LASIK Complications & Risks

Is LASIK Worth the Risk?

LASIK stands for laser-assisted in situ keratomileuses. It is a refractive surgery that can correct astigmatism, myopia (nearsightedness), and hyperopia (farsightedness).

In modern LASIK eye surgery, serious complications are rare. Several large studies have demonstrated LASIK complication rates of less than 1 to 1.8 percent. However, the surgery still carries its own risks.

LASIK Eye Surgery Success Rate

LASIK is one of the most effective and common elective surgeries available. Patient satisfaction with LASIK laser eye surgery is very high.

In 2016, the American Refractive Surgery Council published results of the annual meeting of the American Society for Cataract and Refractive Surgery.

These findings showed:

• Up to 98 percent patient satisfaction
• Nearly 100 percent of patients achieved at least 20/40 vision
• More than 90 percent achieving 20/20 vision
• Less than 1 percent of patients lost two or more lines (on the eye chart) of best corrected visual acuity (BCVA)

Before LASIK surgery, it’s essential to consider what you hope to achieve with the procedure. This helps you define and meet your expectations.

Low-Risk Complications of LASIK

Common complications of LASIK surgery that are low risk include:

Overcorrection or Undercorrection

Overcorrection or undercorrection means your vision is not entirely corrected, and it is a common complication.

If you can still see clearly and are satisfied, retreatment is not necessary. However, your surgeon can retreat you or prescribe glasses and contacts to correct your vision.

Regression 

Regression is related to changes in your eye. It occurs when your vision worsens after LASIK.

Those who experience regression require an enhancement procedure. This is a follow-up laser eye surgery to correct issues from the original surgery.

Only 1 to 2 percent of patients require an enhancement procedure during the first year after LASIK. However, about 10 percent of patients experience some regression after ten years.

Age-related changes may also affect your vision.

Irregular Astigmatism 

Irregular astigmatism is an unequal curvature of your cornea, which causes visual distortion.

Common symptoms include:

• Glare
• Halos
• Starbursts
• Ghosting or shadows around images.

A second procedure may be necessary to correct irregular astigmatism.

Decentration 

Decentration is when the laser was not centered correctly on the eye during surgery. This can cause irregular astigmatism and may require retreatment.

There is a higher risk of this complication with traditional microkeratome LASIK than with bladeless LASIK.

High-Risk Complications of LASIK

Higher risk complications of LASIK eye surgery include:

Epithelial Ingrowth

Epithelial ingrowth occurs when the tissue from the outer layer of your cornea (epithelium) starts to grow underneath the LASIK flap. It occurs in 0 to 3.9 percent of LASIK procedures (the rate goes up in retreatment [touch-up] cases).

Mild cases of epithelial growth don't need treatment. Severe epithelial growth may cause pain, light sensitivity, and blurred vision.

These cases require the surgeon to lift the flap and remove the ingrowth.

Corneal Ectasia

Corneal ectasia is a rare, but devastating, LASIK complication resulting in significant corneal thinning. Some studies reported an incidence rate between 0.04 to 0.6 percent of LASIK procedures.

You may need a procedure called collagen cross-linking to strengthen your cornea or corneal implants to improve your vision.

Diffuse Lamellar Keratitis (DLK)

Diffuse lamellar keratitis (DLK) is a type of inflammation that occurs under the LASIK flap. This complication typically occurs a few days post-surgery.

Mild cases of DLK are self-limiting, and most patients are asymptomatic. Severe cases appear as waves of sand in your cornea, which is why they are nicknamed “Sands of the Sahara.”

Severe DLK is treated with frequent doses of steroid eye drops and may require the surgeon to lift the flap and rinse the inflammatory cells out.

Bladeless LASIK has a higher risk of DLK versus traditional LASIK.

Infection

Infection requires prompt treatment with antibiotics. In some cases, the surgeon lifts the flap and applies antibiotic underneath it.

Symptoms include pain, redness, and light sensitivity.

Overall, infection is rare because the LASIK flap provides protection, and you're prescribed antibiotic eye drops to prevent infection after surgery.

Flap Complications

Flap complications include wrinkles and dislocation of the corneal flap created during LASIK. These problems can happen if patients accidentally rub their eyes after receiving LASIK.

A flap dislocation or significant flap wrinkles require the surgeon to reposition the LASIK flap. 

Most dislocations occur within 24 hours of surgery, but some are seen months to years later, usually due to trauma. A review of 41,845 LASIK patients found a flap dislocation rate of only 0.012 percent. 

Blindness

Overall, the risk of blindness with LASIK is very low. Over 99 percent of people reach 20/40 visual acuity or better, while 90 percent of LASIK patients achieve 20/20 vision or better.

Rarely, serious complications can cause significant vision loss. Following post-surgical care instructions and seeing your eye doctor for scheduled follow-up visits are essential to prevent vision-threatening complications.

Common Side Effects of LASIK

Although most people obtain good visual acuity post-LASIK, side effects can affect the overall vision and comfort after surgery. The most frequent side effects include:

• Dry eyes
• Glares
• Starbursts
• Halos
• Near vision
• Temporary vision loss

Conditions of a Good LASIK Candidate

A person is an ideal candidate forLASIK if they have:

• Healthy eyes
• A prescription within range
• Thick corneas
• At least 18 years old and above
• Stable vision for at least 1-2 years
• Normal-sized pupils
• Realistic expectations

A person is not an ideal candidate for LASIK if:

• They are pregnant or nursing
• They have autoimmune diseases
• They have cataracts
• They engage in high-impact activities regularly
• They have had a previous eye injury or surgery
• They have taken steroids, isotretinoin (Accutane), or amiodarone before surgery

Your eye surgeon can determine if any of your health conditions are contraindications for LASIK. Be completely accurate and detailed when providing your medical history to your surgeon.

LASIK Recovery Time & What To Expect

Generally, the recovery time across most LASIK procedures is similar.

During the first 24 hours after surgery, you may experience irritation and mild pain. Contact your surgeon if you experience severe pain at any point during recovery.

You will have a follow-up visit with your surgeon the day after surgery. These visits will continue for up to 6 months.

Your eyes will fully recover in 6 months’ time. However, it can take longer if you had a higher eye prescription prior to surgery.