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Can you see better after LASIK surgery, compared to glasses/contact lenses?

By Joel Hunter, MD | 7/18/18 7:00 AM
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The cynic in me (the shrunken, mute cousin of the optimist in me) sees the title of this blog and thinks, “I bet some people might click on this blog just to see if I’m dishonest. They want to see if I say, ‘LASIK makes you see better than glasses and contacts!’ Then they will be able to tell everyone that I’m a skeezy sales guy.”

Well, I’m definitely not going to say that LASIK makes you see better than glasses and contacts. The cynic in me comes out every now and then to help me stay deliberate and a little more guarded in how I word these things. In every other way, the cynic is the worst. Except in those rare moments of helpfulness, I try to make sure my cynicism is getting dominated all day by optimism. Just getting dunked on by whimsy 24/7.

The Goal of LASIK

What I can say, even with guarded words, is that LASIK can let you see better than glasses or contact lenses. That isn’t, however, the standard for success in LASIK. It’s not even the main goal. In general, our goal for LASIK is to get you to the point that you can see as well as we know your eyes can see.

There’s a medical term for “as well as we know your eyes can see” called the Best Corrected Visual Acuity (BCVA for short). The definition of your BCVA is what your eye can see with the best pair of glasses or contacts. A LASIK practice with 100% success rate would be one where every patient is happy and every patient has uncorrected (no glasses) vision that equals their pre-operative BCVA.

Surpassing the Goal of LASIK

So now that we know the goal of LASIK, we can talk about superseding that goal. This would be hitting a new PR, in a sense. Uncorrected visual acuity that is better than the BCVA before surgery happens. We know that from peer-reviewed journal articles, and personally, I know it because I’ve seen it happen over and over again.

It’s possible to get better vision with LASIK than you had with glasses or contacts. And while it’s not every time, there are pre-operative diagnostic tests that can indicate if that’s more likely for you. In most cases, it happens when your need for glasses arises from the shape of your cornea.

The main three focusing problems that necessitate glasses are near-sightedness (myopia), astigmatism, and far-sightedness (hyperopia). Any of these three can occur because of the shape of the cornea (e.g. if the cornea is too steep like the point of an egg, that causes myopia). Sometimes, a LASIK consultation is touched by the benevolent hand of serendipity and we see that most or even all of the prescription for glasses is from the shape of the cornea.

This is a wonderful piece of news to be able to celebrate at a LASIK consultation because LASIK fixes the prescription (as you may have heard) by reshaping the cornea! So in these cases, the actual cause of the poor vision is being corrected. The chances of being able to see better than with glasses or contacts is increased beyond the normal “sometimes” into the range of “many times.” That includes situations like driving at night, where a patient that had noticeable difficulty with contacts finds the night vision problems went away with LASIK.

Two Sides of the Coin?

One last note: there are cases where LASIK can make the vision worse than it was with glasses and contacts, just like there are cases where it can make it better. The fact that this is true, however, is not the same as saying there are two sides to the coin. To say that would imply a randomness to the results that is factually untrue. A more accurate analogy (and this is still only an analogy) would be that it is a two-headed coin where one side is “as good as contacts” and the other side is “better than contacts.” The coin, every once in a great while can land and stand on its edge, and those cases would be where someone’s vision is worse after LASIK.

This analogy only works in high-tech, high-touch LASIK clinics. There are modern pre-operative diagnostics to map every detail of your eye, and modern lasers with levels of precision unimaginable when LASIK became popular in the late ‘90s / early 2000s. The reason I always come back to transparency and technology is because they can make excellent results repeatable instead of random. You need the transparency to say whether LASIK is a two-headed coin in your case, and the technology to know it with the highest degree of accuracy possible.

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These articles are brought to you by Hunter Vision. We help people in Orlando discover life after glasses and contacts.
 
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