Possible LASIK Complications
LASIK Vision Correction Complications
Denver, Boulder, Colorado
how bad can it get? Can you go blind from Laser Vision Correction?
has not been one case of blindness in any FDA Laser Vision study since the studies
initially began in the early 1990's. In my practice, no patient that I am aware
of, has had to give up any activity in their life because of a complication from
Laser Vision Correction.
Over 95% of my patients are satisfied after Laser Vision Correction;
however, Laser Vision Correction is NOT PERFECT! Dryness, hazy vision
in dim light, and night glare occur initially after EVERY LASIK
procedure. The dryness often requires the use of lubricating eye
drops ("artificial tears") for weeks to months following
LASIK, and usually resolves after three to six months. Rarely, patients
have persistent dry eyes. The hazy vision in dim light usually resolves
within a few weeks, although it may last longer in patients that
had large amounts of nearsightedness treated with LASIK. The night
glare ("halos" around headlights) usually resolves within
a few weeks, although glare may be permanent after LASIK. I use
a VISX Star 4 Excimer Laser which has a large optical and blend
zone. These large zones on the VISX Laser significantly decrease
the incidence of night glare. And to further decrease the incidence
of glare and halos I would recommend that you consider CustomVue
Wavefront and IntraLase
Lasik. The IntraLase also adds significant safety to the Lasik procedure.
Approximately 5-10% of patients require a retreatment
after LASIK, usually performed about three months after the initial
LASIK procedure. With the CustomVue Wavefront and IntraLase, the
retreatment rate is much lower, approximately 2%. I do not consider
retreatments a "complication". Retreatments are performed
at no additional charge for 12 months after surgery or indefinitely,
if you have annual routine exams by Dr. Levinson. For details, see
Potentially serious complications...
THIN FLAP - When we use the Microkeratome
to cut the LASIK flap, there is less than a 1% chance of a thin
flap occurring. The incidence of thin flaps is much less common
with the IntraLase. If the flap is too thin, I cannot perform LASIK.
If I did Laser over a thin LASIK flap, visually threatening corneal
irregularities and haze would occur. Fortunately, it is easy to
identify a thin flap. If one occurs, I reposition the flap immediately,
and do nothing more. Within 2 to 3 days, the patient will have usually
regained his or her original vision, and can see again with their
original glasses or contact lenses. We can then repeat the LASIK
procedure in 3 months.
FLAP WRINKLES - When
I replace the corneal flap after performing the LASIK procedure, small folds in
the flap are common, and are easy to identify and remove at the time of the LASIK
by simply refloating the flap. However, small folds can occur rarely in the flap
in the first few hours following the procedure. Wrinkles probably occur when the
patient inadvertently squeezes the eye tightly shut. Visually significant wrinkles
occur in less than 1% of cases. If wrinkles occur, I take the patient back to
the Laser Center, anesthetize the eye with an eye drop, relift the flap and smooth
out the flap to remove the wrinkles. This usually removes the wrinkles successfully.
If this does not, I repeat the retreatment procedure a second time.
CENTRAL CORNEAL ISLANDS - Although the configuration of the Laser beam
is highly homogeneous, small central surface irregularities, called "central islands",
can occur in less than 1% of cases. These usually resolve without treatment. In
a very small percentage of cases, the central islands may persist, requiring a
"touch up" with the Laser. I have not had a patient lose vision from a central
4. EPITHELIAL INGROWTH -
Small cells from the corneal epithelium, the "clear skin" that covers the cornea,
can become embedded under the LASIK flap. This occurs in less than 1% of LASIK
cases. The cells can start to grow and form a thin sheet of epithelium under the
flap. This will affect the vision. The epithelial cells are usually easy to remove
by anesthetizing the eye with eye drops, painlessly lifting the flap, and irrigating
or mechanically removing the aberrant epithelial cells. I have had two patients
with epithelial ingrowth; both were very successfully treated and have had no
5. HAZE UNDER THE FLAP (DLK)
- Usually, the corneal tissue under the LASIK flap remains clear.
However, the tissue under the flap can become hazy. The haze can
look like small pieces of sand (this condition has been called "Sands
of the Sahara"). This haze is very uncommon, but has been reported
to occur to the point where vision has been affected. The cause
of the haze is unknown, and usually responds to steroid eye drops.
I have had two patients whose vision has been permanently affected
by this haze with loss of best-corrected vision in one eye.
DISLOCATED CORNEAL FLAP- The corneal flap is remarkably
stable after LASIK, but I have had one patient's flap dislocate after surgery.
The patient had an uneventful LASIK procedure. However, when I saw her the day
after surgery, her flap had come loose, and was tucked up under the upper eye
lid. It was still attached at its base to the cornea. The patient had experienced
significant non-LASIK emotional distress three hours after her LASIK procedure,
and had sobbed heavily for approximately five minutes. This probably caused the
flap to dislocate. I brought the patient back to the Laser Center and easily repositioned
the flap. Fortunately, the flap remained in position and the patient had 20/20
vision 48 hours after the flap was repositioned.
UNCORRECTABLE BLURRY VISION OR "GHOST IMAGES" - Rarely, a patient may have
corneal irregularity after LASIK or PRK that causes blurry vision or "ghost images".
"Ghost images" are similar to a TV picture with poor reception; overlapping the
main image is an identical, but dim second image. A retreatment may not be able
to treat a post-LASIK corneal irregularity.
HEMORRHAGE OR DAMAGE TO THE OPTIC NERVE - In making the LASIK flap, I put
a suction device on the eye which increases the pressure in the eye for approximately
20 seconds. Very rarely, this elevated pressure could cause bleeding in the retina
or damage to the optic nerve. Both of these complications could cause permanent
vision loss. I have never had either of these complications occur.
INFECTION - In any surgical procedure, infection
can occur. An infection after LASIK could potentially cause scarring of the cornea,
with permanent vision loss. Fortunately, however, infection is extremely rare
after LASIK. In fact, I have not had an infection occur in any patient after LASIK.
11. CORNEAL ECTASIA
- Cutting a corneal flap for LASIK can cause structural weakening
of the cornea. Although LASIK has been performed since 1996 in the
USA, the cutting of corneal flaps has been performed worldwide since
1959 for treating corneal diseases and refractive errors. I have
learned that if I cut too deep of a flap or remove too much corneal
tissue with LASIK, I can structurally compromise corneal integrity,
resulting in a "weakened" cornea that may "bulge" months to years
after LASIK. This is called "ectasia" and can cause significant
regression of the LASIK treatment, resulting in the recurrence of
significant nearsightedness and/or astigmatism. Retreatment is not
possible and would even make the regression worse. In the rare case
of extreme ectasia, a corneal transplant would be necessary to regain
useful vision. I have a 1/1000 incidence of corneal ectasia and
I have had one patient require a corneal transplant after LASIK.
To minimize the risk of ectasia, I do corneal topography and measure
the corneal thickness (pachymetry) of every LASIK patient prior
to LASIK to identify patients that are at risk for developing ectasia.
I will not perform LASIK on any patient that I think is at risk
for developing ectasia. Approximately 2% of LASIK candidates that
I examine are at risk for ectasia and cannot be safely treated.
12. HUMAN ERROR - Ugh. To
err is human but..... No matter how thorough, meticulous, conscientious,
etc., I, or any surgeon, am, the possibility of human error exists.
All the above listed complications are inherently potential risks
of Laser Vision Surgery but human error, theoretically, should never
occur. Human error, for me is the scariest of all complications
because, theoretically, at least, I should never make an error.
I am comfortable claiming that I am 99+% "perfect". Regrettably,
I have had one patient for whom I put a wrong number in the computer
that controls the Excimer Laser, in 1999. The patient did see 20/40
in the eye after being incorrectly Lasered by me, and could have
been retreated and corrected to 20/20. Understandably, she was not
that interested in having me ever Laser her again.
The above complications are
all rare and can usually be successfully treated. However, treatment
may not completely correct these, or other problems, and the patient
could, rarely, experience a permanent, non-treatable decrease in
their best-corrected vision after LASIK. The chance of "going completely
blind" from LASIK is probably zero. In the "worst case" scenario,
which is extremely rare (approximately 1 in 2000 cases) a patient
would require a corneal transplant to correct a LASIK complication.
I would like to share one last thought with you. Most of the potentially visually threatening complications in LASIK are related to the flap. If you have PRK, instead of LASIK, you have essentially avoided most of these rare but potentially visually threatening complications. I would encourage you to consider PRK.
Rose Medical Plaza,
4545 East Ninth Avenue, #270, Denver, CO 80220