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Can I go blind from LASIK?

By Joel Hunter, MD | 5/8/17 7:42 AM
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At the end of each LASIK consult, I’ll usually ask my patient if there are any specific questions I can help answer. And it surprises me how common the question about blindness is their one and only. Maybe it shouldn't surprise me since I’ve been asked it hundreds of times at this point. I never open my top dresser drawer where I keep my socks and go, “Hello! What's this?! There’s socks in this drawer!” For one, I could only wish to be that whimsical in the humdrum of daily life. But more to the point, I shouldn’t be surprised if the expected happens.

Yet the blindness question catches me off guard every time. And I think it does because it is a collision of two worlds. There’s the normal world where the fear of someone going near your eyes is a necessary survival instinct. Then there’s this tiny world—an island to its own—of laser refractive surgery where we go near people’s eyes every day, and as a result those people get better vision than they ever had.

It’s smart to protect your eyes

I do realize the thought of letting something near your eye remains unnatural and frightful for nearly everyone, and I’m thankful for that. It’s a good stance to have on the issue for the overwhelming majority of life. Not only should that caution be expected, it should be encouraged. When it’s not, articles show up about people getting tattoos on their eye or doing exactly-as-horrific-as-it-sounds vodka eyeballing.

As a matter of fact, since nearly every case of something permanent happening to an eye means it’s something permanently worse, the idea that LASIK is permanent often causes more reluctance than relief. The small, insular world of LASIK puts up a sign that cheers, “This can change your life!” And for many people, that’s exactly what worries them. It makes them ask one question when they get the chance, “Can I go blind from LASIK?”

The difference really is in the details

So why does the question “Can I go blind from LASIK?” catch me off guard every time? It's because I live in refractive surgery world all day, every day. Since being around eyes is kind of the starting point, the focus of my attention shifts to the specific details. Ultimately, all of the details are lined up around one central goal, which is to make an eye see much better. Now granted, that does include not making it worse, but in the same way that deciding what sounds good for lunch includes not choking to death on it.

The specifics of the diagnostics and the lasers involved in LASIK are all dialed in at levels of precision measured in thousandths of a millimeter and thousandths of a second. There’s tense concern about ensuring that this eye sees 20/15 instead of 20/20, or that reading vision works easily instead of with effort. When someone needs to have a second procedure to fix their vision, it’s almost always because our definition of failure isn’t about if a patient still needs glasses, because we almost never see that. It’s because, now glasses-free, we know we could get someone’s vision a little sharper.

Probable vs. plausible vs. possible

As you might imagine, when I spend all day obsessing over microscopic details that make microscopic differences, the blindness question still comes as a surprise. If I had to compare it to another more common situation, I’d say it might be like planning out the details of a road trip. If you organized an itinerary that maximizes every day away, you make sure to have time for each activity with minimal driving because you planned each day with locations in mind.

If you showed your plans to your travel companion and they said, “Will our plane crash into a mountain on the way there?” You might have the same initial surprise that I have when I get asked if LASIK will make someone blind. Could it? Well, I have to change gears to mentally scroll through from probable, to plausible, to possible. Yes. It is possible. One key deficiency in this analogy would be that the plane thing has happened way more times than someone has gone blind from LASIK. I’ve never seen or met someone who’s gone blind from LASIK, and LASIK is the world I live in every day.

The simple answer may not be the best answer

So whether it’s writing this out, or answering it for a patient who just wants to know they can lay their worries to rest, my goal isn’t to avoid an answer. The answer is yes. You could go blind from LASIK. However, it’s important to avoid the simple answer, because the reality is so much less simple.

In anything we do, including sitting still on a couch or driving to the store, there is an inherent risk that anything possible could happen. In LASIK, as in the rest of life, we’re better served by asking “what choice is the most likely to end up making things better?” If you want to buy milk, the choice to drive to the store is nearly 100% likely to fix your problem and nearly 0% likely to end with driving into a lake, tornado, forest fire, or every other possible but very close to impossible outcome.

If you want your eyes to see well without needing glasses, the choice to get LASIK is nearly 100% likely to fix your problem and nearly 0% likely to end with the number one fear and also number one least likely outcome possible. The questions of what choices lead to making things better are usually easy to answer for the world you live in every day. In the case of LASIK, it’s an easy answer too. The hard part is getting through the unknown so that the right question can be asked.

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