option to me than LASIK in general: apparently vision quality is better than LASIK with IOLs, there's no removal of corneal tissue, and chance for complications was lessened. (Well, as I understood it, there were fewer minor complications, but more possible major complications, which is maybe not a trade-off many people want to make.)

Of course, they cost about 2x as much as LASIK.

I'm pretty sure they are FDA approved, especially given their use in cataract surgery, although the ones in cataract surgery replace the natural lens whereas the corrective type typically do not...

wcarron• 7 years ago

My fiance just underwent LASIK about 6 months ago. She has had zero complications.

It's a very successful procedure, for the vast majority of people who undergo it. I fail to see why "it should never have been approved".

brokensegue3• 7 years ago

i mean if it blinded 1% of people and worked perfectly for 99% of people I would not want it approved

dation3• 7 years ago

If you don't like those risks then don't undergo it but for other people will find the risks acceptable and want to have it done. Being approved doesn't mean it is forced on anyone.

loh2• 7 years ago

I think it also depends on the person (their vision/health/etc.) as well as the surgeon's experience plus the equipment. The hours/days following the procedure are also pretty critical. You have to be very careful to not rub your eyes or anything like that and get plenty of rest while using the eye drops as prescribed.

onfire• 7 years ago

Had PRK 10 years ago, which I always describe to people as the closest thing to a miracle I've ever experienced. Went from not being able to read my bedside clock to better than 20/20. Of course, I am getting older so I need readers now, but my long distance vision is still perfect. Would have done it sooner!

toomuchtodo3• 7 years ago

Also had PRK about 10 years ago, cost me $3k. Best money I've ever spent, my vision is still around 20/20-20/30, and was recently offered a super cheap "touch up" to correct back towards 20/10-20/20 with topo mapping of the cornea.

RyJones• 7 years ago

I had PRK a few years ago and 'miracle' is how I would describe it.

blueadept111• 7 years ago

I had PRK and it left me with astigmatism in both eyes. Afterwards I had both eyes redone and the "touch up" made it better, but it was still bad enough that I needed glasses to correct my vision. I'm trying to decide whether it makes sense to try again a third time.

Whether or not a third time would work, my laser surgeon already told me it would be the last time he'd try to fix it (which is a different tune than he was singing originally). Since my surgery, I've bumped into a number of other PRK patients who've had similar troubles.

Also, the procedure left me with "haloing", which means that when its dark outside and you see lights, they all have a white halo around them, which is super annoying.

Another word of warning to potential PRK patients: the recovery period for me was measured in weeks (over a month, for me), and during that time my vision was hampered enough to make it difficult or impossible to work on computer screen. All in all, I wish I never had PRK.

pathartl2• 7 years ago

I was recommended if I wanted corrective surgery to do PRK over LASIK and the recovery period is honestly what worries me the most. I'm pretty sure my eyes are tuned so well to displays that even contacts give me eye strain when working on stuff. Having that recovery period would be detrimental to me

vladgur2• 7 years ago

The article links to a FDA study on outcomes [1] but is very selective at what it chooses to highlight.

Here is what article singled out: “In a recent study, the FDA found nearly half of participants who had no visual symptoms prior to the surgery reported having some complication three months after surgery.”

AND here are ALL the conclusions from the linked study results:

* Up to 46 percent of participants, who had no visual symptoms before surgery, reported at least one visual symptom at three months after surgery.

* Participants who developed new visual symptoms after surgery, most often developed halos. Up to 40 percent of participants with no halos before LASIK had halos three months following surgery.

* Up to 28 percent of participants with no symptoms of dry eyes before LASIK, reported dry eye symptoms at three months after their surgery. This is consistent with previous studies. * Less than 1 percent of study participants experienced "a lot of difficulty" with or inability to do usual activities without corrective lenses because of any one visual symptom (starbursts, ghosting, halos, glare) after LASIK surgery.

* More than 95% of participants were satisfied with their vision following LASIK surgery.

* Participants were more than twice as likely to report their visual symptoms on a questionnaire than to tell them to their health care provider

So what this means is that more than 50% of participants of the study had NO visual symptoms 3 months after the surgery and including those that did have some symptoms, 95% of ALL participants were happy with the outcome.

Add me to those 95% -- I had my Lasik done a decade ago at the Stanford Eye Center and had a quick recovery with zero complications and zero side effects

[1] https://www.fda.gov/medical-devices/lasik/lasik-quality-life...

lostmsu3• 7 years ago

I suspect the halo thing is not an objective problem. People just get alert and start noticing it, or could not see it before due to blurriness. That was my impression after having several conversations with my wife who had LASIK and complained about halos.

It finally convinced her, when several consecutive days I had what she described as "halos" because I was tired and could not properly focus at late night.

Myself having a nearly perfect vision at the time never paid attention to them before she expressed her concert about that effect after surgery.

planteen• 7 years ago

I'm not sure in your wife's particular case, but halos are a negative side effect of LASIK in some cases. It is not something that is always there the patient can now see. It has to do with the size of a patient's pupil versus the size of the area that can get corrected. Patients with very large pupils are told not to get the surgery period due to adverse halo effects.

JustSomeNobody• 7 years ago

I have decided against LASIK due to the potential for halos. I am susceptible to optical migraines and when I have one I see halos and it drives my nuts. I would hate to have even a fraction of that experience every day.

scottlegrand23• 7 years ago

Reminds me of the time Ralph Nader tried to ban cataract surgery...

https://www.eyeworld.org/article-marcus-welby--md--knew-best

boomboomsubban3• 7 years ago

From your article, his group tried to get lens implants classified as drugs making them subject to FDA regulation.

alistairSH3• 7 years ago

Up to 46 percent of participants, who had no visual symptoms before surgery*

Why would you undergo elective surgery if you had zero symptoms?

lancepioch• 7 years ago

Because having to deal with glasses/contacts is a small but annoying life problem.

dragonwriter• 7 years ago

Poor visual acuity is a significant, life-affecting symptom, and neither glasses nor contacts are full-time, all-conditions-suitable corrective measures.

mywittyname• 7 years ago

They mean of all the people who did not have one of the three side-effects of LASIK before the surgery, 46% now suffer from such symptoms after LASIK. Basically suggesting that LASIK caused these complications.

fpgaminer• 7 years ago

And honestly, three months doesn't seem long enough for a followup. My wife got LASIK and I think it was about six months before her eyes were back to normal (wrt halo and dryness).

the_watcher2• 7 years ago

All of the symptoms listed were clearly discussed and raised as risks of LASIK when I got it (also at the Stanford Eye Center, with the only issue being somewhat more frequent dry eyes)

RedDeckWins• 7 years ago

My wife is an ophthalmologist and would never get LASIK. The benefit of potentially not having to put contacts in every morning just does not outweigh the possible complications.

JohnFen3• 7 years ago

Yes, this is why I was never willing to get the procedure done. The risk/reward ratio is too unfavorable. Even if the percentage of people who have problems is very low, those problems are permanent. To take the risk of permanent injury just to avoid the inconvenience of wearing glasses never made sense to me.

stanski• 7 years ago

I can see it making sense if you're nearly blind without your glasses. I'd feel very vulnerable if I'm so reliant on glasses.

If it's just a slight convenience then yeah... keep that stuff away from me.

AdamN• 7 years ago

Glasses are the least risky. If you're using contacts however, you're taking more of a risk with your eyes than surgery.

keldaris• 7 years ago

What does she think about phakic intraocular lens implantation as an alternative to LASIK/PRK?

brandonmenc• 7 years ago

When I was being fitted for contact lenses for the first time a few years ago, I asked my ophthalmologist about implants and he basically acted like I was insane for wanting that procedure versus laser.

After experiencing truly dry eyes for the first time - from contact lenses - I will probably never get laser correction. Even a 1% chance of having permanent dry eyes at that level of discomfort sounds horrific.

Also, the slight chance of losing near vision in exchange for far vision is not worth it imo. I'd like to put off needing glasses to read in bed for a few more decades.

ggreer• 7 years ago

Isn't the cumulative risk of complications from contacts similar to the risks of LASIK? Contacts increase the rate of eye infections and corneal ulcers. In some cases these issues lead to permanent damage, even blindness.

buboard• 7 years ago

Sounds like she s overly cautious. I hated all kinds of glasses and contacts, and even some dryness sometimes and some glare at night is incomparably better than having to rely on those. Then again, i m lucky that i only had to do it in one eye, so i can compare vision with the intact one. Still, would recommend 100%.

vladgur2• 7 years ago

#protip If you are considering Lasik, do not watch the cinematic gem that is Final Destination 5

at_a_remove• 7 years ago

A few years back I was getting a little eye surgery done, under local, a quasi-regular thing with me. Because I like hearing about people's jobs, I asked my surgeon what he thought of LASIK. He has a very dry presentation. He paused and then began, "You'll notice I'm wearing glasses ..."

I filed that one away.

rchaud• 7 years ago

Lately my FB feed has been full of Lasik ads, and hilariously, the headline on their banner image was "You will not go blind after LASIK". Perhaps I should feel relieved that FB doesn't yet know that the only non-essential surgery I'd be willing to have would be to re-align my teeth.

nominated12• 7 years ago

Dry eyes and halos, many I speak to say they have these issues. Followed by “I don’t regret it, best thing ever”. I walk away mostly confused.

Watching my sister, who had it done ~10 years ago, struggle to stay between the lines on the freeway at night due to halos I wrote it off completely. Even with these issues she’s perfectly happy with the results. Again, I don’t get it.

krapht• 7 years ago

I have halos, very occasional dry eyes. Was worth it.

I was myopic (20/350) that got corrected to 20/15. Things I can do now: * Being able to lay in bed and look around the room and see things in focus. * Being able to lay in bed and look at my significant other and it not be a out-of-focus blurry mess. * Being able to get up in the middle of the night to go to the bathroom without hunting for glasses. * Being able to go swimming without goggles. * Avoiding the discomfort of contact lens wear and cleaning. * Being able to do read while laying on the couch without bending my frames. * Avoiding possibility of eye infection due to dirty contact lenses. * Avoiding the need to clean and wash glasses due to dirt. * Avoiding the painful removal of contact lenses after falling asleep with them in due to tiredness.

etc, etc etc

nominated12• 7 years ago

Most of this reads like quibbles to me. The thought of possibly having permanent eye damage, no matter how “insignificant”, in exchange for minor convenience/vanity and only myself to blame is a bit too much.

In my sisters case, she now has prescription night driving glasses and prefers not to drive at night with my niece. I’m not sure why but “was worth it” is what she’d say and similar reasons to yours are what she’d give.

loh2• 7 years ago

Am I one of the lucky ones? I see quite a few negative comments about dry eyes, halos, etc., but for me that really only lasted about a week or two. It healed so quickly that I actually don't even remember now how long it took, exactly. With that said, I made sure to go to a surgeon with a lot of experience, using the latest proven tech. I spent $4500 on it and I feel it was worth every penny.

vilhelm_s2• 7 years ago

So in the study the article refers to, when asked after 6 months "Currently, how satisfied or dissatisfied are you with the result of your LASIK surgery?" on a 6-point scale, the responses were:

    Completely satisfied         69.9%  (151/216)
    Very satisfied               22.7%   (49/216)
    Somewhat satisfied            4.2%    (9/216)
    Somewhat dissatisfied         0.9%    (2/216)
    Very dissatisfied             0.9%    (2/216)
    Completely dissatisfied       0.9%    (2/216)

(this is from eTable 4 in the supplement here: https://jamanetwork.com/journals/jamaophthalmology/fullartic...).

If the FDA guy concludes from this that the procedure should never have been approved, I'm tempted to say that it reveals more about the risk-averseness of the FDA than about the dangers of the procedure.

Freak_NL• 7 years ago

Three percent dissatisfaction and another four percent merely ‘meh’ is pretty high for an elective, perhaps even cosmetic, procedure that operates on something as fragile and irreplaceable as the eye.

scott_s3• 7 years ago

This is an important perspective. If these were the rates for a necessary medical intervention, we would be ecstatic. Because for a necessary medical intervention, the patient's baseline is not good. But wearing glasses is mostly a nuisance, not a health issue.

I've worn glasses since I was seven-years-old. They are a nuisance sometimes. But elective surgery, particularly for my eyes, makes me nervous. I don't want to take even a 1% chance of chronic eye problems to get rid of glasses.

MFogleman• 7 years ago

I understand the 'cosmetic' argument, and would like to offer my personal experiences as a counter.

I was 20/200 overall vision, and wore glasses since I was 11. At age 27, before going into law enforcement, I underwent the Lasik operation, and it was definitely a life changer.

Living near swamps, in the south, it wasnt uncommon to walk outside from an air conditioned building, and have your glasses instantly fog. My skin gets incredibly oily and the glasses would slide down my face. It was hard to find frames that didn't leave huge uncovered and distracting gaps in my peripheral vision from being too small.

In the academy, I saw plenty of guys have to deal with glasses falling off of their faces while doing pushups/working out. They'd have to evaluate "Do I want to see or do I want to not break my glasses" during defensive tactics training.

Post graduation, I can only imagine how negatively glasses would've impacted my job. Water getting on the lenses in the rain, splatter getting on them while tracking people through the woods. Sweat and condensation blocking your vision. This assumes they stay on.

Having to wrestle around with someone to get them into handcuffs is difficult enough, and its incredibly easy to get tunnel vision. Staying aware of your surroundings is important, and there would be a significant amount of due stress if you couldn't see what you were doing because your glasses got knocked into a ditch.

AWildC182• 7 years ago

We're becoming an incredibly risk averse society. Not sure what that means for the future...

Red_Leaves_Flyy• 7 years ago

I don't think society is becoming more risk averse. We still do a ton of drugs, drink, drive, fly, fight and commit crimes.

As we learn the dangers of things people start the arduous process of protesting them. See bpa, Teflon. Both got phased out after years and years of denials and lawsuits. Bpa and Teflon may have been mostly phased out, but they have been replaced by unknowns, which are reasonably expected to be about as bad as their predecessors.

Rather, I think the stakes for equivalently sized day to day risks are getting bigger because lives are getting more complicated, and bad bets can snowball a lot easier now.

Want to see risk? Take a good long hard look at the speculative and corporatedebt markets. hardly a risk adverse market.

jschwartzi• 7 years ago

I would say losing your eyesight and/or feeling the pain of snowblind for months on end are hazards we should be averse to. You have no idea how important your vision is until you start to lose it, and snowblindness in particular feels like rubbing sandpaper on the back of your eyes with no way to stop it. I can see why someone who experiences either of those symptoms from an elective surgery that they were told is "safe and effective" would want to kill themselves.

aiyodev• 7 years ago

Even a 1% failure rate is extremely high. This is incredibly bad.

martin_• 7 years ago

The results do not suggest failure, there are many other explanations for such results. The patient may have expected better vision than they have (eg 20/20 but wanted 20/15), or their prescription wasn't stable so vision deteriorated slightly after 6 months.

maxkwallace• 7 years ago

Thanks for pulling out the data! One problem is that "somewhat", "very", "completely" don't give a good picture of how dissatisfied these 2.7% of patients are. It's possible some of them developed serious dry eye which can be totally debilitating.

This doesn't mean the procedure shouldn't have been approved, it most likely means that folks need to do better patient education and qualification. Not everyone needs to be a good candidate.

It's also possible that these results vary a lot between LASIK docs. I'd expect that some qualify patients more thoroughly than others. Risk for developing side effects can be assessed beforehand, to some extent.

ars• 7 years ago

216 responses is not enough to gain data on the few people who were dissatisfied.

mcguire2• 7 years ago

From that study:

"Results A total of 262 participants were enrolled in the PROWL-1 study (mean [SD] age, 29.1 [6.1] years), and a total of 312 participants were enrolled in the PROWL-2 study (mean [SD] age, 31.5 [7.3] years). Visual symptoms and dissatisfaction with vision were common preoperatively. Overall, the prevalence of visual symptoms and dry eye symptoms decreased, although a substantial percentage of participants reported new visual symptoms after surgery (43% [95% CI, 31%-55%] from the PROWL-1 study and 46% [95% CI, 33%-58%] from the PROWL-2 study at 3 months). The percentages of participants in the PROWL-1 study with normal Ocular Surface Disease Index scores were 55% (95% CI, 48%-61%) at baseline, 66% (95% CI, 59%-72%) at 3 months, and 73% (95% CI, 67%-79%) at 6 months. The percentages of participants in the PROWL-2 study with normal Ocular Surface Disease Index scores were 44% (95% CI, 38%-50%) at baseline and 65% (95% CI, 59%-71%) at 3 months. Of those participants who had normal scores at baseline in both the PROWL-1 and -2 studies, about 28% (95% CI, 19%-37%) had mild, moderate, or severe dry eye symptoms at 3 months. While most participants were satisfied, the rates of dissatisfaction with vision ranged from 1% (95% CI, 0%-4%) to 4% (95% CI, 2%-7%), and the rates of dissatisfaction with surgery ranged from 1% (95% CI, 0%-4%) to 2% (95% CI, 1%-5%)."

I would really like someone to explaine these figures to me:

https://cdn.jamanetwork.com/ama/content_public/journal/ophth...

jchen52• 7 years ago

The data says a lot of people have mild/moderate visual visual artifacts (halos, starbursts, etc.) and dry eye prior to getting lasik. Lasik appears to make some of those symptoms disappear in many people, but also causes symptoms to appear in a smaller number of people.

E.g. for dry eye, from PROWL-1 [2], table 2: before: 45% any severity, 6% severe; after 6 months: 27% any severity, 3% severe; and those changes included 19.5% of those without symptoms developing new symptoms and 65% of those with prior symptoms seeing those resolve.

But it's really hard to interpret the data because a surprisingly large fraction of people report changes (both no symptoms to symptoms and vice versa) over some period of time without having lasik at all! ("14% (95% CI, 3%-35%) to 29% (95% CI, 13%-49%) of participants answered that they either did or did not have a symptom on the test and vice versa on the retest")

See my comment [1] for more.

[1] https://news.ycombinator.com/item?id=21547710

[2] https://jamanetwork.com/journals/jamaophthalmology/fullartic...

jmwilson• 7 years ago

The FDA's mandate is to ensure safe and effective therapies, not high customer satisfaction.

bogwog2• 7 years ago

This is a dangerous perspective on the issue. Why should the FDA approve an elective procedure that has the possibility of ruining your life? Lots of perfectly healthy people people who had a bad outcome have committed suicide due to the unbearable pain and suffering.

If this was a life-saving procedure with a 50/50 chance of working with no alternatives, then that's different. But an elective procedure where a perfectly healthy person sees an advertisement one day, and has their life ruined the next is not something that should be acceptable.

zionic• 7 years ago

It's entirely acceptable on a society level if the numbers are low enough. If 1 in a billion die from a vaccine, do you approve it? There's probably at least one person who died in an accident from an airbag that otherwise wouldn't have without an airbag. Do we remove airbags despite them being statistically safer? This kind of "Zero Allowable Risk" attitude is quite frankly technophobic.

DiffEq2• 7 years ago

So this then would apply to all kinds of cosmetic surgeries then..Ban them all too?

jacamera• 7 years ago

The FDA should approve the procedure because adults have a right to decide for themselves what risks they are willing to tolerate.

ebiester• 7 years ago

Isn't the real question "how satisfied are you after a decade" when discussing the claims in the article?

einpoklum3• 7 years ago

After a decade you might just be too used to whatever it is you did a decade ago...

tomohawk• 7 years ago

This is like buying a car that has a .9% chance of conking out on the side of the road, a .9% chance of colliding with another vehicle with no injuries, and a .9% chance of blowing up when you turn the key.

Or, you could stick with your reliable car that has some scratches and dents and needs a quart of oil when you fill up.

lern_too_spel3• 7 years ago

The suicides aren't going to take the survey, which skews the survey results in a favorable direction but are of interest to the FDA.

siffland2• 7 years ago

I wanted LASIK so bad starting around 2010, I had worn glasses since I was 6 for my astigmatism. The reason I did not get it was because someone I worked with had a friend who they messed up one of his eyes and he was legally blind. My sister got it in 2015 and I kept putting it off. In 2018 i was turning 40 and needed readers, the eye doctor said i should get bifocals or LASIK and readers.

I got LASIK in September of 2018, I did my 1 year checkup in September of this year and am seeing 20/15. I used eye drops as instructed and now I don't need them. I still use readers for little print (or more light), but I knew I would need to going into this.

No regrets, except I should of done it years ago.

yonaguska• 7 years ago

I was advised to skip LASIK recently, as I was told I'd need it again when I got older and expose myself to all the same risks of a bad result over again. I instead decided to invest in much nicer contacts which has been life changing. I didn't realize there was that drastic a difference between crappy contacts(not even necessarily cheap) and good ones.

Exuma• 7 years ago

How much are good ones, and how much of a pain are they vs just regular eyes? I've never worn contacts, and the thought of having something in my eye seems very weird. I also tend to get dry eyes sometimes with allergies, will that affect it?

marblar• 7 years ago

How do I know if I've got the good stuff?

wavepruner• 7 years ago

What are the good contacts you're using now? I gave up on contacts years ago, but I've never done any research and experimenting to find if there was anything better than the usual Acuvue stuff.

siffland2• 7 years ago

I was also told in 15 to 20 years i might need glasses again (late 50's, early 60's). I am cool with that.

I once had contacts, they did work OK. My issues were that i suck at putting things in my eye. I never got comfortable putting them in, i know that is a personal issue not the fault of the contacts. Also my contacts had to be weighted for some reason (i cannot recall why), and if my eye got dry they would shift and things would become blurry and i had to use eye drops or tear up (didn't happen a lot, but enough to annoy me). Plus i still needed a set of glasses.

Kind of off topic, my other half, she was making fun of my reading glasses, one day she was struggling to read something and i slapped them on her face and her response was OMG. I laughed, went to take them off her and lets just say i had to go buy myself a new pair (she confiscated them). It is interesting that people think readers are only for older people or you need a prescription, she wishes she would of gotten a pair 5 years ago.

notJim• 7 years ago

Do you have astigmatism? Every time I've tried contacts, this has been the achilles heel, because the contacts inevitable rotate a bit and then my vision is intolerably blurry until they get back into place. Maybe it's just my prescription, but my eye doctor straight up told me that I'd never be satisfied enough to switch to contacts (from glasses) full time.

refurb• 7 years ago

I’m in the same boat as you, I stuck with contacts as the risks of the surgery and age-related need for glasses didn’t make much sense when contacts got me really great vision and no complications. They go in when I wake up and come out when I sleep and I rarely know I have them in.

Somewhat surprising because I am very near-sighted and have astigmatism.

If contacts weren’t as good a solution I probably would have gone for laser surgery. I hated wearing glasses - the biggest aspect was how they distort your vision a little. I can see much better with contacts than glasses.

Mirioron3• 7 years ago

I liked the freedom contacts provided me in most situations, but I found two main problems:

1. I couldn't rub my eyes anymore in public. Rubbing my eyes would often end to with one of my contacts in my hand.

2. I had to always plan when I was going to sleep. This pretty much made napping impossible. Going to sleep with contacts was horrible.

Are there better contacts where the above two problems aren't an issue?

sethammons• 7 years ago

I had mine done in 2011. I went to a highly reviewed specialist who charged a lot. No coupons for me! One of the best things I ever did. In 8 years, not a single day has passed where I haven't taken a moment to appreciate my 20/15 to 20/10 vision -- no hyperbole. Eye drops for a while. Then less often. Then nearly never.

Now, what I wish I had known is that apparently a knock to the head can dislodge the flap. Still would have gone for it.

Edit: I do have a bit of halo at night with bright lights. A total non-issue for me as my lenses were always scuffed, causing more halo that I get now. And I'll take an eye drop once a quarter or less.

consultutah• 7 years ago

There has been nothing I’ve spent money on that has been as useful and valuable to me as getting lasik 15 years ago. If I had known ho much it would change my life I would pay 10 times as much.

schnide050953• 7 years ago

This is only a mildly disturbing headline to see, literally a couple hours before my Lasik procedure...

But from what I see in the article, the negative experiences are few and far between, not to mention, they don't seem to take into account variation between different clinics. Is there a connection in quality to the doctor or their practice? Is there some problem with a piece of equipment?

Gigablah• 7 years ago

How did your procedure go?

smogcutter2• 7 years ago

Interesting side note about LASIK, it’s caused problems for the navy: it’s getting harder and harder to fill submarine crews. It used to be that for top-qualified recruits, the ones with perfect vision became pilots and the rest got stuffed into subs. Then the military started providing LASIK, and suddenly no one’s dq’ed from flying because of their vision. The submarine force is a tough sell to begin with, but when the alternative is Top Gun forget about it.

melling2• 7 years ago

How many pilots does the Navy have?

I’m pretty sure it’s a small percentage of people in the Navy.

gamblor956• 7 years ago

Not sure where you heard that. Submarine duty is considered prestigious in the US Navy and most people who serve aboard a submarine wouldn't be rated for (or even interested in) pilot duty.

Wohlf• 7 years ago

I was going to say the same thing, submarine duty is highly competitive. Every sailor I knew who wanted to get it had to work very hard and was very excited when they did.

smogcutter2• 7 years ago

Don’t remember specifically where I first heard that, but for example: https://www.nytimes.com/2006/06/20/us/20eye.html

sgt2• 7 years ago

I asked for LASIK but was turned down by the eye doctor / surgeon because my vision is -9.5 and he felt it was too high of a risk. My optometrist also said to stay away - my eyes are very healthy, so why tamper with them?

I wear glasses every day as I can't seem to read and focus properly using contact lenses (tried about 5-6 times the last 15 years) and the quality is great. I use those high index glasses that are so thin you'd think they are -3.

I still think about some kind of surgery though - maybe ICL ?

deminature2• 7 years ago

It's worth investigating whether you're a candidate for PRK or the more recent SMILE procedure. LASIK is not applicable to high prescriptions, owing to how much cornea loss would be required to correct them.

sgt2• 7 years ago

I did some research now and SMILE doesn't seem to be too widespread yet, but LASIK, PRK and ICL are widely available. For my case it seems like ICL is the best option. It's also reversible (not that I'd easily want to reverse and have a knife shoved into my eye again).

schnide050953• 7 years ago

This is a bit disturbing of a headline to see, literally a couple hours before I'm scheduled for a Lasik procedure.

But after reading the article, I don't know how much weight there is to this. Seems to be a small sample and that report is heavily highlighting a couple negative items out of a largely happy pool of patients.

Was there any connection to the doctor or clinic? Did some clinics or equipment have a higher rate of complications? I'm getting mine performed at a well reviewed practice in San Jose.

This article isn't enough for me to cancel the procedure, but it was enough of a scare to put me on the edge for a second. Sensationalism? Maybe not quite, but it'd be great if these reports would work to remove their bias.

jcranberry• 7 years ago

Here are some relevant quotes from the FDA study for you.

In each of the PROWL studies, less than 1 percent of patients experienced difficulty performing their usual activities following LASIK surgery due to any one symptom.

...

* Up to 46 percent of participants, who had no visual symptoms before surgery, reported at least one visual symptom at three months after surgery.

* Participants who developed new visual symptoms after surgery, most often developed halos. Up to 40 percent of participants with no halos before LASIK had halos three months following surgery.

* Up to 28 percent of participants with no symptoms of dry eyes before LASIK, reported dry eye symptoms at three months after their surgery. This is consistent with previous studies.

* Less than 1 percent of study participants experienced "a lot of difficulty" with or inability to do usual activities without corrective lenses because of any one visual symptom (starbursts, ghosting, halos, glare) after LASIK surgery.

* More than 95% of participants were satisfied with their vision following LASIK surgery. Participants were more than twice as likely to report their visual symptoms on a questionnaire than to tell them to their health care provider

https://www.fda.gov/medical-devices/lasik/lasik-quality-life...

deminature2• 7 years ago

LASIK in the 90s versus LASIK in 2019 is almost an entirely different procedure. Modern LASIK procedures involve mapping the eye on a microscopic level, evaluating vision acuity at hundreds of points on the eye surface, and then allowing an automated laser to perform the procedure. This is known as a wavefront-guided LASIK procedure and produces outstanding results.

LASIK in the 90s involved physically cutting the surface of the eye with a keratome (blade) and relied on the precision of the surgeon's hand.

RantyDave2• 7 years ago

And yet they still make a big deal of how you can come in for a "tune up" or whatever. If it's so accurate, how did I end up an entire diopter off target?

PascLeRasc2• 7 years ago

So, how'd it go?

schnide050953• 7 years ago

For those following along, it went great!

The procedure itself was as comfortable as they could make it, you know, for cutting a flap in your eye and blasting part of it away.

This morning I went in for followup and have 20/15 vision. A mild amount of blood under one flap which will dissipate within a week.

So far, only mild discomfort after the initial healing yesterday, which was pretty irritating. Now, it just feels like there's an eyelash that won't go away. I have to keep reminding myself that I can't adjust my contact lenses any more.

There is some staring I noticed looking at the clock display in a dark room, but nothing worse than the old pair of glasses I was wearing in the interim. But that's supposed to almost completely fade over 6 months.

I know that, "time will tell", but thus far, I'm very optimistic. I'd definitely recommend this doctor to anyone.

RantyDave2• 7 years ago

These risks are not bullshit. On high contrast images I see not just 'halos' but more like blobs. Things it ruins: stars - looking at the night sky is ruined forever; good quality cinema - white letters on a black background are toast. Etc etc. I regret the almighty shit out of Lasik, but most people don't.

overgard• 7 years ago

I ran into a lot of the complications this article mentions (halos, dry eyes, and for a few weeks afterwords a blurriness from cells dying called something like "superficial protein keratitis"). All of them were temporary though and cleared up after a few weeks/months. (Well, except the halos, but they're not that severe and I already had bad night vision and halos before this, it just made them a little more pronounced) I do think it's a procedure you should really think carefully about before you do it, but I wouldn't want the FDA to ban it or something. Overall I'm currently happy with it.

My suggestion would be, if you're thinking of doing it, make sure the eye doctor who checks out your candidacy is one you trust and hopefully have been with for a while. When it comes down to it, the procedure itself is pretty safe and automated so the part to optimize is screening people before the procedure happens.

Simulacra• 7 years ago

I had mine in 2002 but it wore off In 2012 so back to glasses. Corneas too thin to do enhancement, eyeballs odd shaped so I can’t do contacts. Not much more I can do.

aasasd• 7 years ago

While we're exchanging anecdotes here: what I gathered from people's responses on the web is, operation outcome differs considerably depending on the clinic and who knows what else. Three are also apparently a dozen, if not more, variations on the few major procedures.

However, I also notice that better results are reported for later surgeries, over e.g. five years.

dole• 7 years ago

Call me paranoid, but I wouldn't be surprised if stories like these were pushed by Big Eyeglass (Luxxotica).

einpoklum3• 7 years ago

But then, maybe you're just a tool for Big Laser... :-P

tracker13• 7 years ago

She didn’t need glasses when she got the procedure, so it frustrates her that now she does. She blames LASIK for making her eyes worse.

WTF would you get eye surgery if you don't need glasses to begin with!?

jchen52• 7 years ago

I have been looking through the literature on lasik complications since I am considering lasik and there were several articles recently such as [1] which goes into a lot more detail. There are a lot of temporary complications/side effects (e.g. a few months), but what I'm most interested in understanding is the risk of lasik causing serious, long-lasting or permanent complications. The main ones discussed in these articles are visual artifacts (halos, starbursts, etc.) and dry eye (which at the extreme end means constant intense pain).

Unfortunately, as far as I could tell, there aren't very good studies on the topic - they're very limited in number of people and in length of time studied, or they don't measure a control group/baseline - which is a big problem because there is a surprisingly high prevalence of symptoms in the population even before lasik. This makes the data very hard to interpret.

E.g. [1] reports that 6 months after surgery, "41 percent of patients reported visual aberrations, with nearly 2 percent saying the symptoms presented 'a lot of difficulty' or 'so much difficulty that I can no longer do some of my usual activities.' But looking at the data from the PROWL-1 and PROWL-2 studies [2], table 3, 67% of patients had some visual symptom _before_ lasik surgery, with 3.3% / 7.5% having difficulty performing activities and 10.8% / 13.3% reporting "very" or "extremely" bothersome symptoms (again, before lasik). The prevalence of severe visual symptoms decreases 6 months after lasik. However, while some people go from severe symptoms to no symptoms, some of that is just due to regression to the mean (see note on test-retest in [2]), and there is also a substantial percentage of the population that goes from no symptoms to having some symptoms (which is the main thing I am trying to estimate).

Surveying some of the other literature [2][3][4], the overall pattern I saw was that pre-lasik the prevalence of dry eye and visual symptoms is about 60% of any severity, 5% severe, 5-10% moderate. Post-lasik they are about 50% any severity, 3% severe, 5% moderate. Overall they are less postop - but the question is how many people who were normal preop develop symptoms postop (minus how many people who were normal develop symptoms 6 months later without any lasik surgery). I haven't found good enough data to answer this with any degree of accuracy, other than an upper bound of <1% developing severe symptoms and <5% developing moderate symptoms. That isn't a very helpful upper bound to me - a 1% chance of permanent severe complications is a lot, and I think it's obvious that if the rate were that high we'd know about it. But from the data it appears plausible that the rate of developing long-lasting moderate complications is 0.1% - 1%, and the high end of that range is still a pretty substantial rate of complications. I think the actual rates are a lot lower, we just don't seem to have enough data to measure it better. I would love to see pointers to better studies, better analyses of the data, etc.

[1] https://www.nytimes.com/2018/06/11/well/lasik-complications-...

[2] https://jamanetwork.com/journals/jamaophthalmology/fullartic...

[3] https://www.ncbi.nlm.nih.gov/pubmed/25896684

[4] https://www.ncbi.nlm.nih.gov/pubmed/27373395

ww520• 7 years ago

One data point. I had Lasik done about 15 years ago. No problem so far except for the occasional dryness after waking up in the morning. After all the years, still have 20/20 on one eye and the other deteriorated to 20/30. I would consider a success.

GoRudy• 7 years ago

I got LASIK at Standard Medical, one of the best things I ever did for myself...

Didn't read the article...

dreamcompiler• 7 years ago

Most people I know who have had it are happy. But I'll never do it. I have a fantastic microscope available just by taking off my glasses and I don't want to lose that.

Vysero2• 7 years ago

I was considering LASIK but why risk it? Glasses aren't so bad and I could always get contacts if I really wanted. Even without my glasses I can see okay, not great but okay.

dforrestwilson• 7 years ago

If you like to be outdoors, camping etc or in situations where glasses could be broken it is a no-brainer.

Also if you do the math it can potentially save you money on contacts and the ever-obnoxious eye checkups.

9 years since I had it done and it is amazing. No regrets so far.

I get out of bed every day and I can just see. No searching for glasses or going to the bathroom to put contacts in.

Vysero2• 7 years ago

Oh, well, my vision is not that bad. I suppose if I could barely see when getting out of bed in the morning then perhaps I would consider it more seriously. I only had to get them because I failed a drivers vision test but just barely.

jdietrich2• 7 years ago

If I'm in an environment where I'm likely to break my glasses, I want to be wearing some kind of protective eyewear - a scratched eyeglass lens is a lot easier to replace than a scratched cornea. Wraparound safety glasses are comfortable, extremely durable and can do double duty as sunglasses.

https://www.rx-safety.com/product-category/master-safety-gla...

mistrial9• 7 years ago

I met a man whose life as a programmer ended after a failed Lasik in the early 2000s - it was quite traumatic and he had serious financial problems afterwards

1000units2• 7 years ago

They did both eyes at the same time?

CharlesColeman4• 7 years ago

I think that's actually pretty common with Lasik, since the "recovery" time to clear vision is so short.

Other kinds of surgeries have longer recovery times, so they're kinda forced to do them one eye at at time.

llsf• 7 years ago

My husband is an Optometrist, and it did not do LASIK for his own eyes. Actually, I do not think I know one Optometrist in our circle of friends who did LASIK. They pretty much all wear either contact or glasses. It does not seem like we should ban LASIK, but LASIK is not for everyone. And here in US, LASIK is a lucrative business. I would not be surprised that some LASIK have been done on people who were not good candidate at the first place. And now those people are disappointed, after spending several thousand dollars.

cullenking5• 7 years ago

There are a couple other mentions in this thread about PRK. I went the PRK route instead of Lasik, and don't regret it one bit. I chose PRK because it was less risky, and was more durable. Look it up yourself, but brief summary:

  - no flap, they remove top layer of cells with a scraper, then laser
  - no flap means stronger eyes. if you box, mountain bike, work in a high risk environment, it's the procedure to get
  - long recovery time, and it's pretty painful for the first week. ~ 2 weeks to reasonable vision, 4-6 weeks for 20/20 or better.
  - less chance of dry eyes (still a semi-common outcome)

My eye doctor, the casey eye institute, pushed lasik, but that was purely for what people commonly want. They were enthusiastic about PRK, considered it a better procedure for people who were OK with the recovery time, with less chance of complications.

My complications:

  - dry eyes, but nothing worse than contacts get midway through a day
  - sensitive eyes. meaning, a scratch on the eye becomes eye wateringly bad
  - slight halos at night, but again, nothing worse than contacts at the end of the day

I am happy with the results, would do it again, and am currently advising my wife to do PRK instead of lasik (she's on the fence of doing anything). I ride mountain bikes, dirt bikes, and do lots of building, so chances of complications with a flap are non-zero. If you haven't read, those complications are pretty bad - get lazik, take a stick to the eye a year later which causes the flap to dislodge, you now have potentially uncorrectable vision in that eye.

Search the rest of this discussion for PRK. If you aren't afraid of pain, discomfort, and a long recovery time, it's the procedure to get.

Also there's a HUGE difference in lasik or PRK providers. As you can imagine, it's worth spending extra. My procedure cost $4k total, which is $3k more than budget lasik providers. However, I worked with some top eye doctors that regularly perform serious eye surgery, and are at the forefront of optometry. Strip mall discount lasik has less time spent on planning, comes with less experience in recommending procedures, and has less experience working with complications. Definitely don't cheap out!

oriel2• 7 years ago

Supportive personal anecdote:

I got PRK in somewhat unusual circumstances, paying $1.6k total. My cornea thickness was compatible with the procedure (which is one of the big reasons to do LASIK over PRK, i think), but my offset was huge (-7.5, where PRK usually caps at ~-5).

The circumstances boil down to having it done in a foreign country, and they used a non-FDA approved eyedrop (toxic if it got in the bloodstream) that allowed the procedure to correct my offset fully. Four years later my vision is going strong.

Long recovery time was 2 weeks with fireworks in my eyes the first two days. After that it was logrithmic improvement in blurriness.

I would also highly recommend PRK, it enabled an entire lifestyle for me which heavy glasses actively discouraged, and there isnt a day i miss waking up to a blurry space.

rococode• 7 years ago

Definitely don't cheap out!

This is so important for any surgery where mistakes can be life-altering. When I was a teenager we cheaped out on braces with a dentist 3x cheaper than the other one we'd spoken to, and my teeth are now slightly misaligned and I have a fairly weak bite.

Fortunately it doesn't affect my outward appearance and I've gotten used to it as it's not too bad, so it was almost worth it for the valuable life lesson.

lawnchair_larry• 7 years ago

How do you know which providers charge more because their product and competence is actually better, rather than because they are a low quality facility that just decided to charge more?

I don’t believe it’s as simple as finding a more expensive provider to ensure better outcomes.

oriel2• 7 years ago

I forgot to mention this in my other response.

Most doctors will use the same equipment in the same area. For PRK they do a tomographic scan of your eye to determine a number of parameters, and then your doctor pre-programs the procedure.

In my case, the most direct action my doctor had during the procedure was cut back/replace the outer flap, and apply the drops.

I say this because 'cheap' (at least to me) implies someone with less skill or lower ability performing for a lower price. Since so much of the process is automated I'd say that only a small part of this applies.

Especially for those who are looking for a good price, ask revealing questions like where the equipment is, when it was recently obtained, how often this particular doctor has done it. And since costs aren't directly attributed to manual labor (and can easily crest 10k+ for a region), dont be afraid to negotiate and price compare.

jdietrich2• 7 years ago

I ride mountain bikes, dirt bikes, and do lots of building

This is the main reason why I'm sceptical of laser eye surgery and contact lenses - even if you have 20/20 eyesight, there are a lot of circumstances where you should be wearing protective eyewear anyway. Laser eye surgery makes your eyes more vulnerable to damage and doesn't obviate the need for protection from dust, debris, caustic substances and UV radiation.

cullenking5• 7 years ago

I religiously wear eye protection. Sticks can make their way around glasses / goggles. The flap created during lasik doesn't need an object in the eye to dislodge though, a blow to the head will do it in the right circumstance. Lasik makes your eyes more vulnerable to damage, PRK does not. This is why police/military/sports require PRK for corrective surgery, rather than lasik.

basicplus2• 7 years ago

I presume he means to be able to make it easier to use eye protection (as one does not need glasses), not to avoid wearing eye protection.

sizzle2• 7 years ago

How do you know the symptoms won't appear further down the road as you age? That's my only concern and fear.

cullenking5• 7 years ago

I don’t!

the_watcher2• 7 years ago

She didn’t need glasses when she got the procedure, so it frustrates her that now she does.

Why did she get LASIK? When I got it, it was made extremely clear that it wouldn't help with reading glasses-level problems and may in fact cause me to need them.

gdebel7• 7 years ago

Refractive surgeon here. I work in a well-known eye hospital in Paris. I operated my sister (PRK) and my best friend (LASIK). My mother underwent PRK when I was a child and I think the amount of admiration/gratefulness that she had for her surgeon afterward actually gave me interest for this surgery. We regularly operate ophthalmology residents as well, and one of the surgeons of the center underwent LASIK. However, if you consider surgery, please turn to a well-known and experienced surgeon. It is a very secure surgery that can turn really bad if errors are made during patient selection, surgery planning, surgery itself, and management of the unfrequent complications that can occur. Patient selection is especially important. So you have to choose a surgeon that really cares about his reputation, and that will not operate you whatever your examination.

sizzle2• 7 years ago

Have you noticed any pattern of adverse post-op symptoms in your Lasik patients that corroborate the ones experienced by patients in the article?

gdebel7• 7 years ago

Halos are frequent especially in the months after surgery. They tend to reduce with time. They are usually not noticed in everyday life but rather by night, while driving for example (dilated pupils). They also depend on the type of treatment (optical zone, amount of correction) that you perform, and for the quality/generation of the laser platform... Information is essential.

Chronic pain is usually related to dry eyes. Those patients should not be operated at all. Bad patient selection can result in terrible results.

Loss of visual acuity after refractive surgery is more than exceptionnal. It is usually manageable with hard contact lenses.

The special thing about refractive surgery is the contrast between its apparent easiness (non specialist eye surgeon will often refer to it as an "easy surgery, no technical difficulties") and the rapidity with which hard to treat complications can occur if everything does not go as planned. Little things (water drop on the cornea during the treatment, centration error, mismanagement of flap cut incidents...) can lead to disasters that you sometimes cannot repair.

carlsborg• 7 years ago

Great perspective. Genuinely curious: how often does a refractive surgeon such as yourself visit this website? Do you feel the need to activate the noprocrast feature?

gdebel7• 7 years ago

I'm interested in data sciences and coding (Python) for research, and I am/was involved in two startups. I visit HN at least 4-5 times a day ;-)

specialist• 7 years ago

Thanks for weighing in.

A decade back, my SO worked on clinical trials at a research hospital in the eye clinic. I understand nothing about this stuff.

However, I gleened one important bit of advice:

Avoid any surgery, procedure that surgeons themselves avoid. My SO claims that eye doctors avoid LASIK.

Maybe 10 years ago, a visiting eye doctor was lecturing about LASEK (not LASIK), an operation he had done on himself, and other doctors took note. That was evidence to my SO that LASEK was worth considering.

https://en.wikipedia.org/wiki/Photorefractive_keratectomy#LA...

Again, I know exactly nothing about this stuff. I am not saying to have LASIK or not. Progress marches on and I'm certain techniques have improved.

But I do think this is a good universal heuristic. So am encouraging patients to ask their care provider if they'd get it done themselves.

gdebel7• 7 years ago

Actually, we looked yesterday how many eye surgeons underwent LASIK/PRK in the previous 5 years to write a study about this specific topic (this . We found 16 people. LASEK had a surge of interest 5-10 years ago because it was tought that it could have the pros of both PRK and LASIK. Nowadays it is more or less forgotten (no real benefit in comparison with PRK).

Eye surgeons not getting surgery was totally true 15 years ago but it is not anymore (at least in France)

elidourado3• 7 years ago

Do you have thoughts on LASIK/PRK vs. refractive lens exchange? I’ve been holding out for something “better than LASIK.” Would love your perspective on whether that’s sensible or misinformed.

gdebel7• 7 years ago

It depends a lot on your age, and also on your refraction. Refractive lens exchange can be a good option for high myopia/hyperopia after 60, and can be considered after 45. This is hard to give an advice with no context, the topic is quite complex ;-)

diveanon• 7 years ago

I am a happy lasik success story. The procedure changed my life and allowed me to start diving again, it is the best money I have ever spent.

I think it is unfair to blame suicides on the procedure, as they warn you about the risks beforehand and are clear that you may have some halos/blurriness for a few months.

Blame the suicide on mental illness, because that is where the problem actually lies. Anything else seems like an emotional play to get money from a lawsuit.

m463• 7 years ago

I had it in one eye, and after a some eye-1 vs eye-2 comparisons, I never had the second one done.

Now many years afterwards, the only thing I see clearly is that I should never have gotten the surgery.

Both eyes continued to have changes in prescription, and I now wear contacts in both eyes.

By the numbers, it would seem like I have pretty good vision. Corrected I have 20/20 in my non-surgery eye and 20/25 in the eye that had the surgery.

HOWEVER - the non-surgery eye focuses quickly and accurately, even in low light and at night. The surgery eye can read the eyechart as well, but it takes longer, I have to blink and wait and maybe... eventually... I can read the 20/25 line. At night, I get visual artifacts.

I recommend good contacts instead. Your vision will change and you can just get different contacts.

Additionally, contact lenses have advanced. They can now correct almost any level of vision including astigmatism and can be thrown away monthly or even more frequently.

marcoseliziario• 7 years ago

Until the day this thing is done 100% by robots, thanks, I think I will stick to glasses and lenses.

jijji• 7 years ago

i had lasik when i was 24... now i am 44 and would say that number one its really good, but number two it only lasts for about ten years and then your eye sight starts to go bad again... my vision was 20/600 before lasik and 20/20 after lasik. I am probably going to have it done again...

robocat• 7 years ago

Scientific test here: I had only one eye LASIKed and the quality of vision is far below that of the other without LASIK with contact lens (both were approximately -6).

ANYONE who gets both eyes done at once has no baseline to compare against.

I can compare.

The great advantage to engineers/craftspersons of not getting LASIK if you are short sighted, is that you can take out your contact lenses for close/fine work.

The eye with LASIK is useful for swimming, travelling, and convenience of not using contacts (which sometimes irritate).

techslave• 7 years ago

I had LASIK done just the year after a new wavelet tech emerged (or at least, after my doc had access to it).

Now, >15 years later, I still have 20/13 vision in both eyes, from a starting point > 20/100.

It’s fantastic and greatly improved my quality of life.

Ex-FDA Advisor Says of Lasik Eye Surgery: ‘It Should Have Never Been Approved’

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