LASIK Complications update FAQ
Please select your question from the following list of FAQs:
Are LASIK Complications decreasing?
As with any procedure, there are risks of permanent visual problems with LASIK. Dr. Richard Lindstrom, from Minneapolis, MN, discussed the trend of decreasing LASIK complications with increased LASIK experience and the newer generation of LASIK equipment. In particular, the decrease in complications has been helped by experienced LASIK surgeons sharing their experiences, which has enabled surgeons to avoid certain complications, and effectively treat other complications.
How do we know LASIK complications are being reduced?
At the 1999 American Academy of Ophthalmology meeting, Dr. Lindstrom reviewed 4 large series of LASIK procedures. Emory University and Howard Gimble (from Canada) each reported on their initial LASIK results in their first 1000 eyes. A third study was sponsored by CRS/USA and looked at 5,125 patients, while the fourth study looked at Dr. Lindstrom's results from a series of 1000 LASIK surgeries after he had completed over 10,000 procedures.
How have the complication rates changed?
The first 3 studies found intraoperative complications of between 2.5-3.2%. However, Dr. Lindstrom had a complication rate of 1.3%. Dr. Lindstrom's explanation is that the large number of intraoperative complications occurred when the original surgeons were using first generation microkeratomes (this is the equipment that makes the flap). Complications such as button holes, thin flaps, incomplete flaps, and free caps were far more common then than they are today. As well, compared to the first 3 studies, postoperative complications were reduced. Postoperative complications include striae (wrinkles in the flap), flap dislocations, epithelial ingrowth, ocular surface problems, and diffuse lamellar keratitis. The Emory Study had a 2.8% postop complication rate, Dr. Gimbel had a 3.8% complication rate, while Dr. Lindstrom's recent study had only a 1.5% rate.
Have the enhancement rates changed?
With the improvements in techniques, the percentage of patients requiring re-operations (enhancements) has dropped from 33% for the Emory and Gimbel studies to 15% in Dr. Lindstrom's series. Re-operations are performed for patients that are over or under-corrected, and as the laser programming has become more accurate, the need for enhancements has decreased.
What is the bottom line on the reduction of complications?
It is important to realize that many of the intraoperative and postoperative complications are treatable, so that the bottom-line to the patient is the loss of best-corrected vision. The Emory group had a 1.6% loss of 2 or more lines of best-corrected vision, while Dr. Gimbel had an even higher 4.7% loss. These numbers are in sharp contrast to a 0.4% rate in the CRS/USA study and a 0% rate in the Minnesota eye group.
How does this help potential LASIK patients?
As a final caveat, comparing the older studies to Dr. Lindstrom's findings does not mean that Dr's need 10,000 procedures to have better results. Instead, these numbers reflect the incredible mass of knowledge that has been shared by all LASIK surgeons to help prevent and reduce various complications. Besides next generation microkeratomes, better patient selection and improvements in technique have helped substantially reduce the risk of complications and as well reduce the loss of vision loss.
Since surgeons are performing the surgery better, does that mean that the risk of complications with and after LASIK are decreasing
There is concern that the risk of complications following LASIK is actually increasing. This is because of poor patient selection, including patients with very large pupil size, thin corneas, or pre-existing dry eye conditions. It is important to make sure that one is a good candidate prior to actually considering LASIK, and this may require a visit to more than one LASIK surgeon.