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Laser Surgery for Myopia (Nearsightedness)... What Experts Aren't Telling You.

As a physician and someone who suffers from myopia (nearsightedness), I have always wondered whether to undergo corrective laser surgery or not. In fact, I was still working for an eye surgeon back when the excimer laser came into use.

The procedure itself is relatively simple and the most common version of the procedure offered is LASIK. LASIK is a procedure in which the cornea of a myopic patient is circumferentially cut, to create a flap, which is then lifted up. The largest part of the stromal layer of the cornea is then cut with an excimer laser, and the corneal flap is finally covered back in place. As the cornea has become thinner and the focal length shorter, the incoming light can be focused on the retina to correct myopia. The entire procedure in turn, changes where the image is focused on the retina and in most cases, significantly restoring visual acuity to normal or near normal vision (what is referred to at 20/20).

Though outcomes are generally good, there are several serious consideration and negative outcomes to consider. Among the most common negative outcomes is glare and loss of night vision. Many people complain of experiencing halos and glare leaving them unable to drive, particularly at night.

Additionally, "Dry Eye" is a very common negative outcome and this condition can be very painful and potentially destroy your eyesight. One of the other concerns is corneal thinning. Corneal thinning is exactly that, the cornea "thins" and this can lead to serious issues later in life as it can affect the type of cataract surgery you may be able to undergo and even worse, result in a corneal transplant. Corneal transplants are very painful and though "better than nothing," still result in very bad and permament outcomes.

Another rare but serious complication is corneal ectasia. After surgery, the thinned cornea may not be able to withstand the intraocular pressure, resulting in a steepened or bulging corneal surface and vision loss. Scott Petty of Houston was diagnosed with corneal ectasia six months after laser surgery, and his vision continued to deteriorate even after treatment. It was so painful, like having hot grease in his eyes, that he almost committed suicide.Current treatments for corneal ectasia include hard contact lenses, minimally invasive surgery, and in some cases, corneal transplants. A 2017 U.S. study found that corneal ectasia occurs a few days to a week after laser surgery, or as late as several years post-surgery. About 50 percent of the cases occur within the first year after surgery, and up to 80 percent of cases occur within two years.

Myopia laser procedures have been developing for more than two decades, and critics of the surgery continue to make their stance heard.

Most people may be the lucky ones with no serious, painful complications after surgery. However, these people may still face the possibility of having to wear glasses or contact lenses again, especially in dim conditions or as they age.

The FDA warns that people who are considering laser myopia surgery should be aware of several things. These include that multiple surgeries may be required to achieve the desired results; the results may not last; the long-term results of the surgery are unknown; and there may be additional risks associated with simultaneous surgery on both eyes.

Is the low risk something we can afford? Most people would reconsider their options after learning about the risks; after all, each person has only one pair of eyes.

For this reason, the FDA has a separate web page on “When is LASIK not for me?” It is stated in this section that “you are probably NOT a good candidate for refractive surgery if you are not a risk taker. Certain complications are unavoidable in a percentage of patients, and there are no long-term data available for current procedures.”

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