Is going for Lasik worth it for 20/20 vision? Here's what you need to know about the benefits and risks
From persistent dry eyes to unexpected complications – what experts say you should know before undergoing Lasik surgery.
(Photo: iStock/Kunlathida Petchuen)
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Laser-assisted in situ keratomileusis – better known as Lasik – is a popular surgery around the world for those dealing with eye problems such as shortsightedness, longsightedness, and astigmatism.
With current technology, surgery can be completed within minutes and patients typically enjoy nearly perfect or perfect vision with little to no side effects in a week or less.
However, as with any surgery, there are risks involved, some of which are not widely known but have been generating online discourse over the last few years.
They can range from the mild – dry eyes that require frequent use of eye drops – to the severe and even debilitating, such as halos (bright circles of light emitted by a light source) and ectasia, a condition in which the cornea thins and leads to distorted vision.
To get a full picture of these risks, we spoke to experts as well as real-life patients.
THE APPEAL OF LASIK
For many, if not most, people who undergo Lasik, they will say it’s a dream come true. Sonia Lourdes, who had the surgery in 2021, said the procedure freed her from the daily hassle of contact lenses. “I was tired of constantly wearing contact lenses and changing to glasses after,” the 33-year-old explained.
After the surgery, she said her vision stabilised “immediately” and she felt fully comfortable within two days. What she finds most valuable is the time and cost-saving aspect, as she no longer has to constantly purchase a new pair of glasses or contact lenses or worry about losing them.
Luke Phang, 35, another Lasik patient who underwent the operation sometime between the end of 2021 and early 2022, was initially nervous about the procedure but was convinced by his wife, who had it done as well.
“The quality of life that you gain back from not (having to wear) glasses is tremendous and it's life changing,” Phang shared. “You don’t have to care about where your glasses are or putting in (and removing) your contact lenses.”
WHAT EXPERTS SAY ABOUT THE RISKS
Patients must be fully aware of the potential side effects and complications before undergoing Lasik,' said Associate Professor Marcus Ang, Head & Senior Consultant of the Corneal & External Disease and Refractive Surgery Departments at the Singapore National Eye Centre (SNEC).
“This is a cosmetic, elective procedure”, he stated, “unlike patients who have diseases such as cataracts and require surgery to see well.”
“There is a huge benefit to (the cataract surgery patients’) lives, whereas for young patients who are looking to be spectacle-free or contact lenses-free, they are actually very healthy and can see well.”
As such, it can be quite devastating if a risk should happen, even though the chances of it are low.
Although there are no formal statistics on the percentage of Lasik or refractive surgery-related complications in Singapore, SNEC conducted its own 18-year audit of Lasik outcomes.
Based on that study, SNEC’s overall complication rate is 0.98 per cent, with an annual complication rate of less than 0.8 per cent since 2010. Ectasia, a rare but serious complication involving corneal thinning, occurred in 12 out of 53,731 eyes, all of which were linked to microkeratome flap creation before 2007. This refers to the creation of a thin flap in the cornea using a precision surgical instrument with an oscillating blade. "
At the National University Hospital (NUH), data gathered by its Lasik Centre showed that nearly all its patients achieved a vision of 6/12 or better by their final follow-up, which is typically one to three months post-treatment.
A vision acuity of 6/12 refers to the ability to see at 6 metres what a person with normal vision can see at 12 metres. Although it is not perfect, it is “considered reasonable vision and a common indicator of success used," said Dr Charmaine Chai, Senior Consultant in the Department of Ophthalmology at NUH.
She went on to add that the NUH Lasik Centre has been able to achieve a vision of 6/6 (the metre equivalent of 20/20 vision, which is measured in feet) or better in more than 85 per cent of patients who have undergone Lasik.
SMILE: The other laser eye surgical technique
Small incision lenticule extraction, or more commonly known as SMILE, is a newer technique in which a small piece of corneal tissue is removed through a minimally invasive incision with the help of a laser, said Dr Chai.
“This method has gained popularity in recent years due to its reduced risk of flap-related complications, which are associated with Lasik,” she said.
Dr Ang supports this, saying: “Instead of a large flap which is created in Lasik on purpose, SMILE does not have a flap and because of that, the wound recovery is faster.”
In fact, “most patients (achieve) their desired vision within the first week following treatment,” said Dr Chai.
While severe complications are rare, Dr Chai highlighted that side effects like dry eyes, glare, and halos are more prevalent. “Dry eyes affect 30 to 50 per cent of patients within the first six months after Lasik,” she said. “For most, dry eyes are temporary.”
However, she cautioned that some patients may develop persistent dry eyes, particularly those with pre-existing dry eye conditions or poor tear film quality.
This is consistent with Phang’s experience, as he deals with dry eyes to this day. He manages his condition simply with eye drops.
“Despite advice from (my) surgeon, because of my work, I still (have to) stare at the screen for a prolonged period of time,” he shared.
That said, he deems it manageable and not at a point where it disrupts his life.
Fellow Lasik patient, 33-year-old Marilou Chia has also struggled with eye irritation since her surgery. “I realized I only have this stinging feeling when I’m in a smokey area, after (I got) my Lasik,” she said.
Recalling an incident on her recent trip to Korea where she went to a pojangmacha (Korean street food stall), Chia shared that she had to finish her food and drinks in a hurry as the smoke there “was hurting (her) eyes so bad”.
Besides dry eyes, “side effects like glare, halos, and starbursts often do not disappear completely,” said Dr Chai.
These are caused by increased light scattering, which happens after the surgery reshapes the cornea.
Patients who require a large amount of correction or those with naturally large pupils are likely to experience these side effects more intensely.
“However, most patients adapt to them and are no longer significantly bothered after a period of time,” Dr Chai said.
LESSER-KNOWN COMPLICATIONS
In rare cases, patients may experience scarring or haze. In Assoc Prof Ang’s words, “the cornea is a clear structure, and when you are lasering something or doing a procedure to a clear structure, the risk is that it could become not so clear.”
When scarring occurs, abnormal collagen deposition during the healing process can lead to haze formation, which is a cloudy appearance of the cornea.
If it occurs, Assoc Prof Ang assured that there are surgeries to fix it. He stressed, however, that one should consult with a corneal surgeon, specifically.
Another rare complication is ectasia. It can happen either due to one’s genetic predisposition or external factors like constant eye-rubbing. “When you have a thin cornea and you rub your eyes, it starts to wobble and warp,” he said.
He then shared that there are now evaluations that can predict one’s risk of getting ectasia, even though they are not foolproof.
Should ectasia still occur after evaluation and surgery, Assoc Prof Ang maintained that there are ways to resolve it with help from a corneal surgeon.
Expanding further on flap-related complications, Dr Chai said these can also include flap striae (small folds in the cornea), trauma or tears, and epithelial ingrowth into the flap interface.
“In more severe, though less common cases, interface-related infections or inflammations can occur,” she said.
When they happen, the flap may need to be re-lifted for treatment.
In other cases, patients may develop neuropathic pain. “This is a condition where patients have symptoms that are disproportionate to their ocular signs,” he said.
For instance, a patient’s eyes are not that dry, but they present a lot of dry eye symptoms and are in pain.
To address this, SNEC’s Corneal & External Eye Disease and Refractive Surgery Departments has a clinic that caters to such patients and is developing a more holistic approach to treatment.
“Maybe some of them may require attention to other parts of the body or the face, or even mental health to help them (manage) these symptoms,” he said.
FACTORS THAT MAY AFFECT SUITABILITY FOR SURGERY
1. Pregnancy
Lee Feng Yuan, an optometrist at KJ Optometrists, said that pregnant individuals should wait at least six months after pregnancy or breastfeeding, whichever is later, before undergoing Lasik.
This is due to hormonal fluctuations during pregnancy and breastfeeding that can temporarily alter vision, making the surgery inadvisable.
Some medications prescribed during the Lasik recovery process may also be unsafe for pregnant or breastfeeding individuals.
2. Age
Age is one of the main factors in determining whether one is fit for Lasik or other refractive surgeries.
Lee said that individuals under 25 may have progressing myopia. As such, they should first consider using myopia-control spectacle lenses or contact lenses such as Ortho-K to stabilise their prescription.
In Dr Chai’s opinion, refractive surgery is ideally performed on patients between the ages of 20 and 35 as age-related changes in the eye can limit Lasik's effectiveness, such as presbyopia (more commonly known as “lao hua”) and cataracts. She also stated that dry eye symptoms can worsen with age.
Nonetheless, Assoc Prof Ang believes that one can get Lasik to treat their myopia and then undergo surgery again if they develop presbyopia.
Regardless, he stressed the importance of assessing a patient’s suitability and appropriateness for the surgery.
3. Contact lens wear
In the cases of contact lens wearers, Assoc Prof Ang noted that if they are unhygienic with a record of infections, it would prove they already have difficulty wearing contact lenses and have dry eyes. All of this could result in a higher risk of their eyes becoming even drier after Lasik.
HOW TO MAKE AN INFORMED DECISION
To decide whether Lasik or any type of refractive surgery is right for you, experts stressed the importance of a thorough pre-surgery assessment process.
At SNEC, “number one (is the) accurate assessment of the refractive error. You need to measure the power of the eye accurately,” Assoc Prof Ang said.
“Number two, it is about assessing the shape of the eyeball, including the strength of the cornea. So… eyeball shape, strength of the eye, based on imaging and scans. And then we assess the safety, which is whether the patient is suitable (for the surgery) or not.”
He added that it is vital to interview patients about their lifestyle, their occupation, and factors that may put them at a higher risk of complications.
Extensive tests are also part and parcel of the Lasik consultation process at NUH. “Corneal mapping is done to identify patients with an abnormal cornea shape and thickness. We also evaluate for any pre-existing ocular conditions that may increase the likelihood of issues like debilitating dry eyes or visual side effects,” shared Dr Chai.
Besides that, all patients will watch an educational video explaining the process and risks associated with the various treatments.
At both SNEC and NUH, patients are handed forms detailing the risks, and doctors are assigned to take them through what they need to know before they sign.
“We also take the time to highlight risks which may be specific to each patient,” said Assoc Prof Ang.
As for selecting a treatment centre or surgeon, both experts agreed it comes down to trust and reputation.
“Find somebody or a centre that you trust and that has a good track record. Having a conversation with a surgeon who takes the time to explain the procedure and risks is important,” he said.
Dr Chai concurred, saying, “Look for an experienced ophthalmologist you can trust who specialises in refractive surgery treatment and practices within a centre that is equipped to manage any complication that may arise.”
