The Dry Eye Zone

Rebecca's Blog

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Two common misconceptions about LASIK "complications".

Preface: On the need for ‘splaining.

I was motivated to write this by watching the press aftermath of the tragic death of Jessica Starr, the Fox 2 meteorologist in Detroit.

For many of us who have issues after LASIK or other elective laser eye surgeries, it can be quite frustrating to watch experts relegate our issues to “rare”, to say nothing of how they complacently recycle patient satisfaction rates in answer to serious issues being raised.

Time for some patientsplaining.

Misconception #1: You get what you pay for.

This is nothing to do with recent news. It’s simply a hangup of mine, triggered by the advice I see from doctors being interviewed.

The oldest, stubbornest, and most pervasive misconception about LASIK gone bad is that it just happens to the people who went to the bargain basement LASIK chop shop around the corner.

I cannot tell you how many times I’ve seen smug comments online from patients with good outcomes about how important it is to seek out an expert. “After all,” they say, “It’s your eyes!” (Newflash: We weren’t all born yesterday.)

They then proceed to parade THEIR surgeon’s credentials, how s/he was the first in XYZ region to do LASIK (amazing how many of those there are for each region), how many tens of thousands of procedures s/he has performed (amazing how no one’s math skills seem up to the task of multiplying that number by 20 minutes and dividing by the number of working minutes in a year and eventually discovering that this particular surgeon is essentially doing assembly-line surgery and never does any of their own pre-op or post-op care), and how they are the go-to specialist for patients with complications (ah, yes… so was mine, but apparently not for my type of complications).

And then there are the doctors who are interviewed by the press and explain with a straight face that you need to seek out a board-certified ophthalmologist. (Have any of you ever heard of someone getting LASIK done by an optometrist? By an ophthalmologist who was not board certified? By a board-certified proctologist?)

The fact is, an awful lot of us who have had persistent issues after LASIK are intelligent, educated humans who diligently sought out the local experts and still got the short end of the stick.

Don’t get me wrong. Of course you should seek out an expert if you’re getting surgery. That will probably significantly reduce your chances of inadequate pre-operative screening procedures or any of the already rare intra-operative complications.

But my point is that a good LASIK surgeon is not an insurance policy against a bad LASIK outcome.

Why? Because LASIK results are simply not ever fully dependent on the skill of the surgeon. Would that they were… it would all be so simple, and people like me wouldn’t have happened.

LASIK results are dependent on so much more - on pre-operative screening, on excimer laser performance, on post-operative healing, on a host of individual factors that do not lie within your control.

Misconception #2. The things to worry about are complications, which are less than 1%, so don’t sweat it.

There’s a huge disconnect out there about LASIK complications… even after all these years.

Physicianspeak

To doctors, complications are bad things that happen during surgery, or after surgery but as a direct result of the surgery.

Complications are very specific things. Like misbehaving microkeratomes. Damaged flaps. Infections. “Misadventure”. Equipment malfunction, errors, sheer bad luck.

Those things are, in fact, rare, at least by any common definition of the word “rare”.

Do they happen? Yes. Do they matter? Yes. Should we all take them seriously as possibilities? Yes. If you’re risk averse, or if you’re a commercial pilot or someone else whose livelihood will be toast if anything unexpected happens, should you factor this in to your decision? Yes. Are they things most of us would sweat? Not necessarily. This is why we go to good surgeons and not rookies - although, truth be told, LASIK in general is just really not nearly as surgeon-dependent as many other eye surgeries. - On the other hand, there is also a poorly understood, unpredictable long-term complication called corneal ectasia, a progressive sight-threatening disease, not necessarily stemming from any error or misadventure at all… it “just happens”, which can be so disturbing to the doctors themselves, to say nothing of their patients, that it has led to many conscientious ophthalmologists *very quietly* deserting LASIK in favor of surface ablation procedures such as PRK which has been repackaged under a variety of names that sound or look like the more marketing-friendly word LASIK. But I digress.

PATIENTSPEAK

To us patients, complications, are Bad Things, period, that were caused by the surgery. They come in many shapes and forms. Many are not measured or tracked by anyone, anywhere, in any consistent way, regardless of the extent to which they may affect our lives.

In terms of the numbers, some key long-term concerns for patients may actually be things that aren’t considered complications at all - in physicianspeak. Key examples: Dry eye; neuropathic corneal pain; and compromised vision quality. These things are side effects, or outcomes. They are not called complications. Therefore, they don’t get into the numbers. That is not to say that numbers do not exist, even if not measured or tracked with any consistency at all. Incidence of dry eye persisting 6 months or longer after LASIK may be anywhere from 2% to 39%, depending which study you believe. But, not being complications, they most certainly do not figure into the 1% or 0.5% or less or whatever number you have been told. Then there’s compromised vision quality. You can have 20/20 or 20/15 vision and still not be able to drive at night due to starbursts or read street signs due to ghosting. Again, those numbers also aren’t in the 1% or less, because this is not something that is routinely measured or reported to the FDA. These are just examples.

The terminology disconnect is real. This is one of the reasons why a doctor may be quite accurate in quoting complications rates, and yet ineffective in terms of communicating information that is vital to informed consent (if indeed there is such a thing in elective surgery). And this is why the FDA’s MAUDE database is overflowing with complaints from patients, many of whose outcomes were and are not considered complications by their doctor.

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