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    Why I changed what I tell patients about refractive surgery

    Consultation discussion should evolve just like laser technology has evolved

    Over the past 20 years, laser vision correction has improved dramatically. Flying-spot lasers have replaced broad beam lasers, the femtosecond laser has replaced the microkeratome, and Scheimpflug images have replaced Placido disc topography. With these changes in technology, has optometry’s narrative changed?

    While “20/happy” is still the goal and a phrase I use each day, how we position laser vision correction with patients seems stale. A few studies have changed what I tell patients about laser vision correction.

    What research says

    A 2017 study examines laser vision correction patients (90.9 percent laser-assisted in situ keratomileusis [LASIK]) from 45 medical institutions in Japan during 2013.1

    The data is based on three-month, postoperative visits from 131 ophthalmologists. These surgeons used nine different excimer lasers and five different femtosecond lasers to create a LASIK flap.1 Some 95.9 percent of LASIK patients achieved 20/20 or better. This data compares favorably to published FDA data from the Contoura (Alcon) platform with 92.6 percent 20/20 or better and iDesign (Johnson & Johnson Vision) with 94 percent 20/20 or better. 2,3

    Previously from Dr. Owen: Femtosecond advances help ODs, patients

    A controlled group of patients was used to compile the FDA data, but the Japanese data comprised patients who visited Japanese clinics over the course of a year. By contrast, the original FDA approval for the VISX excimer laser system in 1996 was 63.7 percent 20/20.4

    LASIK complications

    In the Japanese study, researchers reported 0.8 percent of patients had the following three LASIK complications combined—diffuse lamellar keratitis, flap striae, and epithelial ingrowth. The most common complication was dry eye at 1.2 percent.

    Schallhorn et al reported on 32,569 LASIK eyes in 2009, finding less than 1 percent of the three complications combined. This study also found less than 1 percent dry eye, but it is not known if the criteria for dry eye was the same as for the Japanese study.1,5

    A 2009 study of 4,772 eyes compared the 15 kHz femtosecond laser to the 30 kHz laser (we are now at 150 kHz) and found less than 1 percent of patients had flap complications.6 A meta-analysis of three FDA filings for the Alcon, Abbott Medical Optics, and Nidek lasers found significant decrease in symptoms of light sensitivity, night driving, and halos.7

    Contact lenses vs. glasses

    Patients elect to wear contact lenses for some of the same reasons they opt to have laser vision correction—they do not want to wear glasses. This results in comparisons between LASIK and contact lenses regarding risk, patient satisfaction, and so on.

    Related: How to manage vision changes over time post-LASIK

    If you randomly ask 100 people if they are afraid of wearing contact lenses few would say yes, but when asked about eye surgery I am guessing the number is much higher. An estimated 41 million Americans wear contact lenses, while only 700,000 LASIK procedures are performed each year.8,9

    Surveys show mixed reviews

    A three-year prospective survey compared contact lens patients; patients who wore contact lenses only, then moved to LASIK; and patients who wore contact lenses, then moved to LASIK. This study enrolled 1,800 patients across 20 sites in the U.S.10 The primary end point was visual satisfaction.

    This study stands out because researchers examined baseline data prior to surgery and surveyed patients before surgery, one year postop, and three years postop.

    In the group which continued contact lens wear only, 63 percent of respondents said they “strongly agree” with the statement, “I would recommend my current method of vision correction to a close friend or relative.”

    In the group which started with contact lens wear and moved to LASIK, 40 percent responded “strongly agree” with the statement, “I would recommend my current method of vision correction to a close friend or relative.”


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