Risks and complications

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Realistic Expectations

After thorough consideration of all the advantages and disadvantages of the treatment, a patient must make the decision to proceed with the excimer laser treatment, based on what they believe are realistic expectations of the outcomes of the treatment. If these expectations will not provide them with the vision they require then they should seriously question whether surgery is the best course for them to follow. What is a realistic expectation or requirement for one patient may be totally different for another. For example; a patient who does a lot of night driving for a living, will have different needs and requirements to a patient working at a computer screen or one working outdoors.

Risks and Complications

Let me put to rest a concern many people have when first contemplating laser treatment - to my knowledge, at the time I write this, there have been only a few cases of blindness reported following excimer laser treatment anywhere in the world after millions of cases of PRK and LASIK to date. The overall incidence of significant complications is now lass than 1% of cases using the IntraLase™ laser to create the LASIK flap.

Having said that, as with any form of surgery, excimer laser treatment has some possible risks and side effects that must be taken into account. We shall now honestly deal with them.

A patient must recognise that a prediction of the degree of correction is just that, a prediction not a guarantee. The expected results are derived from the thousands of previous treatments and so will be close to what will really happen. On the other hand, it is not reasonable to expect perfect 20-20 vision, or that the correction will be exactly what is expected, all people are individuals and no two eyes exactly the same. After treatment spectacles may be needed to fine tune the vision for night driving, subtitles at the cinema, etc.

One of the reasons an exact correction can't be predicted is in the eye's ability to repair itself - it will actually replace some of the tissue the excimer laser will remove, how much it replaces varies fractionally from patient to patient. This is a known behaviour though, so the excimer laser treatment includes an allowance for this effect.

Under correction is more common than over correction, the paragraph above explains one reason why (the eye replaces some of the removed tissue). This can be assessed during the period after surgery and a second treatment applied to refine the optical correction.

Over correction can occur and usually resolves over 2 to 3 months. Occasionally the eye may remain over corrected requiring an enhancement procedure.

Astigmatism can be treated at the same time as myopia or hypermetropia is treated. However astigmatism may be imperfectly corrected or occasionally induced.

Fluctuation and Haloes there may be fluctuation in vision during the stabilising process. In dim light, haziness in vision can be more marked and haloes around lights may be noticed as well as star bursts or multiple images, especially at night. These symptoms usually subside over a two to four week period.

Corneal scarring The treated corneal surface may fail to clear causing hazy vision after PRK. The problem usually resolves over months and can be treated with steroid eye drops or further mild laser treatment. This may occur in about 1% of cases. Severe scarring with loss or distortion of vision may occur after LASIK treatments if there have been serious flap complications.

Delayed healing The corneal surface has usually healed by 3 days after PRK but rarely this process can be slower. It has usually healed the same day after LASIK.

Decentration If the treatment zone is not precisely centred on the cornea distortion with haloes, star bursts or multiple images can result. The VISX laser uses a sophisticated process, tracking eye movement in all three dimensions to minimise this risk.

Dry Eyes Transient dryness of the eyes is common after LASIK and occasionally this may be permanent.

Infection is a rare occurrence if you follow Dr Delaney's advice regarding after-surgery care, especially concerning the medication (e.g. drops) which may be prescribed. Even if infection does occur, it can usually be cleared up with treatment, but the vision may be effected.

LASIK Flap Complications if they occur, are usually minor but occasionally they can be serious and may result in loss of best corrected visual acuity by 1 or 2 lines with symptoms like those with decentration. The risk of complications is further reduced using the IntraLase™ laser to create the LASIK flap

There may be complications which are not known at this stage. The chance of serious and permanent complications, is very low.

Spectacles or contact lenses may not correct some complications.

As with any form of surgery there are risks and benefits. By discussing the life you lead and the demands it places on you with Dr Delaney, a treatment which both achieves the best possible benefit, while reducing the risks as much as possible, can be developed. You will then have the knowledge you need to make your decision to proceed or not - its all about being realistic in your expectations.