Risks

LASIK is a surgical procedure, and like all surgeries, it possesses the potential for risks and complications. It's important to note that the chance of a serious vision-threatening complication is extremely rare (much less than 1%), and for an experienced LASIK surgeon , even lower. Other complications produce symptoms that, for most patients, are temporary and can be addressed with medications or a second procedure. Every patient should weigh the possibility of experiencing complications against the potential benefits LASIK will offer. The following information is provided to you to make such an informed decision. Under/Over Correction: These situations result from the variability in healing patterns between patients and other surgical variables. The uncertainty of the effect of this variable healing is why a surgeon cannot guarantee a specific result from LASIK surgery. Unless severe, these situations do not usually affect overall vision results. High amounts of under-correction are generally retreated with a no-cost enhancement procedure, provided the patient is still a medical candidate. Low amounts are corrected by wearing glasses for certain activities such as driving at night. Over corrected eyes are extremely rare and most tend to regress back toward their original shape as the eye heals. However, some patients may require glasses for reading. Infection: Complications affecting the health of the eye are extremely rare, but are possible. During the early healing phase, the first 48-72 hours, the eye is at its greatest risk of infection. You will be given antibiotic drops both before and after surgery. You will be asked to follow certain instructions, including using antibiotic eye drops. Carefully following these instructions will decrease the infection rate to far below 1%. Most of these minor infections are easily treated and quickly resolved. It's very important that you faithfully see our doctors at your scheduled post-operative visits to monitor the results of your surgery. Halos/Glare/Starbursts: Many patients who wear glasses or contact lenses experience, to varying degrees, some amount of night glare even before their LASIK surgery. Glare can be a side effect from any refractive device. It can also be a side effect of laser vision correction. It is characterized by halos, glare and starbursts that are seen around lighted objects (car headlights, traffic signals) at night or in dim-light conditions. These optical aberrations occur if light is entering the eye from around the edge of the treatment area. This generally presents itself in those patients who have pupils that dilate, in low-light situations, larger than the treated area of the LASIK procedure. It also manifests in patients with average sized pupils but with moderate or high astigmatic correction. Typically, after 3 to 6 months your night glare will tend to decrease and will not be noticeable. However, for some this condition persists and should be a factor in your decision if you spend a lot of time driving at night and/or have large pupils. Recent advances in laser technology, such as the new flying spot lasers and their larger treatment zones, help to minimize or eliminate this condition. Epithelial in-growth: Misaligned/Wrinkled Corneal Flaps: The surface (epithelium) layer of the cornea will usually be healed within the first 12 to 24 hours after surgery. The "healing" of the corneal stroma between the ""flap" and the "bed" takes much longer and may take years to be totally and completely integrated or healed. For practical purposes, it will probably be stable and safe for most patients by 3 months post-LASIK. In a small percentages of cases at Dishler Laser Institute, we find the cap not well positioned, de-centered or wrinkled the day after surgery. These conditions can occur for several reasons. The most common is an eye that has been inadvertently bumped or rubbed. In addition, dry eyes can cause friction between the flap and eyelid and can cause displacement. A patient will typically notice a substantial change in vision when this happens. The patient should immediately call our office for an appointment. These situations require a simple repositioning, smoothing and re-adherence of the corneal flap. If managed in a timely fashion these conditions will not compromise the final outcome of your surgery. Loss of Best-Corrected Visual Acuity: A patient's best-corrected visual acuity is defined as the best vision they can achieve with glasses or contact lenses as measured by an eye chart. A patient's visual acuity post-LASIK is always compared to this pre-surgical benchmark. A small number of patients experience a slight loss of visual sharpness or crispness following LASIK surgery and a small number experience a slight improvement in best-corrected vision. Either an irregularity or haziness in the corneal surface could cause a decrease in best-corrected vision. These typically are short-term conditions during the initial months of healing and are almost always resolved as the healing process progresses. A mild loss of best-corrected visual acuity might not even be noticed or might just be a minor annoyance. A severe loss of best-corrected visual acuity would be noticed by almost every patient and might make it hard to work in occupations that require fine vision (commercial & military pilots). Severe losses of best-corrected visual acuity are extremely rare. Corneal Haze: Numerous studies worldwide demonstrate that the incidence of corneal haze is significantly lower with LASIK than with PRK. This haze results from the cornea's healing response to the laser vision correction procedure. Almost all patients develop trace degrees of haze but the individual reactions to it vary. Corneal haze may not affect the patient's vision at all and thus be unnoticeable, but if severe, can cause loss of best-corrected visual acuity. Although treatable in most cases, it usually resolves itself over time. Regression: Regression refers to the tendency of the eye, after laser vision correction, to migrate back to its original prescription. This response typically is very minimal and is accounted for by the surgeon in the initial procedure. Certain refractive prescriptions experience more regression than others. If there is significant regression you may require an enhancement procedure, if you are still a good medical candidate. If the regression is minor you may need glasses for certain activities, such as driving at night. Severe Dry Eye: All patients should be aware that dry eye is a potential complication of LASIK. Also, patients seeking LASIK surgery who have suffered from dry eye in the past, are bothered by contact lenses, are going through menopause or are taking birth control pills should be certain to mention these conditions during their initial consultation with our doctors. There currently are no definitive studies addressing the correlation between developing dry eye syndrome and LASIK. However, noted surgeons around the country have remarked on the decrease in the overall frequency of other complications after LASIK while the incidence of dry eye after LASIK is increasing. One of the most obvious explanations is that patients seek LASIK precisely because they are contact lens intolerant. Such intolerance is often indicative of dry eye. At Dishler Laser Institute we perform careful preoperative slit lamp examinations with rose bengal and fluorescein staining to identify dry eye conditions. Enhancements: At Dishler Laser Institute, 2% of our patients undergo a retreatment, called an enhancement. It can be for any of the complications described above, but most commonly is due to an under-correction. This is usually the result of an abnormal healing response. In most cases, a significant improvement in vision results with an enhancement, but it is important to realize that this too is a laser procedure, and therefore has the same risks as the first laser procedure. It is possible, but extremely rare, that your vision can be made worse after an enhancement. Complications can occur, even if no complications occurred during your first procedure. If your vision is quite good after your initial LASIK procedure, but not perfect, you should consider carefully whether you want to have an enhancement. If your vision is really not satisfactory, then an enhancement is a good idea. Another consideration in whether to have an enhancement is the medical condition of your eyes. You may have developed some of the conditions listed in the Eligibility section since your initial procedure that would make you an unfit candidate to undergo another procedure. Also, you may have insufficient corneal thickness left after the first LASIK surgery to warrant another treatment. For your safety, these factors will be taken into consideration by your surgeon before making the decision for another LASIK procedure.