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11 LASIK Myths

Patients believe the darndest things. Here’s how refractive surgeons defeat the wrong information.

By Vanessa Caceres

The first LASIK procedure was performed 27 years ago, so you would think all the myths had been put down by now. But you would be wrong. Everything from “LASIK is still a new procedure” to “LASIK can’t correct astigmatism” leaves surgeons scratching their heads and wondering how these myths got started.

“Many of these myths have lived on without much change over the course of time,” says Amin Ashrafzadeh, MD, Modesto Eye Center, Modesto, Calif. The difficulty in dispelling them has to do with the fact that people are receptive to education only at the time of considering such surgeries.”

What follows are common LASIK myths still in circulation, and what several refractive surgeons say or do to better educate patients.

Refractive surgery folklore

1. LASIK is new. “Laser vision correction has been around a long time. I had the honor of doing the world’s first laser vision correction procedure in humans in 1988,” says Marguerite B. McDonald, MD, Ophthalmic Consultants of Long Island, Lynbrook, NY, and clinical professor, Department of Ophthalmology, NYU Langone Medical Center. Refractive surgeons often point to the procedure’s long staying power when speaking with patients, she says.

2. LASIK must be repeated after 10 years. “The 12-year data from the U.S. Food and Drug Administration study of the original PRK and LASIK clearly shows that the refractions have remained rock solid,” says Dr. Ashrafzadeh.

At Hunter Vision in Orlando, Fla., Jason Brinton, MD, and partner Joel Hunter, MD, spend about 20 minutes with each new refractive patient. “We’ll emphasize that LASIK does not wear off,” Dr. Brinton says.

However, the surgeons interviewed for this article believe the perception of LASIK wearing off may trace back to presbyopic development. “When the boomers had LASIK around age 38 or 40, we apparently didn’t do a great job of explaining what would happen later,” Dr. McDonald says. “When we see these patients we tell them their LASIK has not worn off and that they still have great distance vision. If they want monovision, it is possible to retreat most of them.”

Adds Dr. Brinton: “Post-refractive patients return to us for regular exams, thus presenting us with the opportune moment to discuss dysfunctional lens syndrome and our use of refractive lens exchange at the appropriate time to correct for this.”

3. A person who’s had LASIK won’t ever need glasses. Dr. Ashrafzadeh tells patients that presbyopia is still a normal age-related issue that cannot be avoided. “Sometimes, a minor pair of glasses may make some tasks much more comfortable.”

Dr. McDonald explains all options to her older patients: They could choose to use readers or could even use multifocal IOLs in one or both eyes, monovision contact lenses, or they could get a monovision correction procedure.

4. LASIK cannot correct for astigmatism. “I can’t believe this myth is still around,” Dr. McDonald says, who’s often heard statements like, “I’m nearsighted but can’t have LASIK because of my astigmatism.” She is surprised this misconception exists because laser correction for astigmatism has been around almost as long as laser correction for myopia and hyperopia.

However, Dr. Brinton believes that patients’ friends and even some eyecare professionals have reinforced this incorrect belief. “When patients call in, we emphasize the importance of having an exam with a qualified refractive surgeon to determine candidacy and we look for opportunities to educate patients that lasers do an excellent job of correcting astigmatism.”

5. LASIK is painful. “There’s virtually no pain,” Dr. McDonald rebuts. “It’s almost a lunchtime procedure, although most people get a little Valium [diazepam] so they may want to take off the rest of the day.” Any pain associated with LASIK and even PRK has decreased as perioperative and postoperative regimens have improved, Dr. McDonald says.

6. LASIK is dangerous. This myth gains traction mainly because a small but loud group of patients might have had a bad experience in LASIK’s early days, Dr. McDonald says. With the Internet, that vocal minority can command more attention. “Serious complications are extremely rare today. Today’s LASIK has so many fail-safe devices. For example, if the person receiving LASIK with the CustomVue excimer system [Abbott Medical Optics] doesn’t have a matching iris pattern to the one loaded into the software, the laser will basically turn itself off. Today’s LASIK is like a new 747 jet compared with Orville and Wilbur Wright’s first plane, and even back then, LASIK was safe and effective enough to meet and exceed the FDA’s high bar for approval,” she explains.

7. The laser does all the surgery. “The surgery is done by the surgeon,” Dr. Ashrafzadeh says. “The laser is used to perform the tasks that the surgeon wants accomplished. There is still a need to guide and deal with complications as they arise.”

Related to this, Dr. Ashrafzadeh has had patients ask if LASIK is completely laser-driven today. Although 65% of LASIK surgery in the United States is now done with a femtosecond laser, many practices still use a blade microkeratome, he says.

8. LASIK causes dry eye, haloes and glare. “Multiple studies have shown that when good candidates are treated with modern lasers, LASIK does not cause these symptoms,” Dr. Brinton says. He discussed a recent prospective study he participated in at Durrie Vision, Overland Park, Kan. Researchers enrolled 60 eyes of 30 patients, and patients were surveyed preoperatively and at 1, 3 and 6 months postoperatively about dry eye, glare or haloes they were experiencing.¹ “At month 6, patients reported a statistically significant improvement in dry eye symptoms over their preoperative baseline in glasses or contacts,” he says. There were also very few haloes or glare.

Dr. Brinton has participated in other research that has found lower rates of bothersome symptoms with LASIK compared with wearing glasses or contact lenses.^2,3

“It’s been estimated that as many as 3 million patients in the United States this year will become contact-lens intolerant, and many of these highly symptomatic patients seek laser vision correction,” Dr. Brinton says. “It should come as no surprise then that the population of patients in a refractive surgery practice on average experiences more dry eye and bothersome visual symptoms than their peers in the community. Our data make clear that this relationship is correlative and not causative.”

9. The best place to have LASIK is the most expensive. Although this can be a myth, it actually is not far from the truth, replies Dr. Ashrafzadeh. “The skilled and in-demand surgeon also commands a higher premium.” However, despite a higher price tag, Dr. Ashrafzadeh still encourages patients to evaluate the technology offered and a surgeon’s skill and reputation.

Patients aren’t the only ones who believe in certain LASIK myths. Some ophthalmologists also have one or two misguided beliefs.

10. If you’re a cataract surgeon, it’s too late and too difficult to learn LASIK. “Just like anything else, you have to apply yourself and study with someone,” Dr. McDonald says. “For anyone who can do phacoemulsification, LASIK is so much easier.”

11. The cornea should not be too flattened. “There is much debate about what is the minimal permissible keratometry reading after LASIK,” Dr. Ashrafzadeh says. “This debate has no factual basis, and there is plenty of anecdotal evidence in the modern, femtosecond treatment era that patients with relatively flat corneas perform well.”

Combating LASIK myths

The best way to correct LASIK myths is quality chair time — particularly with the surgeon. Says Dr. Brinton: “After a decade of surgeons delegating preoperative exams and postoperative follow-up to nonsurgeons, I believe refractive surgeons are trending back to personally meeting and examining patients before surgery to determine candidacy.” That, combined with better screening algorithms and sophisticated nomograms, has resulted in improved refractive results, he adds.

However, everyone in the practice should be part of the educational efforts, he continues. This includes front desk staff and patient counselors — who all should be able to explain screening exams and the results in understandable terms.

Sometimes, a quality discussion with a patient actually steers them away from LASIK — but not because of problems with the procedure itself, says Dr. Ashrafzadeh. He has patients in their 50s and 60s who initially are interested in LASIK, and he then welcomes the chance to discuss refractive lens exchange with multifocal IOLs.

For patients who enjoy doing research, blogs and written materials are another way to correct any myths. “Blogs provide a source for these patients when they enter the research phase, but sometimes, it is still better handled in person,” Dr. Ashrafzadeh says.

Be ready for the tide to turn

Although many practices are experiencing a drop in LASIK, it’s crucial to stay abreast of LASIK myths, as the LASIK volume is expected to increase in the near future, Dr. McDonald says. “Everyone predicts that as the Millennials get just a little older, they will finally have enough disposable income to have LASIK. All the experts say to get ready because the market has been lean, but it’s about to boom again.” OM

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