Laser Eye Surgery Risks and Benefits Explained—Plus a Smart Option for Women Over 45

We all want perfect vision. And, to be honest, most of us after a certain age will happily settle for better vision. And that’s exactly what laser eye surgery promises. Although it’s highly effective—with 95 percent of patients reporting satisfaction with the procedure—LASIK, the best-known type of laser eye surgery, does come with a few risks. We asked a leading ophthalmologist to explain what this procedure entails and to weigh in on potential complications so that you can decide if the surgery is right for you.

What is laser eye surgery?

There are two main types of corneal refractive eye surgery: LASIK (laser-assisted in situ keratomileusis) and PRK (photorefractive keratectomy), explains ophthalmologist Christopher T. Hood, MD, Medical Director of the Cornea, Cataract and Refractive Surgery Clinic at the University of Michigan.

“LASIK is more commonly done,” he says. “This is where a flap is created in the cornea—the ‘windshield’ of the eye—that provides most of the focus.” He adds that this procedure alters the shape of the cornea to ideally achieve vision as clear as you’d get with glasses or contacts.

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It’s important to note that while LASIK and PRK can correct both nearsightedness and farsightedness, they can’t address age-related presbyopia—a condition we all experience in our mid- to late-40s.

“As we age, the lens becomes less flexible, so even people with perfect distance vision will eventually need reading glasses,” says Dr. Hood. “Lasers can’t restore the eye’s natural ability to zoom in.”

PRK laser eye surgery is less common

The other major type of corneal refractive surgery, PRK, is the precursor to LASIK. “It’s still performed on some people,” says Dr. Hood. “Like LASIK, it reshapes the cornea, but instead of being done under a flap, it’s done directly on the corneal surface.”

This can be very painful for about two to three days, he says, adding that full recovery takes weeks or even months. That’s why about 95 percent of patients who are eligible for both procedures opt for LASIK eye surgery, which has a much shorter recovery time of only one to two days.

So, why might someone choose PRK? “[It’s] typically better for patients with higher prescriptions, thinner corneas or any irregularity in the shape of their corneas,” explains Dr. Hood. And in rare cases, some people who are eligible for both procedures choose PRK because no flap is created in the eye, eliminating the small risk of flap-related complications.

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3 rare laser eye surgery risks

The biggest risk of LASIK eye surgery? “Not getting perfect vision,” says Dr. Hood, noting that most people will come close enough. Still, there are rare complications associated with vision correction surgery. Along with dry eye, he shares a few more potential side effects to talk to your doctor about:

Dry eye

“Middle-aged and older women have a higher risk of dry eye, partially due to hormonal changes. LASIK can exacerbate this condition, usually temporarily and in rarer cases, permanently,” Dr. Hood notes. That’s why your doctor will assess your baseline level of dry eye and discuss treatment options before moving forward with the LASK procedure.

Glare or halos

“The more you alter the shape of the cornea, the more risk there is of getting some glare and halos,” says Dr. Hood. That’s why the higher your prescription, the more likely you are to experience this side effect.

Fortunately, glare or halos tend to improve over the first few weeks and months after surgery. What’s more, Dr. Hood notes that today’s lasers are much better than they were 15 years ago, making this laser eye surgery risk even less common.

Corneal flap problems

“Rarely, the corneal tissue isn’t perfectly cut, and that can lead to an incomplete flap-cut or problems lifting the flap,” says Dr. Hood. This can cause cells to grow under the flap or even an infection, but he is quick to point out these are rare outcomes of this type of surgical procedure.

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Risk factors to consider before laser eye surgery

Like any medical procedure, you have to weigh the risks and benefits individually, urges Dr. Hood. Here, he shares a few potential factors that can increase your risk of complications:

• Autoimmune disorders: In rare cases, patients with autoimmune conditions like lupus, sarcoidosis and fibromyalgia, are at higher risk of neuropathic eye pain after surgery, he says. “This is caused when the corneal nerves signal that there is more pain than there actually is.”

• Certain medications: Some antidepressants can cause eyes to dry out, worsening this potential side effect of the surgery.

Alternatives to laser eye surgery

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Whether your corneas are too thin or your glasses prescription is too strong, if you’re not a candidate for LASIK, Dr. Hood shares two other effective procedures that can help correct vision problems:

• Implanted collamer lens (ICL): “This is almost like putting a permanent contact lens in the eye,” says Dr. Hood, explaining that it’s particularly effective for people with extreme nearsightedness.

• Clear lens exchange (CLE): “It’s essentially the same as cataract surgery, except you don’t have a cataract. We remove your natural clear lens and replace it with a ‘powered-up’ artificial one,” says Dr. Hood. The procedure is especially good for women over 50, because it can help correct presbyopia, or age-related farsightedness, that LASIK can’t fix.

Over 45? Ask about monovision

While laser eye surgery can’t correct the natural farsightedness that develops with age, monovision LASIK offers a clever workaround, says Dr. Hood. “We adjust one eye for distance and leave the other slightly nearsighted. It’s a compromise—you won’t have perfect distance or close-up vision, but together your eyes work to provide good overall vision.”

The bottom line on laser eye surgery risks

“This is a very individualized surgery,” says Dr. Hood. “Meeting with a medical provider you’re comfortable with, and who can actually spend time talking with you to assess your individual risk, is so important.”