LASIK Long Term Effects and Safety

Omar asked:

Good Afternoon Mr Allamby,
I’m considering getting some treatment on my eyes, but am very worried about the long-term effect cutting the cornea can have. As i get older and my eyesight deterioates. will the my eyesight be worse off than if i had just kept wearing glasses?

Omar, I think this is one of the most common worries that prospective candidates have when considering laser eye surgery be it LASIK or PRK. It is just over 20 years since we first performed PRK for short-sight, and just under 20 years for LASIK, so we have considerable experience of long-term results.

The long-term outcomes have been excellent to date. Regression is seen in the London PRK study in 1-2% of patients, with a partial return to myopia, but not as bad as the vision had been before without glasses.

Cutting the cornea (e.g. to create a flap or flap disc) has been around for decades. Lamellar cuts were made in the 50s, and the first mechanical keratome was first used in 1963. No long term problems were seen, except when too little thickness was left in the cornea. At my clinic, we use a high safety standard of leaving 300 microns in the corneal bed, after creating the flap with a femtosecond laser and using the excimer laser to reshape the cornea.

The main worry is in excessive weakening of the cornea. However, the incidence of bending of the cornea through weakness in post-LASIK patients is the same as the incidence of bending from a disease known as keratoconus (KC). So in normal LASIK where all the safety parameters are observed, we are not sure if LASIK actually contributes to corneal bending post-operatively.

The key here, as always, is rigorous screening pre-operatively and visiting a centre where you get sufficient time for your consultation. Some clinics do consultations in 30 minutes, or even less. Others (mine included) spend much longer. Focus consultations take at least 2 hours.

Choose carefully.

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About the Author: Mr. Dave Allamby FRCS FRCOphth is a leading London-based laser eye surgeon. You may have seen him on the This Morning TV show with Phillip Schofield and Fern Britton or read one of several articles in the national press, recently for treating Denise Van Outen, rock giant Rick Wakeman and broadcaster Paul Ross. David is Medical Director at Focus Laser Vision, known as a world-leading clinic in the treatment of presbyopia, or age related loss of close vision. Focus Laser Vision is also London's only clinic to offer next-generation Z-LASIK laser eye treatment for short sight, long sight or astigmatism.

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  1. Damian says:

    Thank you for the reply. I’m planning to get lasEk anyway as I don’t see any advantages to lasIk other than the end result being reached quicker and with less discomfort – which are factors that aren’t all that important to me. And from what I’ve read I suspect Tsai’s findings, if there is actually anything to them, aren’t as relevant to lasEk.

  2. Damian says:

    Hi,
    A Taiwanese surgeon named Ray Tsai, who is presented as a pioneer of LASIK in the papers, recently decided to no longer offer the treatment. He appears to have had a number of patients return to him after a decade with sudden vision loss. From what I can gather he is blaming it on inflammation. I’d love to hear your interpretation of this, and whether it has any nearing on LASEK or the new i-LASIK. At the moment, this news is the only thing holding me back from getting surgery.

    • Dave Allamby says:

      Hi Damian. It’s hard to comment here without any information. I hadn’t heard of Dr Tsai before but seems he started LASIK in the early 90s as most countries did, including the UK. He has mentioned 10 patients but without any other details, apart from ‘some had inflammation’, as you mentioned. We haven’t seen this in other countries or centres, and LASIK hasn’t led to late inflammation elsewhere. Or indeed any other late complications over 20 years. So hard to wonder what is going on here. There may be a local back story we are not aware of. Normally a doctor would present such patients as a case series to the profession, either at a clinic conference or in a peer reviewed journal. But in this case, he held a local press conference to the general media, and didn’t present any clinical details. We don’t any more about these cases, or indeed if related to LASIK or not. Until then it appears to be a media headline grab. Lets hope he share details so others can comment intelligently. Regards, Dave

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