I Don’t Want to Take any Risks!

Many times I hear patients say that they don’t want to take any risk. Risk is something that we can not avoid and must evaluate every day and with every action we take. Every time you get in your car, an airplane, or ride your bicycle you are taking some degree of risk. The question is what is your best “risk to benefit” ratio. Obviously, daily activities would be very limited if you decided that the risk of driving an automobile was too great for the benefit of traveling somewhere. But driving in extreme weather, or when you’re tired or your vehicle is not in good repair, all are examples of risks we can avoid.

Similarly, contact lenses have risks and benefits. Vision correction surgery has risks and benefits. In this blog post, we will discuss the risks and benefits of each option from wearing glasses and contact lenses  to LASIK, PRK, ICL, Refractive Lens Exchange (RLE) and Cataract surgery.

To put it in perspective, however, the risk of infection with LASIK is about one tenth of the risk of infection while wearing contact lenses.

Contact Lens Risks

Corneal infection: Because contact lenses are in direct contact (hence the name) with our eyes every day, there is a risk of infection. A contact lens is porous and has a surface to which bacteria can adhere. The bacteria are sitting on the surface of your eye, and if given a chance, they may penetrate the skin layer (also called corneal epithelium) end an infection can begin. The bacteria love the collagen which provides nutrition for the bacteria to prosper and divide. Corneal infections are much more common with contact lenses in your eyes because it is a foreign body and there is constantly a shower of bacteria in your tear film. Most bacteria come from the eyelid margin, specifically the meibomian glands. An infection of the meibomian glands is what causes a stye. Those same bacteria, while mostly harmless, potentially harbor some dangerous bacteria among them also. If you develop a contact lens related infectious corneal ulcer, it can result in a corneal scar or potentially even lose your eye.

Sleeping in Contacts: Bad Idea!

As in the paragraph above, sleeping in your contact lenses is like driving your car with a flat tire in a snowstorm. Don’t do it! The risk is simply not worth it. When we sleep, the acidity of our tear film increases which makes bacteria very happy. They grow better and can permeate the corneal epithelium (skin layer) and set up shop.

If you do experience symptoms of an eye infection, such as redness, pain, blurry vision, discharge, or can visibly see a spot on the surface of your eye, we recommend:

• Remove your contact lenses immediately and do not put them back in your eyes.
• Contact your eye doctor right way.
• Don’t throw away the contact lenses! Store them in your case and take them to your eye care professional. He or she may want to use them to perform a culture to determine the cause of your symptoms.
• Report serious eye problems associated with your lenses to the FDA’s MedWatch reporting program.

Giant Papillary Conjunctivitis (GPC): This is a condition that is not very well known outside of eye care professionals. GPC is basically an allergy to the contact lens material. We blink our eyes 8-10 times per minute, and wear our contacts up to 16 hours per day. That adds up to over 3-5 million blinks per year! The surface of our contacts is a plastic. That plastic can become covered in proteins from our tear film, mucous and cells, that can cause an allergic inflammation on the underside of our eyelids. The severity of symptoms of GPC is variable. Sometimes people can wear contacts for the majority of the day, but their eyes are irritated and red. They complain of “dryness” or “dry eyes” when the reality is their eyes are inflamed. Sometimes people can no longer wear their contacts. Their eyes get red and irritated within an hour or less, and they simply can’t wear them any longer. That happened to yours truly when I was in my mid 20s. Thank goodness LASIK became an option a couple years later.

Dry eyes: Dry eye symptoms affect nearly 90% of all people at some point in their lives. Risk factors for dryness include:

• Age: The overall risk of dry eye symptoms increases dramatically at about age 50.
• Sex: Women have the majority of dry eye disease by a factor of about 5 to 1.
• Menopause: Hormonal changes after menopause result in a large increase in dry eye symptoms.
• Certain medications: Many medications have side effects of drying out our secretory glands.
• Acutane is an acne medication that is known for drying up the meibomian glands.
• Contact lenses: Chronic contact lens wear results in damage to our meibomian glands, the glands that secrete oil on the surface of our eyes.

Financial Risk

If we told you we could make your life better and easier and for less money, would you consider it? That is the reality of LASIK. Another risk that you must calculate is to your bank account. LASIK is extremely cost-effective. Like infection, contacts keep costing you. LASIK is once. At SharpeVision, we even offer a “LASIK4Life” benefit whereby if you ever need an enhancement, we will perform it at no additional cost.

LASIK Surgery Risks and Benefits

LASIK risks should be weighed against its benefits, just as any healthcare choice should be carefully evaluated. There is indeed a very small risk of infection when you elect to have LASIK. To put it in perspective, however, the risk of infection with LASIK is about one tenth of the risk of infection while wearing contact lenses. https://pubmed.ncbi.nlm.nih.gov/28317680/

LASIK has other risks, which should all be assessed in a discussion with us at your free comprehensive LASIK exam at SharpeVision. Dry eyes is commonly experienced, but is temporary; usually between 1-3 months. A small percentage of patients need a touch up, also called an enhancement. The creation of the LASIK flap has some risk as well as a tiny risk (about one in 2000) of the flap moving from trauma to your eye. This has most commonly been from toddlers poking mom or dad in the eye in the first couple months after their LASIK procedure. Other activities such as SCUBA, weightlifting, soccer, running, bicycling, can all be safely enjoyed the day after LASIK. The risk to benefit ratio in my experienced opinion is an easy choice in favor of doing LASIK. The lifestyle benefits of never again needing to put in contacts when you’re traveling or camping; you don’t have to take them out when you’re tired or away from home. I’m biased, but I have enjoyed my adult life without glasses or contacts for the past 25 years since I had LASIK. I’ve performed LASIK on my daughter, EVO ICL on my son, PRK on my mom and my wife.

PRK Risks and Benefits

PRK surgery is commonly performed at SharpeVision. It’s approximately 5% of our laser vision correction procedures. Sometimes we recommend it to our patients for various reasons such as if their cornea is too thin to safely do LASIK. Sometimes PRK may actually be used to remove a scar from a contact lens infection. Sometimes our patients choose PRK after doing their research and they want to avoid the LASIK flap risk, albeit it is a small one. We often perform PRK on patients who have hobbies or vocations such as MMA fighting or are in certain branches of the military such as Navy SEALs or Army Rangers. I believe PRK may have a slightly greater theoretical risk of infection as compared to LASIK because we remove the skin layer of the surface of the eye that then takes 3 to 5 days to heal over and reduce the risk of infection. That is in contradistinction to the risk of infection with LASIK where there is only a very brief (four or five hour) exposure of the underlying tissue of the eyes before healing begins. PRK has zero risk of a flap complication because there is no flap. This is a feature that some people like and even request PRK to avoid this risk. PRK is sometimes performed for anatomical reasons including an orbit (the bones around the eyes) that is too small to allow a LASIK flap to be created.

RLE Risks and Benefits

RLE, which stands for refractive lens exchange, is an excellent procedure for our patients as they arrive at the presbyopia milestone of vision. This is generally age 46 and older where the lens of our eye becomes dysfunctional. First, it loses its flexibility to the point where we can no longer have both clear distance and near vision without some sort of sacrifice. Presbyopia solutions include:

• Monovision: One eye corrected for distance, one eye for near.
• Reading Glasses: A pain!
• Multifocal Contacts: Most people don’t seem to like these, although I have a selection bias, in that I likely see the patients after they’ve given up on multifocal contacts
• RLE: This solves all the issues at once: Nearsightedness/Farsightedness, Astigmatism, Presbyopia (obviates the need for readers) and no cataract will ever develop!

A common presbyopia solution we perform is called “monovision“- when one eye is focused at distance, and one eye is focused at near using LASIK or PRK. Most people find this works pretty well, but it is admittedly not perfect. Most people find that they adapt to this vision without thinking about it. The adaptation can take anywhere from one day to one year. Another presbyopia solution is to wear reading glasses. Kind of a pain! Especially considering how many times a day you look at your phone. That leaves us with: RLE. RLE is a great solution for presbyopia. It’s basically cataract surgery before your lens further degrades into cloudiness. There is no perfect fix for presbyopia, but RLE is often the best! (Vuity is a new patent on a very, very old (1870!) medication called Pilocarpine that conches your Iris muscles to help focus up close. I have not seen enough evidence of benefit to currently promote this option.)

The lens of our eye further degrades in our 60s, 70s and beyond, until we cannot see to drive at night, or distinguish colors as we once did. Many people don’t even realize how bad it’s getting. As our eyes develop cataracts, the lens gets very slowly cloudy. This generally presents as decreased night vision. People complain of glare while driving at night especially with oncoming headlights. The loss of transparency continues to the point where glasses cannot correct the vision adequately. When this develops, the only solution is to remove the lens and replace it with an artificial lens.

At SharpeVision, we often recommend Refractive Lens Exchange at the earlier stages of lens dysfunction, so we don’t have to feel like we’re getting old. Losing vision does NOT have to be a normal part of aging in our modern society. My thinking is that if you’re 50-something, you could wait another 20 years until you get a cataract that is cloudy enough for surgery, but you will have suffered for many years with symptoms of cataracts before the insurance pays its small portion of the surgery. For instance, if you are 57 years old, wearing glasses, and want vision correction surgery, why not have Refractive Lens Exchange which fixes nearsightedness, astigmatism, and reading glasses! In addition, you will not need cataract surgery when you are much older because you have already had your lens replaced! The artificial lens (IOL) never needs to be replaced. It does not wear out and can last in your eyes for the rest of your life. It is painless, takes about 5 to 10 minutes, and results in immediate better vision.

Risks of RLE surgery are also very small, but not zero. The risk of infection for Refractive Lens Exchange is somewhere in the 1 in 10,000 range. There can also be risks depending on the anatomy of your eyes, your general health, and the type of lens that you need to allow you to see clearly. We will discuss your specific risks with you at your comprehensive exam. There are over 4 million cataract surgeries per year performed in the United States. RLE is simply replacing your lens when you want to, rather than when the insurance company wants you to. This allows you to enjoy clear, uncorrected vision when you are in excellent health and can enjoy your vision for many more years.

Why are you waiting? Schedule your free comprehensive exam at sharpe-vision.com or call us at 425-451-2020. Can’t wait for you to experience any of these profoundly life changing procedures!