When you considering your lasik eye surgery options, one of the most important lasik eye surgery cons to consider is the fact that right at the start of the lasik procedure, the surgeon cuts a thin flap in the cornea (the front of the eye) either using a blade called a microkeratome, or a laser.
During the procedure this flap is lifted out of the way and the surgeon reshapes the cornea using a laser, and then the flap is replaced.
And it is this flap creation that can to complications.
Lasik Eye Surgery Cons – Wrinkles
The medical professionals call them corneal striae. Essentially, they are wrinkles that can develop in the flap after lasik surgery. There are large (macro) and small (micro) striae, and they are more like to occur when near-sightedness is being corrected, although they can also occur when far-sighted correction is being undertaken.
Macrostriae must be treated as soon as they develop, but microstriae will usually disappear during the normal healing process.
Striae are more likely to occur when a big correction is being undertaken. Severe striae can cause ghosting and degraded vision. Patients who suffer from dry eyes after lasik may find that striae are made worse by this condition.
Lasik eye surgery Cons – Keratectasia
This complication is a biggie with a big name – Keratectasia – and is a potentially very serious problem.
It occurs when the flap is too thick (the cut was made too deeply) or too much corneal tissue is removed during the procedure. The structure of the cornea is weakened, and the cornea will start to bulge outward, resulting in more astigmatism and distorted vision.
There are some estimates that this condition occurs in about 1 in 2000 lasik procedures, but not enough research has been done to know if this figure is accurate.
The bad news is that this is one of the most serious lasik eye surgery cons, as it cannot be correct by a second lasik enhancement, or even by eyeglasses or contact lenses. In severe cases the patient may need a corneal transplant.
In the United States corneal transplants are relatively routine operations – but the procedure involves further surgery, and surgery always involves risk.
There is some evidence that there is a lower risk of ectasia where a patient opts for one of the following procedures:
- Photorefractive keratectomy (PRK), a form of treatment that does not require the cutting of a flap;
- Lasek (Laser Assisted Sub-Epithelial Keratomileusis), which uses a thinner blade than Lasik, and in which a thinner flap is created; or
- epi-Lasik, which uses a different blade and is a sort of cross between Lasik and Lasek.
Better screening methods have been developed to help surgeons assess the risk that a lasik procedure will induce keratectasia; anyone with a thin cornea is a high-risk patient.
Lasik Eye Surgery Cons – The Microkeratome Blade
Lasik flaps can be cut either with a blade, or with a laser.
Metal blades sometimes create a flap with uneven edges, or even too shallow a cut that results in a “buttonhole” flap – a flap with a hole in it. This in turn could cause scarring that will result in less than ideal vision.
Generally, using a laser to cut a flap results in a more accurate procedure that produces better results and certainly lowers the risk of post-lasik complications.
Lasik Eye Surgery Cons – Other Problems
Getting the flap size right can be a problem.
Sometimes flaps are cut too short, or too thin, or are not smooth enough.
Sometimes instead of the flap being left on a hinge, it is cut right through. The lasik procedure can still be performed if the “cap” is of a high quality, but this “corneal cap” is then replaced immediately and the eye is allowed to heal.
In such circumstances the eye needs special care to make sure that the cap is not lost or moved over the next two days or so.
Another of the lasik eye surgery cons related to the flap is epithelial ingrowth. The epithelium is the outermost layer of the eye, and sometimes cells from this layer get under the flap and start growing there. To treat this condition, the flap must be lifted again and the cells removed.
Small areas of ingrowth are not really a problem, but large areas can distort vision and cause flap damage.
So the reality is that because the flap exists, there are always potential flap problems. If these issues still worry you after a thorough discussion with your surgeon, you might like to consider PRK, which does not involve the creation of a flap.
When you are assessing the benefits of the operation versus these lasik eye surgery cons, discuss the matter carefully and select the option that gives you the best chance of a successful outcome to the procedure.
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