The "Hassle" of LASIK?

There is one primary reason why LASIK has rocketed to popularity over the last decade, and it has to do with the quick recovery and results.  There are few if any medical procedures where the results are so predictable and rapid as in LASIK laser vision correction.  Although as with any medical procedure their are risks and complications, for the vast majority of patients undergoing this procedure, the vision is restored to normal levels virtually overnight.  Despite this fact, many potential LASIK candidates are cautious due to their previous experience with contact lenses. 

This is the secret question that many potential LASIK patients ask themselves:  "If my eyes can be so uncomfortable with a tiny glob of mascara underneath them, how will I tolerate having my eye burned with a laser beam? And even though everyone says it doesn't really hurt, maybe it will hurt me because I have sensitive eyes.  In fact that is the reason that I am here, my eyes are so sensitive that even contact lenses bother me."

Common sense agrees with these sentiments, and it is only because LASIK is something that nature did not intend through millions of years of evolution, that it works so well and with so little discomfort.  Our body is covered with receptors that are designed to tell us when something noxious, foreign or dangerous has come in contact with it or worse penetrated our outer defenses.  Even a small pebble in our shoes alerts us that there is something wrong, and a speck of dirt in our eyes feels irritating.  There is no where in the human body where there are more nerve endings than the surface of the eye.  However, when we make a corneal flap with a laser, we are just under this surface and away from these nerve endings.  The only place where this surface is touched is at the edge of the flap, and it is such a fine line, that the healing of the skin of the eye literally heals in just a few hours.

Underneath where the laser corrects the vision is the second thing that nature did not intend and is therefore not reacting to: a laser that resurfaces the inner cornea to a new shape.  Here, a very special laser, an excimer laser is not really burning the surface but is polishing the surface by removing tiny bits of material without heating or burning the surface.  This is key to the process not creating pain or inflammation of the eye.  After the material is removed, there is no way for the eye to tell that it is missing.  When the flap is replaced, the edges heal quickly and there is very little additional healing that occurs which translates into very little pain or sensation to the patient.  This is why from day one the vision is good and it changes little from that time onward.

This is an oversimplification and there is certainly some healing and the eye has some indication that it has been altered, which is why patients are put on steroid eye drops for a few weeks after the procedure, to help quiet any inflammation that could occur.

Compare this to wearing a contact lens where there is something constantly in contact with the eye, and when some material (mascara) gets trapped under the contact it is constantly being rubbed against the receptors that we are programmed to pay attention to.  You are alerted that there is something wrong, and remove, wash, and replace the contact.  The lens itself acts as a barrier to oxygen reaching the eye, which is the natural way that the eye gets its oxygen.  It has no blood vessels to bring it oxygen like the rest of the body, and even with gas permeable contacts, the eye is stressed.  In addition contacts hold onto things like bacteria, and inhibit the natural cleaning process of the eye.  This is why infections are much more likely in contact lens wearers.

If LASIK does not really hurt much and the recovery is quick, what are the hassles of LASIK the next week, month, year after the procedure?  Are there a bunch of things that after having this done will still make it a bother?  In a word, no but here is what to expect.  You will need to be extra careful not to rub your eyes for a couple of days.  You will need to put medicated drops in the eyes for a few weeks about four times a day.  And you will need to put in extra artificial tears for as long as three months from time to time.  This is because, those nerve endings that were impacted can take up to three months to fully heal and during that time, you may make less tears than usual.  Also, outdoors sunglasses are suggested for that same three month healing period.  For most people, they rapidly forget that they ever needed contacts or glasses, and begin quickly to live their lives like they always had good vision.

LASIK is a little bit of a hassle for a few days, followed by less and less of one over the next few months and virtually none after that.  Contacts are a constant irritant with periods of significant stress throughout the entire time that they are worn.  Even glasses can be a problem with discomfort wearing them at times, and the need to clean them, and the annoying feeling of always seeing the world through a window of plastic or glass.

When I was a young boy, I visited a friend who's father was an Optometrist and had his office in their home.  I was fortunate to have excellent vision, but saw the continuous stream of patients coming to his office for glasses and some teenage girls getting their first pair of hard contacts.  They suffered through the adjustment to them in order to be able to see without glasses.  He told me that some day there would be a procedure that doctors would perform on the eye so that most people would no longer need glasses or contact lenses.  He even guessed that this would be done with lasers which were new at the time.  I think if he were here today, he would smile at me and say, "see, I told you so."