Laser-assisted in situ keratomileusis (LASIK) stands as a cornerstone in the field of refractive surgery, offering individuals the opportunity to attain visual acuity without the reliance on corrective lenses. Amid the multitude of vision correction procedures available, LASIK often garners attention as the quintessential option. However, it’s imperative to recognise that LASIK represents just one facet within a spectrum of surgical interventions tailored to address various refractive errors and individual patient needs. In this article, Dr Lourens Coetzee aims to provide a comprehensive exploration of LASIK, its alternatives, and safety considerations, as well as dispel common misconceptions surrounding refractive surgery.
Understanding LASIK and alternative procedures
LASIK
LASIK epitomises the pinnacle of vision correction procedures, characterised by its efficiency, rapid recovery, and high patient satisfaction rates. The procedure involves the creation of a thin corneal flap, followed by the precise reshaping of the underlying corneal tissue using an excimer laser to correct refractive errors such as myopia, hyperopia, and astigmatism. Notably, LASIK boasts minimal discomfort and rapid visual recovery, with the majority of patients achieving about 90% of optimal visual acuity within a day post-surgery.
Alternative procedures
While LASIK remains the cornerstone of refractive surgery, alternative procedures cater to specific patient demographics and ocular characteristics.
- Photorefractive keratectomy (PRK), akin to LASIK, corrects refractive errors by reshaping the cornea, but involves surface ablation without the creation of a corneal flap. PRK may be preferred for patients with thin corneas or those engaged in contact sports, albeit with a longer recovery period.
- Implantable contact lenses (ICLs) offer a viable solution for individuals with high refractive errors or inadequate corneal thickness, preserving the natural lens while providing excellent visual outcomes. Presbyopia can also be corrected by LASIK, PRK, and ICLs, reducing dependence on reading glasses.
- Additionally, refractive lens exchange (RLE) addresses presbyopia and cataracts in more mature patients by replacing the natural lens with a multifocal intraocular lens (IOL), offering spectacle independence for a broader age range.
Safety considerations
LASIK safety profile
Extensive research underscores the safety and efficacy of LASIK, positioning it as one of the most studied elective outpatient procedures globally. Complications are rare, and with meticulous patient selection, thorough preoperative evaluation, and skilled surgical technique, the incidence of adverse events is minimised, ensuring optimal visual outcomes and patient satisfaction.
Temporary complications
Surgically induced temporary discomfort syndrome (STODS) may manifest as dry eyes post-surgery, typically resolving within three to nine months. Other complications, though rare, may include under-correction, overcorrection, and flap-related issues.
Long-term expectations
LASIK offers lasting visual improvement for the majority of patients, with minimal regression observed in approximately 5% of cases. Many refractive surgeons offer enhancements for these patients at no additional cost. Presbyopia may necessitate the use of reading glasses in later years, while ongoing screening for ocular diseases such as glaucoma remains imperative for overall eye health.
Compared to alternative options
Glasses are the safest option, as there is no surgical procedure involved. If you are content with glasses, LASIK is not for you.
For certain individuals who participate in contact and adventure sports, the safety of glasses compared to LASIK should be considered on an individual basis. Studies have indicated that contact lens wearers face a significantly higher risk of experiencing vision loss or blindness compared to individuals undergoing LASIK surgery.
Complications associated with contact lens wear, such as eye infections, can accumulate over time, potentially leading to severe visual impairment. Conversely, complications from LASIK surgery are typically transient and resolve quickly, minimising long-term risks to ocular health. If you are a contact lens wearer and get repeated eye infections, you should consider LASIK.
Addressing misconceptions
Dispelling myths
Despite its efficacy, LASIK does not impede the natural ageing process of the eye, necessitating periodic eye examinations for the detection of age-related conditions such as presbyopia and cataracts. Furthermore, LASIK does not prevent the onset of ocular diseases such as glaucoma, underscoring the importance of ongoing eye care beyond refractive surgery.
Exploring age and vision correction
Age considerations
Vision correction procedures are available for individuals older than 18 years, with no upper age limit. The FDA recommends refractive surgery after ocular maturity at age 18, with careful consideration of refractive stability. An annual change in refraction exceeding 1 dioptre may indicate conditions such as keratoconus, necessitating further evaluation and potential treatment to halt disease progression.
Presbyopia correction
Contrary to popular belief, presbyopia, the age-related loss of near vision, can be addressed through procedures such as PresbyLASIK, which modifies corneal shape to improve near vision. Additionally, refractive lens exchange (RLE) offers a long-term solution for presbyopia by replacing the natural lens with a multifocal intraocular lens, providing functional vision at multiple distances.
Conclusion
In conclusion, LASIK represents a significant advancement in the field of refractive surgery, offering individuals the opportunity to achieve visual clarity and freedom from corrective lenses.
However, it’s crucial to acknowledge LASIK as just one component within a comprehensive armamentarium of vision correction procedures. By collaborating with a skilled refractive surgeon and undergoing thorough preoperative evaluation, patients can make informed decisions regarding the most suitable procedure tailored to their individual needs, ensuring optimal visual outcomes and long-term ocular health.
MBChB (UP), Dip Ophth (SA), FC Ophth (SA), MMed Ophth (UFS), FWCRS
Dr Coetzee lives his life by a compass, not a clock. He is an adventurer, and it is his nature to go out, to climb crags, and to paddle rivers, to cycle mountains and plunge into the depths of the oceans.
He completed his ophthalmology degree at the University of the Free State. In the ever-evolving landscape of ophthalmology, Dr Coetzee has made a professional commitment to constantly enhance his expertise and acquire—and share—new knowledge across these surgical disciplines.
Dr Lourens Coetzee has been accepted as a certified fellow of the World College of Refractive Surgery. Being certified by the WCRS signifies the pinnacle of achievement in education, training, experience, and expertise in the field of Refractive Surgery. He is a member of the Refractive Surgery Alliance (RSA), a network of refractive surgeons spanning more than 30 countries. In addition, he is a preceptor of the RSA Fellowship Network and heads a sub-specialist training site for refractive surgery, the Emira Eye Clinics group, where he trains the refractive surgeons of the future. He is also a stakeholder of the World College of Refractive Surgery and Visual Sciences.
As a consultant for NGOs including Doctors for Life and the Keratoconus Foundation, he has gained experience in high volume cataract surgery as well as the treatment of keratoconus including corneal transplants.