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All About Vision

LASIK Risks and Complications

LASIK is the most common refractive eye surgery, partially due to the fact that the risks and complications are low. The majority of patients don’t experience any long term complications as a result of the surgery. Nevertheless, as with any surgical procedure there are some risks, however rare they are and it is important to know them and to discuss them with your eye doctor or surgeon prior to undergoing the surgery.

Side effects of LASIK

There are a number of side effects that are somewhat common immediately post-op and in some instances can last longer – sometimes indefinitely. Those include:

Dry Eyes

About half of LASIK patients experience dry eyes, which are usually a temporary side effect that resolves within 3-6 months after the surgery. Your doctor will likely prescribe artificial tears in the days and weeks following the surgery which should be continued as long as the symptoms persist. Because of this, it is usually recommended that patients with a history of chronic dry eyes opt for another type of refractive surgery such as PRK, another style of laser refractive surgery with reduced risk.

Eye Infection or Irritation

While not common due to the eye drops and checkups prescribed post surgery, there is a chance of developing an eye infection. If this does occur, it can be treated with antibiotic eye drops, anti-inflammatories or sometimes may require other treatment such as oral antibiotics. If you are experiencing symptoms of an eye infection such as redness, pain, discomfort, discharge or any change in vision, see your eye doctor immediately. As a precaution, it is imperative to follow your surgeon’s instructions for your post-operative care including prescription medications and doctor’s visits.

Vision Issues

Following surgery, you may experience certain vision issues such as such as poor night vision, double vision, halos around lights or glare. These side effects are common and can last up to a few weeks, but typically go away. Some patients report a lasting reduction in vision in low light conditions and may require vision aids for seeing better at night.

Other risks of LASIK include surgical errors, many of which can be corrected by a follow-up surgery. These include:

Overcorrection or Undercorrection

The key to vision improvement in LASIK is accurate reshaping of the corneal tissue. If too much is removed or not enough is removed, your vision will remain imperfect and when possible may require a follow up procedure to obtain the clear vision being sought.

Flap Complications

Perhaps the greatest risk involved in LASIK is the accurate creation and healing of the flap of the cornea that is lifted to reshape the underlying tissue and replaced after. If the flap in the cornea is not made accurately, cut too thick or too thin and not carefully replaced back on the eye, it can cause complications in the shape of the eye surface and therefore clear vision. Studies indicate that these complications occur usually in under 6% of cases and the experience and skill of the surgeon play a large role.

There can also be complications in the healing process of the flap which include infection or excessive eye tearing.

Vision Loss

There is a chance, albeit small that the surgery can result in a loss of vision or reduction in visual clarity due to complications with the surgery.

It is quite rare for any permanent damage or vision loss to occur as a result of LASIK and usually any vision problems can be corrected by a follow-up procedure. However, as with any surgical procedure, there are risks, so it is important to reduce your risks by finding an experienced surgeon and carefully considering your suitability for the surgery in the first place.

Preparing for an Eye Exam

For both adults and children, an eye exam is a critical part in maintaining your overall health and well-being, and therefore, regular eye exams should be incorporated into your health routine. Comprehensive eye exams assess your vision and the health of your eye, looking for early signs of disease that may not have obvious symptoms. You should not wait until you experience a vision problem or symptoms of an eye condition to schedule a routine exam.

Depending on your age, family history, general health and eye health, it is recommended to have an eye exam every one to two years. Of course if you experience any serious symptoms that affect your eyes or your vision, you should contact your eye doctor immediately.

The Difference Between an Optometrist (OD) and an Ophthalmologist (MD or DO)

Confusion about the difference between optometrists and ophthalmologists is common, and many people are not aware of how the two eye care professionals differ.

Optometrists

Optometrists or Doctors of Optometry attend optometry school which is usually at least four years of graduate level training. They are able to perform eye exams, provide prescriptions for eyeglasses and contact lenses, and diagnose and treat eye diseases as as glaucoma, dry eyes, or eye infections that may require medication or drops. They can consult with and co-manage patients in pre- or post-op surgical care, however they do not perform surgery.

Ophthalmologists

Ophthalmologists are medical doctors that attend medical school and later specialize in ophthalmology. They are able to do all of the services mentioned above but also perform eye surgeries such as cataract surgery, refractive surgery such as LASIK and deal with more urgent eye conditions such as retinal detachment.

Infant and Child Eye Exams

According to the American Optometric Association (AOA) children should have their eyes examined by an eye doctor at 6 months, 3 years, at the start of school and then at least every 2 years following. If there are any signs that there may be a vision problem or if the child has certain risk factors (such as developmental delays, premature birth, crossed eyes, family history or previous injuries) more frequent exams are recommended. A child that wears eyeglasses or contact lenses should have his or her eyes examined yearly.

Adult Eye Exams

Healthy adults under 40 with good vision and who do not wear eyeglasses or contact lenses are recommended to have an eye exam at least every two years. Those that do use vision correction or have a health issue such as diabetes, high blood pressure or another health condition that can have an impact on your eye health should schedule a yearly exam, unless the eye doctor recommends more frequent visits.

Once you reach 40, you become susceptible to a number of age-related eye conditions such as presbyopia, cataracts or macular degeneration, therefore annual or bi-annual exams are strongly recommended.

As you continue to age, particularly after age 55, the risks of eye disease increase, and early detection can be critical to preventing significant vision loss or blindness. Scheduling a yearly eye exam can make all the difference in maintaining your independence and quality of life.

How to Prepare for Your Exam

Prior to your exam you should decide whether you will be seeking special services such as a contact lens exam or LASIK consultation. These services may cost extra. Check with the doctor’s office or your insurance provider to see if they cover any of the exam expenses.

You need to know if you have medical insurance, vision plan coverage or both. Medical insurance usually does not cover “wellness/refractive” exams for glasses or contact lenses. Vision plans will cover exams for glasses or contacts, but usually cannot be used for red eyes, floaters, or other medical eye health problems. Please bring your insurance cards with you.

In addition to bringing your current pair of glasses or contacts if applicable, it is important to be aware of your personal and family history and to have a list of medications or supplements you are currently taking. Your pupils will probably be dilated as apart of your exam, so plan accordingly.

Your Comprehensive Eye Exam

Your eyes are one of the most complex organs in your body. A comprehensive eye exam to assess your visual system and eye health involves a number of different of tests. Unlike a simple vision screening, which only assesses your vision, a comprehensive eye exam includes a battery of tests in order to do a complete evaluation of the health of your eyes and your vision.

The tests that you will undergo in a comprehensive eye examination may vary from eye doctor to eye doctor but here are are some common exams that you may encounter:

Patient Background and History

One of the most important parts in a comprehensive eye exam is your patient health history. This information will alert your doctor to any conditions that should be monitored closely, such as an allergy to any medications, current or family history of systemic or eye pathology or environmental conditions that could be affecting your vision or eye health. This will also help your doctor to determine any preventative eye care measures that are relevant to keep your eyes healthy for years to come.

Visual Acuity

Visual acuity is a measurement of your vision using an eye chart, the Snellen Eye Chart. In this test the patient is seated at a standard distance and is asked to read letters or symbols of various sizes, which get smaller as you move down the chart. The results are the familiar ratio of 20/20, 20/40 etc. which is a comparison of your vision compared to the average person with good vision, which is typically 20/20. For example, a patient that has 20/40 vision, can only see at 20 feet what the normal person can see from a distance of 40 feet. This test is a preliminary test of how clearly you are seeing in each eye but it does not give you a prescription for corrective lenses.

Refraction

Those who don’t have 20/20 vision have what is referred to in most cases as a “Refractive Error.” The patient may have nearsightedness, farsightedness, astigmatism or other eye conditions that prevent the patient from seeing 20/20. A refraction will tell the doctor which prescription lenses will correct your eyesight to achieve 20/20 vision or whichever amount your vision is correctable to.

A refraction may include a couple of steps.

Retinoscopy

Retinoscopy is a test that allows the doctor to obtain an approximate prescription for eyeglasses. In this test the doctor uses a hand-held instrument called a retinoscope that shines a light into the patient’s eye. The doctor then analyzes the reflex of the light from the patient’s eye to determine the patient’s prescription for glasses.

An instrument called a phoropter is something most patients associate with an eye exam. This space age appearing instrument, positioned in front of the patient’s face during the eye exam, gives the doctor the ability to determine the patient’s focusing ability as well as their eye alignment. The phoropter also determines which, out of the hundreds and hundreds of potential eyeglass prescriptions, will help the patient see as clear as possible. Using the phoropter, the doctor will ask the patient which series of lenses makes their vision the clearest.

While retinoscopy is quite effective for children and nonverbal patients, there are now a number of computerized or automated instruments available today to help doctors accurately determine a patient’s eyeglass prescription.

Autorefractors and Aberrometers

Autorefractors and aberrometers are computerized machines that are able to measure your refractive error to determine your prescription for glasses or contact lenses. These instruments are usually used in addition to testing described earlier:

– An autorefractor is similar to retinoscopy, which electronically analyses the light reflex from the patient’s eye.

– An aberrometer measures distortions or aberrations in the cornea and lens of the eye that disrupt proper focus of light on the retina. Using wavefront technology, the instrument measures the rays of light as they pass through your eye to look for imperfections which may indicate a refractive error.

Eye Focusing and Eye Teaming Tests

During the comprehensive eye exam, your eye doctor will also want to test how your eyes function individually and together from a mechanical perspective. In order to see clearly and comfortably, your eyes need to work together as a team.

Eye Health

The final and most important aspect of a comprehensive eye exam is a check of your overall eye health. These tests (below) are done to identify any eye conditions or diseases, both inside the eye as well as the external parts of the eye, that could affect your vision and general health.

Slit Lamp Test

The slit lamp or biomicroscope is an instrument that allows the doctor to examine the internal and external parts of the eye in detail, such as the conjunctiva, iris, lens, cornea, retina and the optic nerve. The patient rests their forehead and chin on a headrest to stabilize the head, while the doctor looks into the eye with the slit lamp microscope, which is magnified with a high-intensity light. A slit lamp test enables the doctor to evaluate the eyes for signs of normal aging and eye pathology, such as conjunctivitis, cataracts, macular degeneration or retinal detachment. Early diagnosis and treatment of eye diseases are essential for preventing vision loss.

Tonometry

Tonometry is a test to detect glaucoma by measuring the pressure inside your eye or IOP (intraocular pressure). Glaucoma can cause vision loss and even blindness if the IOP in the eye is too high and damages the optic nerve.

The applanation tonometer, typically attached to a slit lamp, is one of the most common instruments used to measure the pressure in the eye. Prior to doing this test the doctor will numb the patient’s eyes using an anesthetic, before gently applanating (putting pressure on) the patient’s cornea to measure the pressure in the eye.

Pupil Dilation

During your comprehensive eye exam, your doctor may decide to do a dilated eye exam. In this test, your doctor will instill dilating drops in each eye, which would enlarge your pupils to give the doctor a better view of certain parts of the back of the eye. Dilation is done at the discretion of the doctor, with some patients dilated every year and others at specified intervals; the frequency of dilation will vary for each patient.

Typically the drops take around 20 to 30 minutes to take effect and may last up to several hours following the exam; each patient is different. Since more light enters your eyes when your pupils are dilated, you will be more sensitive to bright light, especially sunlight. Although your doctor may provide disposable sunglasses, you may want to bring a pair of sunglasses to wear after the exam to make it more comfortable until the drops wear off.

A comprehensive eye exam is an important part of your overall general health maintenance and should be scheduled on a regular basis. The findings from your comprehensive eye exam can give your doctor important information about your overall health, particularly diabetes and high blood pressure.

Your Infant’s Visual Development

Your baby’s visual system is not fully developed at birth and continues to develop gradually over the first days and months of life. In fact, from your baby’s perspective at birth, the world is black and white, blurry and rather flat. As the days and months go on, they begin to focus, move their eyes and start to see the world around them. While each child will grow and develop on his or her own schedule, knowing an infant’s vision milestones will help you ensure that your infant is on track to achieving good vision and eye health and start treatment early if there is a problem.

Birth – 3 months

Because newborn babies’ eyes and visual system are underdeveloped, they can not focus their eyes on close objects or perceive depth or color. Babies need to learn to move, focus and coordinate eye movements to team the eyes (have them move together as a team). The brain also needs to learn how to process the visual information from the eyes to understand and interact with the world. In fact, until about 3 months, the optimal distance a baby can focus on is about 8 – 10 inches from their face, about the distance their parents face will be during feeding.

Your baby will start to be able to perceive color within the first 2-3 weeks, however it will take a few months to learn how to focus and use the eyes, to track objects, differentiate between two objects and shift from one object to the other. During this time you may notice that the eyes appear crossed and do not work together or team. This is quite common at the early stages of development, however if one eye appears to be constantly turned in or out, seek a doctor’s evaluation.

At around three months, as hand-eye coordination begins to develop, a baby should be able to follow a moving target with their eyes and reach for objects.

4-6 Months

By 6 months, your baby will begin to move his eyes with more speed and accuracy, seeing at farther distances and focusing well. Color vision should be fully developed and the eyes should be able to work as a team and follow moving objects with relative ease. Hand-eye coordination and depth perception should be greatly improved as your baby will begin to understand the 3-dimensional world around them.

At six months, you should take your baby for his or her first comprehensive eye exam to ensure that the eyes are developing on track and there are no signs of congenital or infant eye disease.

7-12 Months

At this stage of development babies will be coordinating vision and body movements by crawling, grasping, standing and exploring the surrounding world. They should be able judge distances accurately, throw a ball toward a target and pick up a small object with their fingers. Delays in motor development can sometimes indicate a vision problem.

The First Eye Exam

While at 6 months, your baby will not be able to read an eye chart, eye doctors can perform an infant eye exam through non-verbal testing to assess visual acuity (for nearsightedness, farsightedness or astigmatism), eye teaming abilities and eye alignment. The eye doctor will also be able to see inside the eye for any signs of disease or problems that could affect eye or vision health.

InfantSEE®

InfantSEE® is a public health program in which participating optometrists provide a free comprehensive infant eye exam to babies between 6 and 12 months of age. The program was initiated to provide accessible eye and vision care for infants to ensure they have the best chances for normal development and quality of life.

If your child has any unusual symptoms such as excessive tearing, constant eye misalignment, red or crusty eyes or extreme light sensitivity consult an eye doctor as soon as possible.

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