LASIK in the head: or 20/happy

The first question I am usually asked, when I tell folks at cocktail parties that I am an eye doctor is: "so, waddja think about LASIK?" (right before they ask me for advice on treating their cat’s persistent conjunctivitis.) "Is it safe?" My patients consider the option, with trepidation. Well, it is an important decision, and should be discussed seriously with your eye doc.

Let me begin by expounding on the two main refractive surgeries available today: LASIK, and PRK. In LASIK, a thin corneal flap is first created with either a blade or a laser (Intralase or Femtosecond), and then a second laser re-shapes the cornea into the correct prescription. In PRK, laser is applied directly to the surface of the cornea to carve your prescription in. In LASIK, visual recovery is much more rapid, and there is minimal pain following the procedure. For PRK, the wound created on the corneal surface takes a few weeks to heal, resulting in more pain and blurrier vision at first. So, why not opt for LASIK every time?

Whether you are a good candidate for LASIK depends on the shape and thickness of your cornea, as well as your prescription. Generally speaking, the surgery is intended for myopes (people with minus power glasses) in their 20's and 30's, with a stable prescription. Reshaping the cornea requires removal of corneal tissue -- the higher your prescription, the greater the amount of tissue marked for clearance. So, when I determine whether you are a good candidate (don't be offended, it is not personal), I need to make sure your cornea is thick enough for the procedure. Irregular corneas in conditions such as keratoconus (where the cornea is more conical than spherical) are also faux-pas for LASIK, so ophthalmologists obtain a corneal topography before offering the procedure to their patients. A friend of mine from San Diego came to me for LASIK evaluation last year, only to discover to her horror that her corneas were too steep and irregular for LASIK -- she suggested that perhaps they would be more suitable for skiing, topographically speaking. In cases where corneal tissue is too thin for flap creation, or the cornea is mildly irregular, PRK is still a viable refractive surgery option. PRK is also a safer option for boxers, pilots, and bungee jumpers, because flaps may actually become displaced with severe direct trauma to the eyes.

To answer the question of safety more fully, I refer you to Dr. William Mather's multiple articles on the safety of LASIK/PRK over contact lens wear from an infectious and visual perspective. The risk of irreversibly losing vision is much greater over the life-time of patients wearing contacts than those who undergo refractive surgery. Ophthalmologists who use the laser (Intralase) for flap creation also significantly improve the safety profile of this procedure.

Still, there are a few risks or complications that patients must consider before undertaking the procedure. Most if not all of these risks can be predicted pre-operatively in certain patients and treated if they arise. Dry eyes can can get drier as the result of some nerve damage from the laser. It usually improves in 3 months, and must be treated prophylactically in everyone before and after the procedure. Halos are another possible complication, though they usually resolve as well, and occur much less frequently with the strictly laser-driven procedure (Intralase). If the exact prescription is not achieved for the procedure, an "enhancement" can be done to touch up the corneas.

So, are people happy with this surgery overall? Dr. Kerry Solomon conducted a review pooling thousands of patients' responses about their experience with LASIK. This multivariate analysis showed a 95% satisfaction rate with the procedure. In conclusion: 20/happy! If you are considering undergoing LASIK or PRK, make sure you have a fair and balanced evaluation of your corneas by a conscientious ophthalmologist.


Mather WD, Fraunfelder FW. Rich LF. Risk of LASIK Surgery versus Contact Lenses. Archives of Ophthalmology. 2006; 124 (10)


Solomon KD, Fernández de Castro LE, Sandoval HP, Biber JM, Groat B, Neff KD, Ying MS, French JW, Donnenfeld ED, Lindstrom RL; Joint LASIK Study Task Force. LASIK world literature review: quality of life and patient satisfaction. Ophthalmology. 2009 Apr;116(4):691-701.