Nearly half of the adult population of the United States has a degree of refractive error (nearsightedness, farsightedness, or astigmatism) significant enough to affect their vision. Through the course of recorded history, people with these visually significant refractive errors were relegated to a lifetime of visual handicap. Glasses, which first became widely available just two centuries ago, were the mainstay of prescription visual correction until the mid-20th Century when contact lenses were introduced. For a variety of reasons (cosmetic, functional, sports, lifestyle, etc.), a significant percentage of Americans remained dissatisfied with their dependence on glasses or contact lenses to correct their vision. A ready and willing audience of early adapters was available approximately 30 years ago when the first surgical procedures designed to address refractive errors were introduced. While initially popular, procedures such as radial keratotomy (RK) were associated with significant side effects and, in many cases, shifting prescriptions even several years after the procedure. The concept of using a laser to reshape the cornea to achieve correction of refractive errors was introduced in the early 1990s. LASIK, the most popular type of laser vision correction procedure, has amassed a nearly 25 year track record worldwide and has been performed on an estimated 30 million people.
“In spite of its longevity and popularity, concerns have remained in the general public and even amongst some segments of eye doctors regarding the effectiveness and safety of LASIK,” said Jeffrey Robin, MD. Many studies of LASIK patients looking at their satisfaction with the procedure have been performed over the last several years. In spite of the excellent results (usually showing patient satisfaction rates in the 95+% range), lingering doubts about the procedure have remained. In order to address this, a large study of patient satisfaction was performed over the last three years at 20 different LASIK ophthalmology practices across the United States. Importantly, the study recruited patients who elected to have LASIK and compared it to patients who elected to stay in their contact lenses. These two groups comprised nearly 1,800 patients (700 contact lenses and 1,100 LASIK) and compared satisfaction rates, as defined by how happy the patient was with their result and would they recommend it to family/friends. Patients were followed for a minimum of three years. Dr. Robin said, “The goal of the study was to compare LASIK in the “real world” – meaning, comparing it not to a “perfect” hypothetical correction, but rather to “real world” options, particularly contact lenses.”
The results of this study were just published in the August 2016 edition of Ophthalmology, the official journal of the American Academy of Ophthalmology, and were amazingly impressive, surprising even experienced LASIK surgeons. First, were patients happy with their choice of refractive error correction? The study showed that the satisfaction rate for LASIK patients was nearly twice that of the contact lens wearing group (90+% vs. 55%). Additionally, for those patients who were prior contact lens wearers and then had LASIK, 97% indicated that they were happier with their LASIK correction than they had been with contacts. The dissatisfaction rates, meaning they wouldn’t recommend to family/friends, were identical (1%) between the LASIK and continued contact lens groups.
The study then examined incidence and severity of some of the postoperative side effects that in the past had plagued LASIK, namely dry eyes, infection risk, and nighttime vision disturbances. LASIK patients reported a transient increase in dry eye symptoms; however, in most patients, these resolved to preoperative levels. There was no significant difference in dry eye symptoms between the LASIK and contact lens groups. “Prolonged contact lens wear has been associated with an increased risk of serious eye infections and, as such, it was not surprising that the study showed the incidence of infections in the contact lens group was nearly double that in the LASIK group,” explained Dr. Robin.
Nighttime vision disturbances (i.e., glare and haloes around lights) had been associated with LASIK in the past. This study, which utilized modern LASIK lasers, interestingly found that the incidence of nighttime vision disturbances after LASIK was actually less than that reported by patients who continued to wear contact lenses. It was concluded that the modern era of LASIK lasers – which had incorporated state-of-the-art technologies designed specifically to address the concerns of nighttime vision disturbances – indeed had achieved this goal!
“This study is groundbreaking in many ways,” said Dr. Robin. “It has confirmed that the advances in our understanding of LASIK, combined with improvements in laser technology and tighter patient selection, have resulted in a procedure that is not only as good as contact lens wear but actually superior to it,” he said. “Patients undergoing LASIK with experienced surgeons utilizing state-of-the-art technology, such as we offer at Frantz EyeCare, have a great chance to enjoy a better quality of vision with fewer significant side effects compared to those electing long-term contact lens wear,” he added. So, after a generation of incredible developments, it is truly safe to say that LASIK has indeed come of age!
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