fast586 wrote:To All Those Who Are Considering Lasik; Don't Do It. Lasik, Lasek or any other form of refractive surgery is extremely damaging to the human cornea.
It may be helpful for readers to learn of the specific difficulties fast586 has had after Lasik for hyperopia (farsighted, longsighted) vision in 2003. Visit
fast586 ThreadI will attempt to respond to some of the concerns fast586 has raised. Throughout this discussion it is important for the reader to keep in mind that the possibility of a problem is not the same as the probability of a problem. There are a gazillion things that can harm you every day, but we reasonably expect to get through the day without mishap.
Another important issue to consider is that a defect in the eye does not always equate to diminished vision quality. Some problems are sub-clinical – that is they do not actually affect vision.
I will reference the USAEyes Competence Opinion Relative to Expectation (CORE) patient survey. This is a comprehensive survey of patients who have had various types of vision correction surgery. A summary of the
USAEyes CORE survey or a PowerPoint presentation made to the
US Food and Drug Administration.fast586 wrote:Here's a few facts for you that I bet you don't know:
It is extremely important that each patient do his or her own due diligence to learn as much as necessary about the unique issues that relate to his or her own vision correction surgery proposed treatment. We provided information here, but there are many other resources available including other medical websites; patient websites; and, of course, a competent physician who has performed a comprehensive examination.
fast586 wrote:The first thing the Lasik surgeon does is prep you; he numbs your corneas with eye drops so your don't feel it when he cuts them. Either him or an associate, places a metal object in your eyes that stretches the daylights out of the eyelids and has the potential for causing nerve and goblet cell damage. Your goblet cells make proteins that keep your eyes lubricated.
Epithelial goblet cells are scattered throughout the epithelium, which is the soft pliable outermost layer of cells of the cornea (clear front of the eye) that are the fastest reproducing cells in the human body. Goblet cells secret mucus.
The eye lid speculum is used to keep the eyes open during surgery. This is an absolute necessity. You don’t want to laser your closed eye lids. The probability of the speculum causing problematic or long-term damage to the epithelium and its goblet cells is virtually nil, but not impossible.
The eye lid speculum can bruise the orbit (area around the eye), but this is rare. Bruising may cause inflammation that could reduce the flow of the liquids that comprise tears. Inflammation commonly resolves with treatment and healing.
There is one case report of two patients who experienced cheek numbness, tingling, or pain and at the time the eye lid speculum was positioned. This was attributed to infraorbital nerve dysfunction caused by the speculum One patient’s symptoms persisted for eight months, the other for one year. Speculum induced infraorbital nerve dysfunction is not quantified as a common or even uncommon Lasik related complication, however the case reports affirms it is possible.
fast586 wrote:Then the Lasik surgeon applies a huge amount of suction to your eyes to pull up floaters and potentially damage your retinas and optic nerves.
The first step of Lasik is to create a thin flap of corneal tissue. This is accomplished with a laser or conventional microkeratome. The microkeratome is affixed to the eye with suction.
The suction of the microkeratome raises the pressure inside the eye (intraocular pressure or IOP) for the short time it is affixed. This will cause vision to go dark or black out. Although increased IOP for an extended period of time can cause optic nerve damage, the amount of increased IOP and the duration of this IOP increase does not cause long-term damage to a healthy eye.
Floaters are small bits of the inner tissue of the eye that float in the clear jelly-like vitreous that fills the large chamber of the eye behind the natural lens. Floaters occur naturally, but can also be disrupted, repositioned, or even dislodged during the application of the microkeratome.
Problematic floaters after Lasik are relatively rare, but can be a nuisance. Whether formed naturally or exacerbated by Lasik, the brain commonly learns to ignore floaters along with the many and varied irregularities within human optics. As an example of the brain’s ability to ignore imperfections, all humans have a blind spot. It is actually rather large, but we don’t “see” it because the brain has learned to ignore it.
A key issue regarding elevated IOP and floaters is starting with a healthy eye. People who are extremely myopic (nearsighted, shortsighted) have a higher risk of floaters, retina, and vitreous issues. People with a history of retina problems are at an elevated risk for problems after Lasik. A competent doctor will examine the inner portions of the eye for signs of trouble and will send a high risk patient to a retina vitreous specialist for evaluation before Lasik.
If elevated IOP is a concern, a patient may elect to have a surface ablation technique such as PRK or LASEK. These do not use a microkeratome.
fast586 wrote:In addition to that, the surgeon severs your corneal nerves with a knife that often leaves metal debris behind in your eyes for the rest of your life. You'll have permenant nerve loss as a result.
This is one of those sub-clinical issues. Debris, including microscopic metal molecules, may remain at the interface of the Lasik flap, but if it does not affect vision quality it is likely not an issue for concern.
A personal example of sub-clinical metal issues is my late father. He worked around metals most of his life. At one point he needed an MRI, but upon prior examination it was determined that there were so many metal fragments in his corneas that the high magnetism of a MRI may cause serious damage. Despite all this debris, his vision was a clear 20/20 (corrected for myopia).
If debris is under the Lasik flap, the flap can be lifted, flushed, and the flap repositioned.
fast586 wrote:Did you know that the human cornea has more nerve endings than any other part of your body? Do you know what happens when you have Lasik? The Lasik surgeon cuts about 80 percent of those nerve endings and you'll never have the same concentration of nerve endings you once did before surgery.
Creation of the Lasik flap; and the laser reshaping of the eye, for that matter; are going to disrupt tissue including corneal nerve cells. A metal surgical blade would be used with a mechanical microkeratome, but a laser may also create the Lasik flap.
Although the corneal nerves are severed, corneal nerve density returns to preoperative levels after about three years for surface ablation techniques like PRK, LASEK, and Epi-Lasik, and after about five years for Lasik.
Of course what really matters is the return of corneal sensitivity. Regardless of the nerve cell density, it is the sensitivity that provides appropriate function. Although corneal nerve sensitivity may be slightly diminished after vision correction surgery, functional sensitivity commonly returns within weeks to a few months.
fast586 wrote:Guess what else this means? If you don't have dry eye immediately after surgery, you will undoubtedly have it at some point down the road, guaranteed. This happens because the nerve endings his severs provide communication and sensitivity so the eye knows when and how to lubricate itself. Once that communication channel is cut, it never returns. Then dry eye sets in.
As explained above, the communication relative to eye lubrication does return.
Dry eye after Lasik is not guaranteed. It is the most commonly mentioned complication after six months according to the USAEyes CORE survey, but of all patients surveyed, 7% said they had a complication that was seldom problematic, and of that 7%, 91% said they would have the surgery again. Of the same patients surveyed, 2% said they had a complication that was frequently or always problematic, and of that 2%, 22% said they would have the surgery again. This includes all complications, not just dry eye.
fast586 wrote:You'll loose about 1/3 of your corneal strength too. What does this mean? It means that your corneal strength is greatly reduced and you could end up down the road with a condition known as ecstasia or the forward bulging of your cornea. If this happens to you, be prepared for a corneal transplant.
The statement that one loses 1/3rd of your corneal strength after Lasik is inaccurate or, at the very least, incomplete. About six decades of studies and practical application has determined that if at least 250 microns of corneal tissue remains untouched on a health cornea, the cornea will remain stable. More untouched tissue is always better, but 250 is the generally agreed minimum. Even if 1/3 of the cornea is disrupted by the Lasik flap and the removal of tissue to reshape the cornea, so long as enough tissue remains untouched, the cornea will remain stable.
Of course there are always outliers. There are people with more than 250 microns of untouched cornea that have had problems, and there are people with less than 250 microns of untouched cornea who have not had problems...but you don’t want to expect stability below 250 microns even if it has occurred.
fast586 wrote:Lasik surgeons don't tell their patients these things because they know that if they told the truth about Lasik, that anyone in his or her right mind would run screaming from the Lasik surgeon.
This seems to be an opinion more than a stated fact. Reasonable people can disagree with opinions. Even if a person’s Lasik surgeon does not tell a patient the actual facts above, we just have. The information is available.
fast586 wrote:I know these things to be true because I had Lasik on one of my eyes a number of years ago and I now have nothing but trouble with the eye; it never stops. The eye that had Lasik is now more sensitive to light, wind, heat, cold and barometric pressure changes than it ever was. The eye doesn't look the same and I have trouble with the pupil of the treated eye varying in size from that of the untreated eye.
I never knew any of these things until I did research on my own because of the trouble I've been having. I naively believed what the Lasik surgeon told me because I trusted him. My life is now forever changed, but not for the better. I have pain in my eye right now as I'm typing this. The other eye is fine because it didn't have Lasik.
Lasik is surgery and every surgery has potential complications. Just because Lasik complications are relatively rare, they are 100% if you have them. Just because Lasik complications are relatively rare, one must accept that they do exist and consider what fast586 has to say about his/her own Lasik outcome. Don’t dismiss real negative results with an “it won’t happen to me” attitude. Even if the probability is low, the possibility exists.
fast586 wrote:My best advice to ANYONE considering Lasik; "DON'T DO IT!" It's not worth it. Wear your glasses. When you need a correction to your glasses, you can take them off. You can't do that with Lasik however and each time you need another correction, your corneas become more damaged and weaker. At any time (post Lasik), even years after the surgery, you run the risk of a detached cornea if your heavy into sports or any activity that places undue stress to the surface of the corneas.
I believe fast586 is not referring to a detached cornea, but is referring to a dislodged Lasik flap. It is true that enough or the right kind of trauma can dislodge a Lasik flap. The flap may be able to be repositioned, but not in every case. If this is an issue of concern or if a person is involved in contact sports, the alternatives of PRK, LASEK, and Epi-Lasik do not use a Lasik flap. Even if the probability of a Lasik flap complication of any kind and at any time is relatively low, no Lasik flap means no possibility of a Lasik flap complication. No possibility is almost always better than a low probability.
fast586 wrote:I'd estimate that about 99 percent of Lasik surgeons won't tell you the truth about Lasik because if everyone knew the truth, nobody would do it. Everything I've said here is quite true, so don't waste your time asking a Lasik surgeon about what I've said here; he or she won't tell you the truth anyway; it's not conducive to making money you know. They'll even try to paint you as irrational. So don't waste your time. Just take my advice and forget about ANY type of refractive surgery; they're all damaging to the cornea and not worth it.
I don’t believe it is irrational to think long and hard about any elective surgery and to get multiple opinions from multiple sources before making a decision. In fact, that’s the most rational thing a patient can do.
fast586 wrote:Lied-To Lasik Patient - NJ
Whether anyone believes fast586 was lied to or not, what is important is to recognize and understand that this is what fast586 believes. This is not only concerning for fast586, but shows a clear breakdown between the patient and his/her healthcare providers. That kind of situation makes any sort of resolution difficult, if not impossible.
I am sorry to read of your long suffered difficulties fast586. I sincerely hope you can find a provider you trust who will properly advise you on what steps may resolve or reduce your difficulties.