How Safe Is LASIK Eye Surgery In 2019

Posted by: Philadelphia Eye Associates in Eye Health, LASIK Surgery on March 22, 2019

Vision is our most precious sense and we all want to do everything possible to preserve it. Before considering any elective surgery on our eyes it is important to know the facts about the safety and success rates for those surgeries. So how safe is LASIK vision correction?

The short answer is that LASIK is very safe and continually getting even safer.

But let’s dig deeper…

LASIK, or laser-assisted in situ keratomileusis, the most common vision correction surgery, is performed around 700,000 times per year in the United States. LASIK was first FDA approved in the US in 1998. Curiously, before the long term safety of the technique was well-established, the surgery was extremely popular, peaking at nearly 1.5 million surgeries per year in 2000.

Since 2000, there have been countless advances in the technology used for LASIK and a massive amount of research performed on the outcomes, safety, and long term effects of laser eye surgery. We now know that some patients who had LASIK in those early days were not actually good candidates for the surgery, and therefore our current selection criteria for who qualifies for LASIK is much narrower. However, we can better treat higher amounts of astigmatism as compared to 20 year ago.

Among the advances in LASIK technology have been the introduction of:

• Pupil tracking (to follow patient eye movement during surgery)
• Iris registration (to adjust for any eye rotation during surgery)
• Custom laser ablation profiles (to improve 20/20 rates and “higher order aberrations”)
• The incorporation of both wavefront and topographic data into the design of treatments
• The replacement of mechanical blades (microkeratomes) with safer femtosecond lasers for flap creation.
• Better screening through refined criteria, tomographic tests (i.e schiempflug imaging), and selective treatment approaches

LASIK in 2019 is much better and safer than LASIK in 2000. We have more predictable outcomes, fewer complications, lower rates of re-treatment, and much lower rates of night vision problems. But how safe and effective is LASIK these days? Let’s look at the data.

The most recent FDA review of LASIK outcomes, PROWL-1 and PROWL-21-2 found that there was a very high rate of 20/20 or better vision after LASIK. Patient satisfaction was also very high and dissatisfaction was extremely low. Dry eye, known to be a side effect (although often temporary) was found in a subset of patients after the initial healing period.

• Vision better than 20/20 without glasses:
  • 99.5% in PROWL-1
  • 96% in PROWL-2
• Satisfaction at 3 & 6 months:
  • >90% satisfied
  • <2% unsatisfied
  • <1% had difficulty with visual function after surgery
• Despite this high rate of satisfaction, LASIK can induce changes or problems:
  • 28% of patients described new onset dry eye (although most categorized this as ‘mild’)
  • 24 – 46% described a new visual symptom at 3 months

In short, LASIK is highly effective and patients are far and away very satisfied with their procedures. However, LASIK is a surgical procedure with risks that need to be weighed against the expected benefits of the procedure. Each potential patient needs to have an honest discussion with their ophthalmologist and needs to spend time reviewing any preoperative literature before making this important decision.

1. Eydelman M1, Hilmantel G1, Tarver ME1, Hofmeister EM2, May J3, Hammel K3, Hays RD4, Ferris F 3rd5.Symptoms and Satisfaction of Patients in the Patient-Reported Outcomes With Laser In Situ Keratomileusis (PROWL) Studies. JAMA Ophthalmol. 2017 Jan 1;135(1):13-22. doi: 10.1001/jamaophthalmol.2016.4587.
2. Sugar A1, Hood CT1, Mian SI1. Patient-Reported Outcomes Following LASIK: Quality of Life in the PROWL Studies. JAMA. 2017 Jan 10;317(2):204-205. doi: 10.1001/jama.2016.19323.

Author: Dr. Brad H. Feldman

Dr. Brad H. Feldman is a board-certified, fellowship-trained ophthalmologist specializing in cornea transplantation, cataract surgery, and laser vision correction such as LASIK and PRK. Learn more about Dr. Feldman.