When Laser Surgery Turns Into a Nightmare

Does this mean that the dream of getting rid of glasses while still improving vision should be forgotten?

Improved Technology

Refractive laser surgery aims to change the profile of the cornea, the front and clear part of the eye, to correct common vision problems: nearsightedness, farsightedness, and astigmatism. The idea is to eliminate the need for glasses.

In the absence of this feedback, the eye dries out and its surface can deteriorate. In the majority of cases, the cut nerves will return to normal function within four to six months. But for a number of patients, this doesn’t happen.

Karen (not her real name) is one such patient I recently met. As a young, dynamic executive, she had opted for surgery for practical (work, sports activities) and esthetic reasons. Attracted by promotions and a tempting price, she went to a laser center and was quickly examined by the staff. Even more quickly, she was given an appointment for surgery—the next day. Without thinking too much, she proceeded.

In the days and weeks that followed, her eyes began to hurt more and more—intense pain that felt like knives in her eyes, redness, and sensitivity to light requiring her to wear sunglasses even indoors. She had difficulty sleeping.

The staff at the center tried to reassure her, saying it would be temporary, that she is the only one to whom this happened, and that it would heal by itself. Weeks went by, without improvement. She asked to see the surgeon again.

The surgeon told her that her eye was healed and that nothing more could be done for her. His tone and attitude left Karen in great despair. She had feelings of rejection, of denial of what she was experiencing, of incomprehension. The situation affected her work. She began to consult other professionals, always being told that her eyes were perfect. No one seemed to understand.

A Puzzling Condition

Karen actually suffers from neuropathy. It is a disorder of the peripheral nerves that causes symptoms but is not associated with any visible pathology. Following LASIK, the nerves in the cornea remain permanently damaged, like bare electrical wires, or they regenerate but make poor connections. In either case, the nerves send a constant signal of pain to the brain.

After a few weeks/months, the pain becomes internalized (like pain emanating from a phantom limb) and the brain is therefore involved in making the symptoms chronic. Because no one really understands this condition, patients are dismissed and depression sets in as the condition worsens.

The lack of understanding of this case stems from the fact that it is a new field in ocular medicine that is poorly documented in the scientific literature. Treatments are complex and time-consuming. It is, in fact, necessary to create new normal nerve connections while breaking the bad ones, using medication such as cortisone, drops of autologous serum, and dressing lenses made of amniotic membrane, etc.

Karen lost her job due to frequent absenteeism and loss of productivity. Her treatments are expensive and are eating into her savings. The financial stress increases as the months go by and the light at the end of the tunnel is not always clear. The situation put great pressure on her marriage and her spouse has found it difficult to cope with the circumstances.

What to Know Before Deciding to Have Surgery

To avoid an outcome like Karen’s, certain precautions can be taken.

First of all, it’s best to avoid making decisions on a whim. Get information from your own eye-care professional, the one who has known your eyes for a long time. Then, get at least two opinions—in different centers—before proceeding, and assess those interactions and the level of trust you feel.

Certain risk factors can reduce the effectiveness of the procedure. For example, many patients opt for surgery because they become intolerant to contact lenses, with uncomfortable and dry eyes at the end of the day. If this is the case, it is because the eye is already prone to dryness and surgery will only increase it. It is, therefore, necessary to consult your optometrist in order to treat this dryness before the operation and wait until the surface of the eye is ready for surgery.

Patients with severe myopia (>8D) as well as patients with large pupils (larger than five millimeters) are prone to the continuous perception of halos and glare after surgery.

After the Operation

Once the operation has been performed, it’s important to ensure adequate professional followup. Demand to see an optometrist or ophthalmologist at every opportunity. Assistance personnel, even properly trained, are not legally authorized to diagnose your condition (saying that everything is fine is a diagnosis in itself).

It’s also important to never neglect regular eye health checkups. A severely near-sighted person, even after surgery, is still at risk of having a torn retina.

Laser surgery is performed successfully in more than 95 percent of cases. To avoid chronic problems, it is important to be well assessed and well informed.

You only have two eyes and they are irreplaceable. So take every precaution to ensure laser surgery is safe for you.