My Previous Doctor Recommended That I Have LASIK Surgery Saying That It Was Safer Than Contact Lenses. It That True?
This question has been asked by a number of patients over the years. At the present time there are cornea specialists in North America and elsewhere presenting statistics to make this point. In my opinion and in the opinion of most eye doctors, nothing could be further from the truth. I have been a contact lens specialist for over 40 years. Over the years I have seen and taken care of thousands of patients who were permanently damaged by refractive eye surgeries such as radial keratotomy and LASIK. Over the same period of time, I have seen no more than 6 patients whose corneas were damaged by contact lenses. In almost all of these cases, the involved patients did not take care of or wear their lenses in the prescribed manner.
The list of complications resulting from LASIK surgery is very long. The following are just a few of the complications and problems that millions of LASIK patients around the world have to deal with: Halos, starbursting, loss of contrast sensitivity, fluctuating vision, eye pain, dry eye, blurred vision, dry eyes, corneal ectasia, epithelial ingrowth, flap dislocation, debris under the flap, posterior vitreous detachment (floaters), inflammation, haze, double vision. Please note that this is not a complete list. In addition, some of these complications may not make themselves known for months or even years after the LASIK surgery is done.
There is no medical or surgical cure for LASIK complications. The "bottom line" is why would you want to take a chance on permanently damaging your vision when there are safer alternatives such as eyeglasses and contact lenses? So, to answer the question presented above, of course, without a doubt contact lenses are infinitely safer than any type of laser surgery, whether it be PRK, LASIK, or any other invasive procedure.
Dr. Boshnick, how do you prefer to treat patients with post-LASIK complications? I don't want to have any more surgeries or "enhancements".
Almost all of the patients visiting our office with post-refractive surgical complications are fit with GVR Scleral lenses. In almost off the post-refracive surgical eyes that we see, the cornea is compromised. By that I mean that there may be incomplete wound healing, or the cornea may be so dry that the cornea is very irritated. In addition, with our post-LASIK patients there may be issues with the LASIK flap. For these reasons (to name just a few) I feel that a gas permeable scleral lens is the best option. The scleral lens that I use is designed using proprietary software made by Zeiss Optical and the Oculus Ophthalmic Company. That is why we name our uniquely designed lens the GVR Scleral lens after the name of our practice, The Global Vision Rehabilitation Center. Our scleral lenses are made from a highly oxygen permeable material. The lenses are designed to vault over the compromised cornea and rest on the white portion of the eye (the sclera). Unpreserved saline solution fills the space between the back surface of the lens and the front surface of the cornea. Vision and comfort is excellent. Because the cornea is always in a moist environment, the lens also acts as a therapeutic device and promotes healing.
What are some of the LASIK complications that can affect LASIK patients? Are these complications just unique to LASIK patients?
LASIK complications are the unexpected events that can take place after LASIK. Some of these complications take place immediately after the surgery is done. Other LASIK complications can occur many years later. Some of the post-LASIK complications that we see are:
- A. Severe dry eye. This is the most common post-LASIK complication seen and affects about one third of the post-LASIK population. Very often, this will be a life long problem. Eye drops alone will usually not address this problem in a satisfactory manner.
- B. Irregular, uneven or distorted corneas. Eyeglasses and conventional contact lenses will not provide both good vision and comfort.
- C. Blurred, distorted and fluctuating vision. Multiple pairs of eyeglasses may be needed to see clearer. Conventional contact lenses may prove to be very uncomfortable.
- D. Reduced vision indoors and at night. Light sensitivity (photophobia) outdoors, especially in the bright sunlight.
- E. Glare, halos, starbursts and double vision. This is known as "higher order aberrations."
- F. Eye pain, sometimes constant.
- G. Posterior vitreous detachment and vitreous floaters.
- H. Complications with the surgically created LASIK flap such as wrinkles, debris under the flap or epithelial ingrowth beneath the flap.
- I. Corneal ectasia which is a protrusion of the cornea. This can occur weeks after the LASIK surgery or years later. The blurred distorted vision resulting from the ectasia cannot be corrected surgically or with eyeglasses or contact lenses. The preferred method of restoring quality vision is with gas permeable scleral lenses.
- J. Corneal epithelial erosion.
- K. Severe depression and in some instances thoughts of suicide.
Why should I consider being fit with a GVR Scleral lens and not just get a corneal transplant?
There are risks involved with corneal transplant surgery, including infection and rejection of the transplant. Also, the drugs used to prevent rejection which must be taken for an extended period of time following the surgery, can increase the risk of glaucoma and cataracts. In addition, long term studies of patients with corneal transplants have shown the following to be true: Over 50% of patients who received a corneal transplant needed some form of rigid contact lens or scleral lens in order to achieve visual acuity better than 20/50. Stable vision in most cases is not achieved for one year or longer after the surgery. In many cases, the life of the donated cornea is limited. Repeated corneal transplant surgery (due to infection, rejection etc.) is the 2nd commonest indication for a repeated corneal transplant operation. There is a lifelong risk of rejection. This risk is greater in younger patients. There is a lifelong risk of wound rupture due to trauma.
What is a scleral lens and why does it work so well with patients who have undergone refractive eye surgery?
A scleral lens is a large diameter lens made from a highly oxygen permeable material. It does not move on the eye, which is one reason why it is so comfortable. It is not a contact lens in that it has no contact with the cornea. Instead, a liquid reservoir (pure saline solution) fills the space between the back surface of the lens and the front surface of the cornea. This liquid reservoir fills in the surface irregularities of the cornea allowing vision to be restored in a comfortable manner. The lens and the liquid reservoir beneath it protect the cornea from exposure to the environment and the rubbing effects of the blinking action of the eye lids. This liquid reservoir beneath the lens also provides oxygen to the cornea allowing the eye to heal. The result is a smooth optical surface that replaces the cornea as an optical surface in a non-invasive manner. The GVR Scleral lens dramatically improves vision and comfort.
My present lenses hurt and very often pop out of my eye. Will this happen with scleral lenses?
No. When properly fit, the GVR Scleral lens will not dislodge or pop out of your eye. This is because the lenses are large and come to rest on the white portion of the eye. The lenses are stable and will not move with the blinking action of the eye or with rapid eye movements. The edges of the lenses tuck underneath the eyelids so when you are blinking, the eyelids pass over a smooth uninterrupted surface. With almost all of our patients, the comfort or their GVR Scleral lenses are as comfortable as any soft lenses. Many patients report that their GVR Scleral lenses exceed the comfort of their prior soft lenses.
How long can I expect my scleral lenses to last?
In our patient population, the average life expectancy of over 3 years. Many of our patients are wearing the same lenses for over 6 years. We recently introduced new cleaning solutions which are now able to keep the optical surface of the GVR Scleral lenses clear and smooth for many years. We expect our scleral lenses to last even longer since the introduction of these new cleaning solutions.
Why should I consider a GVR Scleral lens over a corneal transplant. My insurance will pay for the transplant and therefore I will not need any type of contact of scleral lens. What do you think about this?There are real risks involved with corneal transplant surgery. These risks include rejection and infection of the transplanted cornea. In addition, long term studies of patients who have had corneal transplant surgery show the following to be true:
- 1. Over 50% of the patient population who have received corneal transplants still needed rigid contact lenses or gas permeable scleral lenses in order to achieve visual acuity better than 20/50.
- 2. Fluctuating vision or unstable vision can persist for up to one year following the surgery.
- 3. In many cases the life of the donor transplant (or graft) is limited. Repeated corneal transplant surgery (due to rejection or infection) is the 2nd most common indication for a repeated corneal transplant operation.
- 4. There is a life long risk of rejection. This risk is greater in younger patients.
- 5. There is a life long risk of wound rupture due to trauma.
One more point of information: During my career, I have seen over one thousand patients with transplanted corneas. During this time I have only seen a handful of cornea transplant patients who did not need a gas permeable or scleral lens for vision purposes. Undergoing cornea transplant surgery is not "a walk in the park." Every effort should be made to find a non-invasive technology for vision restoration before embarking on surgery.
Why should I get a GVR Scleral lens and not a gas permeable contact lens or hybrid lens?
Almost all eyes that have undergone refractive eye surgeries such as LASIK or Radial Keratotomy, have corneas with significant surface issues. These issues include severe dry eyes, open incisions or incisions that have not (and will not) heal completely. There also may be issues with the LASIK flap. Because of these issues, I feel that it is best that no lens come in contact with the surgically altered cornea. Scleral lenses, and in particular, the GVR Scleral lenses vault over the surgically altered and often compromised cornea. The space between the back surface of the lens and the front surface of the cornea is filled with sterile saline solution. In other words, the cornea is always in a liquid environment. This liquid reservoir also acts in a therapeutic manner and promotes healing. Vision and comfort is excellent and all day lens wear in the norm.
What is the safest surgical procedure that will allow me to get rid of my eyeglasses? I read that PRK is safe since there is no LASIK flap involved, it that true?
There is no flap involved with PRK. However, every refractive surgical procedure involves its own set of risks. There is no safe or risk free surgical procedure. I have seen and treated every form of refractive surgical procedure including LASIK, Radial Keratotomy, PRK, CK, ALK to name just a few. The consequences in my post-refractive surgical patient population has been devastating. Many have spent all of their savings trying to find help. Others have lost their jobs and the resultant family issues resulting from all of this have resulted in a number of my patients getting divorces. In addition, over the years about a dozen of my patients who have suffered debilitating loss of vision and comfort and spoken to me about suicide. Stick with your contact lenses or eyeglasses. If you are having difficulties with your contact lenses find a doctor who specializes in contact lenses and get refit with lenses that will provide you with good vision and comfort. There are dramatic changes taking place in the contact lens industry. Many of the lenses in use today are much more comfortable and provide better vision than the lenses used used just two years ago. Your eyes are your most vital organ. Don't allow anyone to touch them surgically.
Why Do Patients Develop Dry Eyes Following LASIK surgery? My LASIK Doctor Told Me That This Is Temporary And After I Use Lubricating Eye Drops For A Few Months My Eyes Will Be OK. Is This True?
During LASIK surgery, the corneal nerves that provide sensation and that are also part of the nervous system that controls tear production is interfered with. These corneal nerves send signals to not just the lacrimal or tear producing gland, but also to the mucous and oil producing glands to make sure that the pre corneal tear film maintains its integrity. Once the relationship between the pre corneal tear film and the corneal nerves is interfered with, irreversible damage to the cornea and adjacent ocular tissues may take place. Most LASIK surgeons will advise their patients to use lubricating drops until these corneal nerves regenerate or until the eye heals. It has been my experience based on having taken care of thousands of post-refractive surgical patients that this is just not the case with many or possibly most post-LASIK patients. Since long term studies going beyond one or two years have never been done, it is not possible to know what percentage of patients who underwent LASIK are suffering blurred vision and ocular pain years after the procedure was done.
Dr. Boshnick, I’ve read a great deal about the possible complications that can occur after LASIK eye surgery. Are there any precautions that I can take to make sure that these problems won’t happen to me?
There really isn’t anything you can do before undergoing LASIK surgery that will prevent any or all of the life changing complications that can take place either immediately after having LASIK surgery or that can occur years later. There are just too many unknowns and unknowables about the procedure itself as it pertains to each individual eye. Every eye is different and can respond differently from another eye with the same visual defect. Every eye heals differently and how the brain interprets the surgically altered vision will vary from individual to individual.
If you are determined to undergo LASIK eye surgery, however, there are several precautions and steps that should be taken before you proceed:
1. Your LASIK surgeon or his representative will give you a list of possible problems and complications that can occur. It is required that this be given to you (FDA requirement). If the surgeon or his representative tells you that these complications do not occur any more, or that this information is based on outdated information do not believe him/her. If this person tells you that the doctor has performed 50,000 procedures or some staggering number and not one patient has ever complained, do not believe this. Problems and complications do occur. How do I know this? Because every day I am busy treating hurt LASIK patients who have suffered life altering vision and ocular complications.
2. If you are still determined to undergo LASIK surgery, DO NOT under any circumstances have the procedure on the same day as this informed consent list is handed to you. You should wait at least 72 hours. I would also suggest speaking to your family physician about this extremely important decision that you are about to make. I would also suggest that you make an appointment with an experienced optometrist who specializes in contact lenses and is not involved with a LASIK surgeon. In addition, visit the FDA website dealing with LASIK. There you find un-biased information about LASIK and the problems associated with LASIK surgery.
3. Many LASIK centers and surgeons have assistants (known as “handlers”) and technicians that will evaluate you to make sure that you are a proper candidate for LASIK. Many of these patients never get to meet the LASIK surgeon until the day of their surgery. In my opinion, this is unacceptable. You should be given the opportunity to meet with the LASIK surgeon before you commit to this procedure and ask as many questions as you feel need to be asked. If this pre-surgical consultation is not offered to you walk out the door..