Joel Hunter, MD Refractive Surgeon, Hunter Vision Updated 07/29/19 5:17 PM
The answer to this question depends on the level of technology involved in the LASIK procedure. Depending on the time in history you get LASIK, a poor outcome has very different meanings. That time in history also includes our current day situation, because there are still LASIK providers using technology that was the best available at one point—it’s just that the point in time we’re talking about was 2001. Luckily, it’s not super difficult to spot places where LASIK from a different time in history was performed. If it costs noticeably less than other places in town, there’s either a very good reason (an eccentric millionaire philanthropist is funding it) or a very unnerving one (old technology is cheaper).
What’s the deal with discount LASIK, e.g. LASIK 250?
There’s a reason that places with discount LASIK still exist, and if you think about it for a second, you’ll realize the reason can’t be that their patients are okay with bad vision. If a LASIK practice had 100% poor results, it wouldn’t matter if it cost $300 per eye or $3 per eye. They’d go out of business very soon after opening if every patient ended up with bad vision. Eventually a growing angry mob overcomes even the best advertising. This is true now more than ever; the internet helps isolated angry mob members find their co-mob members as well as their torches and pitchforks much quicker these days.
And that leads me to a secret about discount LASIK and old technology that I’d like to share with you. A lot of the patients get really great results when they get LASIK at places with equipment from a different time in history. And really, why shouldn’t they? In 2001, LASIK was really popular, and the best LASIK providers in the world were using technology from 2001. Sure, if they could have LASIK performed with the most advanced laser from 2017 in one eye and have the other treated with a laser from 2001, they’d almost certainly see better out of the “good eye.” But whether it is 2001 or just yesterday, if you were blind without glasses, and now you’re pretty close to 20/20, that’s going to be exciting.
Why then does the improvement in technology matter so much?
It matters because of the question asked in the title of this article "LASIK GONE WRONG". The incremental improvements in the quality of vision certainly have added up over the years: the improved night vision, higher contrast sensitivity, the ability to get supernormal level of vision better than 20/20. The biggest difference, however, matters much more than those other improvements. The difference between what it looks like when LASIK goes wrong is by far the biggest reason I would only let a friend or family member get LASIK with the best tech available today.
At a different time in history, LASIK complications were more common than they are today, but thankfully, they were still very rare. When LASIK went wrong in those days though, it was a bad scene. If there was a LASIK complication with the portion of the procedure that involved a blade, the best outcome possible was that the eye would heal back to being only as bad as it was before the procedure. When that didn’t happen, there was permanent damage to the vision in an eye that was otherwise fully healthy before an elective procedure. Sometimes that meant permanent poor vision out of that eye even with glasses. Sometimes it was terrible and permanent dry eyes instead. Again, it was really rare even then, but it was tragic.
LASIK complications today are categorically different from the past.
To be really open about it, I couldn’t have been a LASIK surgeon in those days. I don’t have the intestinal fortitude for those kinds of possibilities. The reason I’m a LASIK surgeon today and that I love my job is because the answer to the question in the title is categorically different today. The laser that replaced the blade changed the complications landscape in a categorical way. I don’t ever see complications of catastrophe in LASIK like the ones I just told you about. By that I mean, I’ve literally never had something like that happen to a patient. How? Well, now if something happens during the procedure (and it’s insanely rare that it does) we stop at that point and tell the patient that it would be better to wait a week before completing the procedure. In the meantime, they see the same as they did before in their glasses. Once the procedure is completed, all is well.
Sometime, if a patient looks extra nervous before LASIK, I’ll tell them, “If it helps at all, the worst thing that can happen in the procedure room is that we delay the procedure for another day.” Complications in LASIK today are issues of inconvenience rather than catastrophe. When LASIK goes wrong, it means we have a delay, or an enhancement in the future, or some extra drops to make dryness go away faster. Those issues are inconvenient, but they are pretty rare and usually end up being more of a bump in the road than a change in destination. The possibility of what LASIK can look like when it goes wrong makes the technology we have today far more valuable than the fact that it can look better than ever when it goes right.