LASIK Complications & How to Avoid Them
Lasik Surgery: Introduction
As you may know, LASIK is today’s most commonly performed refractive surgery procedure. It is highly well-known
in the United States and many people considered it as an extremely effective outpatient procedure that suits low,
moderate, and higher prescriptions. Being widely recognized, a number of eye centers particularly in the United
States are now offering this kind of eye correcting procedure for those who have problems with myopia, hyperopia,
The term LASIK (many people call it “LASIX”) actually stands for Laser Assisted In Situ Keratomileusis. It is a
type of refractive surgery that reshapes the cornea of the eye in order to correct myopia, hyperopia, and
astigmatism. And, perhaps one basic thing to note about LASIK is that, it is an outpatient procedure performed by a
refractive surgeon. So being outpatient, you can take LASIK and go home afterwards.
Now, what is involved in the LASIK
Basically, a medical device known as microkeratome is used in LASIK eye surgery to create a thin, circular flap in
the cornea. The surgeon will fold the flap back out of the way, then extract some corneal tissue underneath with
the use of an excimer laser. The excimer laser uses a cool ultraviolet light beam to precisely remove the very tiny
bits of tissue from the cornea to reshape it. When the reshaping is done in the right way, it is said that the
reshaped cornea works better to focus light into the eye and onto the retina, providing clearer vision then before.
The flap is then laid back in place, covering the area where the corneal tissue was removed.
Although considered highly effective for some reasons, the LASIK eye surgery, just like any other surgeries, has
its own risks and complications. But, how risky is it really to undergo LASIK?
Well, in this article I will discuss some complications that might occur with LASIK. But, also I will give you
ideas on how to avoid the LASIK problems. Let’s start with the complications.
How Common Are LASIK
Numerous studies in the late 1990s indicated that up to 5 percent of people who underwent LASIK experienced some
type of problem. However, many expert LASIK surgeons these days are reporting that the LASIK complication rates can
be held below one percent if surgical candidates are selected carefully. And, even when complications do occur,
they often can be resolved through laser re-treatments or enhancements of the eye.
Here are the common LASIK complications:
1. Undercorrection – This problem usually occurs when the laser has not removed an adequate
amount of tissue. It is often noted that regardless of how meticulously a correction is calculated and a laser is
calibrated, several factors can still affect the outcome of the procedure. Experts say that these factors include
but are not limited to aftershave, perfume or any other scented products; density and composition of tissue; room
temperature and humidity; and regression.
2. Overcorrection – This problem occurs when the laser has removed too much corneal tissue.
Usually, this occurs in the immediate postoperative period as an outcome of a normal swelling which occurs after
any surgical procedure. Studies have also revealed that overcorrection occur due to the factors as outlined for
undercorrection. But, certain enhancements or re-treatments are usually an option.
3. Too Small An Optical Zone – This is a LASIK laser complication which commonly occurs when
the optical zone is smaller than the nighttime or dilated pupil. People who are commonly victims of this problem
are those with very large pupils or very large corrections.
4. Decentered Ablation – Is commonly caused by one or more of the significant patient eye
movement during the laser treatment and incorrect centering of the laser beam. In some cases, this problem is said
to cause optical aberrations and astigmatism, glare, starbursts or contrast sensitivity problems.
Flap and Operative Complications
1. Dry Eye Syndrome – This case is actually not exclusive to patients who have had
refractive surgery. However, reports indicated that it has developed into the most common complication after laser
vision correction. It particularly affects what now appears to be the majority of all LASIK patients.
2. Free Cap – This complication occurs during the creation of the flap, but this is rarer
than the one mentioned above. This is more common in patients with a flatter curve on the surface of their eye. As
often said, if this problem occurs, the laser treatment may or may not proceed depending on the situation. At the
start of all procedures, alignment marks are placed on the surface to realign the flap at the end of a normal
procedure. But, these are also invaluable in the unlikely event of a free cap.
3. Wrinkles in the Flap – Wrinkles commonly appear when a patient rubs or squeezes his eye
too tightly in the first few hours following the procedure. In refractive surgery, it is a common practice to have
your eye examined with a slit lamp, prior to discharge from the clinic. This is often considered to make sure that
your flap has not moved from where your surgeon had place it.
4. Incomplete, Irregular, Decentered Flap or Button Hole of Flap – According to some experts,
this LASIK complication occurs at the time of flap creation. The most common cause of this is a loss of suction, or
discrepancy in the fit of the eye surface to the suction plate.
5. Epithelial Abrasion – This is but another LASIK complication that usually occurs at the
time of flap creation. This is said to be more common than the two complications listed above. The common victims
of this are the older patients, ages 45 and above.
6. Displaced Flap – An unusual occurrence which appears from rubbing or trauma to the eye
within the first 24 to 48 hours after the LASIK surgery. This is however decreased as with time and is normally
very minimal after three months.
7. Infection – This is an extremely rare occurrence, but if this occurs, it could be
8. Inflammation Under the Flap – This is said to occur when the tissue under the flap reacts
to minutes traces of microorganism toxins. It has been noted that all microorganisms and most of their byproducts
are destroyed with heat sterilization. Unfortunately, some of these toxins are not destroyed by heat and even in
very minute amounts can cause an adverse reaction. This is what triggers the inflammation to occur.
9. Debris Under the Flap – This complication is fairly common for the reason that the tear
film normally has particles of oil and other material like make up and lint from clothing. What contribute to the
occurrence of this are primarily the loose cells which result from the flap creation, which can cause the most
problems because they may continue to grow under the flap.
So you’ve learned about the complications that may occur with the LASIK eye surgery. The question now is how to
avoid such problems?
Knowing the Factors that Affect the LASIK
Although millions of people can benefit from LASIK, it is important to note in the first place that the
procedure is not for everyone. Doctors typically divide potential LASIK patients into a number of categories. There
are the ideal or good LASIK candidates, the less-than-ideal candidates, and the non-candidates.
The ideal LASIK candidate has the best chance of a complication-free outcome. The less-than-ideal on the other hand
is at increased risk for LASIK complications, thus need to discuss them thoroughly with the surgeon before taking
the operation. And, the non-candidate is not absolutely eligible for LASIK due to a preexisting condition.
Given this fact, the most important thing to consider then before proceeding for LASIK is to get screened out
beforehand if you are an ideal candidate for the eye correction procedure or not.
Below are some criteria that could negatively affect your visual outcome or even disqualify you for LASIK
completely. Note them carefully for there is a possibility that your surgeon will run some objective examinations
for most of these criteria. If you think that you might fit into one of the categories below, just let your surgeon
know. And, if he skips a test, don’t hesitate to ask why. You can even ask your surgeon to have the test done.
When it comes to how much vision correction LASIK can provide, some limits are set for every candidate. There are
some patients who have poor eyesight that they are beyond the help of refractive surgery. As noted, the FDA limits
on approved procedures do not include those with more than -14.00 diopters of myopia, more than 6.00 diopters of
astigmatism or over +6.00 diopters of hyperopia.
Anterior Eye Health
Typically, the eye specialists divide the eye into two portions: anterior (front) and posterior (back). In terms of
the anterior portion, the doctors commonly employ a biomicroscope known as a slit-lamp to examine the anterior
portions for abnormalities that could affect you LASIK outcome. For this specific test, you will need to place your
in the chin rest over the examining chair and the doctor will simply shine a light onto your eyes and examine the
anterior portions through the microscope.
Posterior Eye Health
By examining the posterior portion of your eye, the doctor is able to distinguish certain eye diseases, such as
ocular hypertension, glaucoma, and diabetic retinopathy. This examination is known as fundus exam and the doctor
performs this by shining a light into your eye and looking through your pupil.
One should note that as we mature, our eyes change shape and size. This is the reason why a young person’s
eyeglasses or contact lens prescription is constantly changing. Most of these prescriptions become constant by the
age of 18, but many do not and continue to change throughout our 20s. Well, the LASIK surgeons commonly prefer to
operate on patients who are over 18 and whose prescriptions have not changed significantly in two years. This is
considered because operating on eyes that are still in the process of growing creates the risk that the vision
corrected will be negated as the eyes continue to change. So, before you can qualify for LASIK, the doctor will
compare the results of your eye exam with your history to see if your prescription is stable.
In the first place, the area treated by the LASIK laser is only a small, circular part of the cornea. If you have
larger than average pupils, their circumference might exceed that of the treatment area, causing a different kind
of visual problem, especially at night when your pupils are at their largest. Note that large pupils can result to
some visual problems such as starburst, ghosting, and halos.
Dry Eye is but a very common condition. This primarily affects people age 40 above, especially women. Studies have
shown that this complication is may occur when your eyes fail to produce enough tears to keep the cornea moist, or
when the tears dissipate too quickly. So, before taking the procedure, it is important to know if your eyes are
chronically dry as this condition can affect post-LASIK healing, including the quality of vision you achieve.
If you think that you might have chronically dry eyes, ask your surgeon to administer the Schirmer test. This will
actually the amount of moisture on your eyes with the use of a thin piece of paper placed in your eye.
Another factor that could affect your LASIK outcome is the irregularity of your cornea. Often said is that, if the
cornea is too irregular in shape, it can’t be operated on. Your doctor will examine your cornea with a corneal
topographer to make sure that you qualify. The topographer works with its camera taking picture of your eye, and a
computer generates a map of your cornea.
Some people have corneas that are too thin, so there’s not enough tissue to create a good flap. In this case, LASIK
could worsen rather then improve the quality of your vision. So before taking the procedure, you doctor must
measure the thickness of your cornea with a device called a corneal pachometer. If in the end you are not
considered an ideal candidate for LASIK because of a thin cornea, other vision correction methods may be available
to you though.
There are several systemic diseases that could also keep you from being an ideal candidate for LASIK. These
hindrances could include autoimmune disorders and conditions that require a medication that slows healing. These
are said increase your risk of complications.
Also, if you arte pregnant or nursing, you are not an ideal candidate for the reason that the related hormonal
changes can temporarily affect the shape of your eyes. So, before considering the procedure, your surgeon will
obtain information about your overall health from a number of sources, including the records from your primary-care
doctor and the fundus exam.
In summary, what you can do to avoid some of those above mentioned LASIK problems is to determine whether you
are an ideal candidate or a less than ideal candidate for LASIK. Knowing that will give you an idea of the result
you can expect from LASIK. But, to further help your surgeon determine your risk of complications, send your
medical records to him or her and make sure to get the necessary tests and measurements done. Take a routine eye
exam, slit-lamp exam, fundus exam, corneal thickness, corneal topography, corneal pupillometry, and schirmer test