Laser Eye Surgery Risks


Laser eye surgery is still a relatively new procedure and there is limited data on the long-term effects.  Serious risks and sight threatening complications are rare.  Thousands of laser eye surgeries are completed daily and they can have dramatic effects on a person’s life.  It is important for you to consider the risks that are involved with the procedure so that you can make an informed decision.  As with any surgery, results cannot be guaranteed and often depend on the healing process.  Occasionally, unexpected results can require further laser eye surgery, to achieve the desired vision and reduce the dependency on glasses or contact lenses.

Non-Specific Risks:

The main complications that are not specific to the procedure are:

The cornea may become infected

This may result in discomfort and a delay in the healing process.  To reduce the likelihood of infection the eyes and lashes are cleaned before surgery and antibiotic eye drops are usually given immediately following the procedure.  As a safe clinical measure, if both eyes are undergoing surgery at the same time, different instruments are used for each eye.

An abnormal reaction to the anaesthetic

Bleeding

Laser Eye Surgery Specific Risks:

All laser eyes surgeries use excimer lasers to produce the refractive correction, this means that the complications encountered are similar across the different types of laser eye surgery including LASIK, PRK and LASEK. 

Risks specific to laser eye surgery are minimal but include the following (this list is not exhaustive):

Over Correction/Under Correction

Everybody differs in the rate and manner of healing, and results might not reveal the expected correction.  You may experience over-correction or under-correction and this may result in the requirement for glasses or contact lenses.  Laser eye surgery may be repeated to try to improve the result by a second enhancement procedure.

Reduction of Visual Acuity

A reduction in visual acuity by two or more lines on the Snellen letter chart is a risk, but very rare. See Visual Acuity

Corneal Haze

Corneal haze or irregular tissue removal can cause your best obtainable vision with corrective lenses to be worsened.  Excessive corneal haze, which lasts over several months, can be corrected by further laser eye surgery. See Haze.

Anisometropia

A difference in refractive error between the two eyes, know as anisometropia, may occur if only one eye is treated and you may need to continue using glasses or contact lenses to balance the two eyes. See Anisometropia.

Contact Lens Use

It may be more difficult to wear contact lenses following laser treatment due to the changed shape of the cornea.

Glare, Halos & Starburst

These may occur partly because of the inappropriate scatter of light as it enters the eye.  Temporary halo affects when driving are common but are not usually severe.  These problems are more common at night when the eye is dilated and therefore decreased night vision may be experienced.  Eye drops can prevent pupil dilation at night and improve vision.  If you already suffer from glare, halo or starburst, these may become worse after laser eye surgery but initial assessments can show vulnerability.  The laser treatment can however, include an element to compensate for changes in the aberrations of the eye, which in turn can reduce the possibility of halos and starburst. See Glare, Halos & Starburst.

Presbyopia

This refractive condition, which usually occurs after the age of 40 years.  However, if you are short sighted you may not require glasses for reading when you reach this age as removing your distance glasses can enable reading unaided.  Laser eye surgery for a myopic patient treated for distance vision will effectively become “normal sighted” for reading, but when they reach around 45 years of age, reading glasses will be required for near work. See Presbyopia.

Damaged Cornea

The cornea may be damaged and require stitches or a graft.

Ptosis

Drooping of the upper eyelid usually resides in the first few weeks and rarely persists. See Ptosis.

Increased Eye Sensitivity

Eyes may become sensitive to touch but this rarely persists.

Retinal Detachment

If you suffer from myopia, you have a greater risk of retinal detachment and it is important to remember that retinal detachment risk remains after laser surgery. See Retinal Detachment.

Irregular Astigmatism

Symptoms include double vision or ghost images which may be caused by an irregular corneal surface or when the laser correction is not properly centred on the eye.  Further laser eye surgery can treat this condition. See Astigmatism.

Keratectasia

This is a condition that occurs when the corneal flap is cut too deeply or there is excessive removal of corneal tissue, which causes the cornea to bulge because it is weaker.  Distorted vision occurs and cannot be corrected with further laser enhancement but contact lenses may be used to hold the cornea in place. See Keratectasia.

Dry Eye

This condition may be experienced following laser eye surgery as laser eye surgery disturbs the wetting of the surface of the eye.  Tear supplements can be prescribed to reduce symptoms.  If symptoms are severe and include burning and stinging, it is advisable to consult your surgeon.  This symptom is reported more with LASIK surgery as the procedure compromises the ability of the eye to form a normal quality tear film.  Eyes may feel uncomfortable and vision may fluctuate with dry eye.  See Dry Eye.

LASIK, corneal flap problems

In the case of LASIK laser eye surgery, the corneal flap which is cut to access deeper corneal tissue may become wrinkled, damaged by being cut unevenly or may be removed instead of hinged.  This may lead to a distorted cornea shape and blurred vision.  It is also possible for the flap to be lost. 

LASIK, epithelial in-growth/trapped debris

The epithelium on the surface of the cornea, may grow beneath the flap in LASIK laser eye surgery and alter vision.  Similarly, debris may become trapped under the flap.  In both circumstances, the flap would require further treatment by lifting and scraping the flap to remove the dead cells/debris.  In Diffuse Lamellar Keratitis (DLK), dead cells underneath the corneal flap can cause inflammation and scarring.  Treatment with antibiotics and/or topical steroids is necessary to avoid potentially permanent vision loss. 

LASIK, retinal haemorrhage, retinal artery, venous occlusion, and penetration of the eye by the microkeratome

These may lead to the loss of an eye but these are all very rare risks.

Many of the possible concerns associated with laser eye surgery can be corrected and treated with timely and accurate professional care.  Other risks, which have the potential to cause permanent damage, are very rare.

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