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Surgeon David Allamby FRCS(Ed), FRCOphth
 David Allamby

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What are the short- and long-term laser eye surgery effects?

Learn more about vision correction

06
Mar
2018

With any surgical procedure, including laser eye surgery, it’s important to address a number of principal issues and questions up front.

Is it the right option for you personally? What exactly will the procedure involve? And – most importantly for many people – what can you expect the outcomes to be? What are the laser eye surgery effects both short- and long-term?

The latter question is usually among the first one people ask when weighing up a decision about whether or not to have laser eye surgery. That’s completely understandable: it’s a significant step to take, both financially in the short-term, and in its potential impact on your personal lifestyle. Naturally, you want to be assured of the outcomes.

But can you be? And if so, to what extent?

Firstly, let’s acknowledge a few key facts:

  • Laser vision correction is among the most common surgical procedures performed worldwide
    - Since it became commercially available in the late-1980s, more than 35 million people have opted for the procedure!
    - Statistically, it’s also one of the safest medical surgeries you can undergo
  • The vision correction people gain from laser eye surgery isn’t temporary, as is often (wrongly!) assume
    - As a living organ, the human eye does of course continue to change with age
    - However, the structural improvements made to the shape and function of the cornea during surgeries are lasting, even in the context of ongoing age-related vision impairment
  • The likelihood of experiencing worse vision after laser eye surgery than before it is incredibly small
    - If you don’t already have corrected vision – i.e. you don’t currently wear glasses – there is very little chance at all that your vision could be worsened by surgery
    - If you do already have corrected vision, the chances that your best spectacle-corrected visual acuity (BSCVA) being reduced by surgery is extremely slim; somewhere in the region of 1:1000 (0.1%)
  • Laser eye surgery has proven highly effective at improving a wide array of vision issues, including astigmatism, presbyopia, short-sightedness and long-sightedness
  • Laser vision correction typically involves minimal discomfort, and offers very speedy recovery times compared to many other types of surgery
    - For the vast majority of patients, the procedure itself isn’t painful at all – the outer window of the eye is anaesthetised with eye drops prior to starting
    - It’s commonly described as a slightly ‘unusual’ sensation, with many people reporting a feeling of gentle pressure on the eye during surgery that is mildly uncomfortable at worst
    - It’s extremely common for patients to experience little or no inconvenience or discomfort within a day or two
  • In the long-term – over a period of anywhere between 10 and 30 years – laser eye surgery is a far more cost-effective vision-correcting measure than either glasses or contact lenses

The likelihood of experiencing worse vision after laser eye surgery than before it is incredibly small

Who should have laser eye surgery?

Today, laser eye surgery is a widely available and extremely popular method of vision correction for millions of people around the world.

Various groups have been instrumental in helping the procedure achieve such a positive reputation. Notably, the backing it received from the US military was a big step in helping to instil greater public confidence in the procedure:

  • During the early 2000s, it quickly rose to become the preferred Department of Defense method for improving the vision of around a quarter of a million soldiers and other key military personnel
  • US Navy and Marine Corps pilots who underwent the procedure further helped to underline this confidence, with test cases in one widely-reported 2008 field study delivering a 100% success rate for 20/20 post-op vision

Many more such studies have been conducted in the years since, and the numbers make for increasingly happy reading: one prominent sample group of over 100,000 individuals who opted for laser eye surgery reported just a single case of complications leading to early disability retirement

Perhaps most persuasively of all, a UK initiative was launched in 2013 enabling optometrists to undergo the procedure for free, for the purposes of developing their own first-hand understanding of the entire experience from a patient perspective. More than 800 qualified professionals took up the offer, and 99% subsequently said they would recommend it without hesitation to friends, family members and patients alike

Even so, laser eye surgery isn’t for absolutely everyone – indeed, one of the most crucial factors in achieving such fantastic success rates is the identification of suitable candidates.

Military laser eye surgery

The procedure itself: safety and likely effects

Now, let’s take some of the information outlined above, and examine it in a little more detail according to most people’s three most important criteria when considering laser eye surgery: safety, short-term effects, and long-term effects.

1)      Safety

As noted above, one of the main factors in achieving high success rates is appropriate patient selection. An expert surgeon who chooses suitable candidates to work on will inevitably see much lower complication rates even than the (already very low) statistical averages.

A great many people are perfectly well suited to undergo the procedure, but there are a few specific conditions and scenarios that can make it a less appropriate choice for certain individuals (see below).

Eligibility issues are more likely to arise in:

  • Patients with specific issues concerning the physical structure of the eye, such as thin or irregularly-shaped corneas
  • Patients with a very significant existing refractive error, or an unstable prescription
    - It’s important that laser surgery is performed when a patient’s vision is stable, even if it’s significantly compromised
  • Patients diagnosed with various medical or physiological conditions, including (but not limited to):
    - Diabetes
    - Immune system disorders
    - Pregnancy
    - Rheumatic conditions
    - Certain degenerative illnesses
  • Anyone under 18 – you’re ineligible for the procedure until this age

pregnancy eligibility for laser eye surgery

In any good practice, all potential candidates must be guided through a rigorous suitability consultation. GPs play a key initial role in helping identify suitable patients for laser eye surgery, while preoperative examinations from eye surgeons focus more specifically on any potential issues regarding the physical structure and condition of the patient’s eyes themselves.

In terms of laser eye surgery gaining official approval as an inherently safe and effective procedure, one of the strongest advocating reports to date came from the National Institute of Health and Clinical Excellence:

  • Its 2006 paper, the Guidance Document on LASIK, identified ‘no serious concerns’ regarding the long-term safety of the procedure in cases where appropriate surgical techniques, modern equipment and suitable aftercare were all in place
  • Laser eye surgery has been widely available to the public for more than two decades now, meaning that medical bodies and industry watchdogs have begun to amass significant quantities of data on longer-term effects of the procedure
  • When large data samples are viewed in that context, the consensus remains very much that undesirable long-term effects are rare occurrences, and that a majority of those few complications tend to be treatable with subsequent procedures

There are also a number of precautions that patients can take following the procedure, to help speed up recuperation and reduce inconvenience or discomfort.

These include:

  • Arranging for someone else to take you home if possible
  • Booking an appropriate amount of recovery time off work (typically 3-4 days is ideal)
  • Wearing sunglasses temporarily, to help protect the cornea from heightened sensitivity to bright light
  • Avoiding rubbing or touching the eye area
  • Wearing eye shields at night to prevent inadvertent rubbing
  • Lubricating the eyes with antibiotic drops
  • Avoiding strenuous physical activity for 2-3 weeks
  • Avoiding submerging the eyes in water – particularly public baths, hot tubs or open waterways – for up to 8 weeks, to minimise the risk of secondary infection

precautions to take after laser eye surgery

2)      Short-term effects

There are various short-term effects that certain individuals might experience as the eyes heal following a surgical procedure.

The majority of these are fleeting, and may only last a day or two, while others can take slightly longer to calm down.

Some of the most commonly reported short-term effects include:

  • Foggy or blurred vision
  • Heightened photosensitivity (discomfort caused by bright light, particularly sunlight)
  • Sensations of dryness, redness, grittiness, itching or irritability
    - These can occur even when the eyes otherwise appear to be excessively watery, which is also fairly common in the hours after surgery
    - Alterations to the shape of the cornea can mean that tears don’t flow directly across the affected area during the early part of the healing process
    - This is easily corrected in nearly all cases with regular applications of lubricating eye drops until the ‘dry eye syndrome’ clears up on its own
  • Temporary increases in visual artefacts and disturbances – speckles, ‘floaters’, ghosting etc
    - These can occasionally be longer-lasting, taking anywhere from 2-6 months to fully clear

short-term effects of laser eye surgery

The halo effect is another relatively common phenomenon reported by a small minority of patients following laser eye surgery:

  • This most often manifests as a tendency for bright light sources to appear ringed with ‘halos’ of colour, ‘starbursts’, or secondary, blurrier lighting effects – see below for an example
  • They can be particularly noticeable in low ambient light conditions – when viewing car headlamps or street lighting in the evening, for example
  • Some patients find it helpful to avoid night-time driving for a period after surgery
  • Rather than being a true side effect per se, haloing is a sign that the healing process is underway, as it stems from slight swelling caused by an accumulation of fluids in the area of the cornea that has been operated on

laser eye surgery the halo effect

Many of the symptoms, side effects and healing processes involved in normal recovery from laser eye surgery will pass in around 2-4 days on average, while a few can take slightly longer on occasion.

You’ll have a follow-up appointment with your Surgeon / Optometrist in the first couple of days following the procedure, which is a great opportunity to ask questions and clear up any concerns you might have. After this, you’ll be expected to schedule regular check-ups for around 6 months or so, to help monitor the full healing process to completion.

3)      Long-term effects

As noted above, long-term negative effects occurring as a result of laser eye surgery are extremely uncommon.

In 95% of cases, the one commonly observed lasting effect is a marked improvement in vision clarity, and a much slower rate of age-related eyesight degeneration than would otherwise be expected for most conditions and prescriptions.

During follow-up appointments with your doctor, you should always feel free to ask any questions and raise any lingering concerns you might have about the recovery process and its projected timeline in your specific case.

long-term effects of laser eye surgery

For a very small number of patients, of course, there is a slim chance of laser eye surgery leading to complications or undesirable outcomes – but it’s important to remember that most of these can be treated effectively at a later date.

Some examples of unusual longer-term side-effects may include:

  • Corneal flap complications
    - During LASIK laser eye surgery, a small, very thin flap is created in the front of the cornea to allow access for the reshaping laser
    -In rare cases, this flap doesn’t quite align flush with the surface of the cornea when it’s replaced at the end of the short procedure
    - Over time, as the healing process continues, this can create a microscopic ‘wrinkle’ that subsequently interferes with vision clarity to varying degrees
    - The American Journal of Ophthalmology estimates this to occur after 0.3-0.57% of procedures and notes that all occurrences within its 2006 study group were later successfully corrected
  • Corneal bulging (Ectasia)
    This is an even less common complication, having been observed at a rate of less than 1 in every 5000 laser eye surgeries
    - It can cause impaired vision, arising from insufficient corneal thickness –
    - This complication is increasingly uncommon because ever-more stringent patient screening tends to eliminate most candidates who might be at risk
    - Acknowledged risk factors include abnormal corneal topography (unusually thin or degenerated corneas), severe myopia with astigmatism, advanced age, or previous eye surgeries
    - Even in cases of more serious complication where further surgical treatment is deemed necessary, the prognosis is regarded as excellent
    - According to the American Academy of Ophthalmology, consensus reports indicate corneal grafts show a success rate of 97% over five years and 92% over a decade

laser eye surgery corneal bulging

It’s always sensible to manage long-term expectations to some degree when deciding to undergo the procedure. Some people who have laser eye surgery will still need to wear glasses or contact lenses to achieve optimum vision, although their natural eyesight should nevertheless be much improved over what it was before

It was once a popular misconception – thankfully much less widespread now! – that surgery was somehow a ‘temporary fix’. But, while the effects of laser eye surgery do indeed last impressively well, there is naturally a small risk of regression in some people.

In other words, there will always be a chance that, over time, certain refractive errors (short-sightedness or long-sightedness) can return to an extent:

  • This is a result of the natural healing process that takes place following the surgery
  • For a small percentage of these patients, a further benefit can be gained from undergoing a secondary procedure which can help to keep them out of glasses or lenses for longer

  However, the bottom line is that for most people, the only long-term effect of laser eye surgery is to provide an effective and lasting answer to a host of sight problems.

All around the world, hundreds of thousands of people every year now opt for the procedure, going on to enjoy dramatic improvements in their clarity of vision, much slower advancement of degenerative or age-related eye conditions, and a greatly enhanced quality of life as a result.

By: David
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