LASIK vs. Contact Lenses
leukoma
the time that extended wear contact lenses were hitting the market. I
remember being so busy trying to set up my practice at the time, that
I hardly noticed the lawsuits involving extended wear contact lenses
and eye infections. Remember, in those days they were promoted for
30-day wear. The reaction was swift, as many practitioners recoiled
from prescribing lenses for overnight wear, and the FDA reacted by
changing the labeling to a maximum of 7-day continuous wear.
There were lots of studies and publications - a war of statistics.
Then, finally some very large scale studies were done involving many
thousands of patients, and the true risks became known. The most
recent of those studies was by Chang, et. al. in the prestigious
journal, Lancet, published in 1999. The report cites the incidence of
bacterial keratitis - the most serious type of eye infection - as
about 2/10,000 wearers of daily wear soft lenses, per year, and about
10 times that rate for overnight wear, per year. In the case of
overnight wear, this distills down to 1/500 cases annually, and about
13% have loss of some vision, or 0.026% per year have a permanent
problem from sleeping in their lenses.
However, what really got my attention was the conclusion that contact
lenses are unsafe to sleep in. If there is a 3% rate of long-term
complications from LASIK, how many years of sleeping in contact lenses
does it take to achieve the same equivalent risk? Now, I'm not saying
that somebody should, or should not elect LASIK, but are contact
lenses really dangerous in comparison?
Comments?
Drg
Glenn Hagele - Council for Refractive Surgery Quality Assurance
refractive surgery did so because they believed that contacts were too
dangerous. I believe the primary reason to seek refractive surgery is
for a permanent relief from glasses or contacts.
One of the issues that I deal with each day is the assumption from the
public that LASIK is as easy and safe as a haircut. It is not. LASIK
is real surgery on your eyes. As is often pointed out here, there are
a gazillion things that can go wrong with LASIK - like there are a
gazillion things that can kill you, but it is the probability of
something actually going wrong that is what most people need to
consider.
In addition, here is the issue of what people are willing to exchange
for a reduced need for corrective lenses. As an example, many people
would gladly trade the unseen and unfelt punctal plugs that treat dry
eye for the ability to not need corrective lenses. Some would argue
that the need for punctal plugs means LASIK didn't work. Others point
out that having plugs put in once and checked about every year is
hardly a disability.
Of course, spectacles and contacts are an appropriate and acceptable
alternative to LASIK, but for some, LASIK is an appropriate and
acceptable alternative to contacts.
Glenn Hagele
Executive Director
Council for Refractive Surgery Quality Assurance
http://www.usaeyes.org
glenn dot hagele at usaeyes dot org
I am not a doctor.
leukoma
However, there is another point to be made here, and that involves the
estimation of risk. Trading in a set of high maintenance contact lenses
for low maintenance plugs is one thing. Trading high maintenance contact
lenses for high maintenance complications is another. But, I get your
point, in that that those risks are known, if not fully predictable for a
given patient. But, what if the risks are either being over-estimated - or
worse, underestimated?
My wish is that Chang, et. al, would publish another study similar to the
study on contact lenses, involving at least 100,000 patients who have had
LASIK or PRK.
DrG
Glenn Hagele - Council for Refractive Surgery Quality Assurance
>My wish is that Chang, et. al, would publish another study similar to the
>study on contact lenses, involving at least 100,000 patients who have had
>LASIK or PRK.
As much as a study of this type could provide clarification on
important issues, it is just as likely to confuse the issues even
more.
We have witnessed here on multiple occasions that the definition of
what constitutes a complication is sometimes elusive. It is our
organiztions contention that what remains after the normal six-month
healing period is a complication. What occurs and is resolved during
the recovery period is simply a part of the process of refractive
surgery.
Our organization determines the rate of unresolved complications at
six months postop. That number is (of course) lower than the rate of
the occurrence of complications. There is a big difference between
occurrance and unresolved.
By looking at many different studies and reports, CRSQA's outcomes
analysis is accurate to what we measure. At a point in time of
six-months after initial surgery, 3% of refractive surgery patients
have one or more unresolved complications with 0.5% having
catastrophic complications. If you did the same evaluation at one
year, you would have a different number. If you evaluated at two
months postop, you would realize a different number still.
A study of the occurrence of complications is significantly different
than our analysis of what remains after six months of treatment and
healing. Chang et al was a study of the occurrence of complications,
and included residual results such as loss of best spectacle corrected
vision acuity. The anti-refractive surgery/surgeon/industry zealots
like to use studies that show anything and everything that was less
than instant perfection in an attempt to discredit refractive surgery
as a class of surgery. This is misleading as the vast majority of
problems related with refractive surgery resolve with healing and
treatment. One could even argue that our 3% complication rate is
over-reporting complications because at one year postop the rate of
unresolved problems would be less.
Eric 10Dpt
Lasik wins. I think that contact lenses contribute to the success of Lasik.
Once people get used to not wear spectacles they want to keep that advantage.
Some optometrists told me that most people can't tolerate contact lenses
forever. It seems to create problems when you wear soft contacts every day and
all day long for many years. I have read several times that RGPs can be
tolerated for a longer time than soft lenses.
So I think that many people just wear contacts as long as possible. Then they
get RS or stick to glasses. I know so many young people who cannot wear contact
lenses full time. I don't know whether americans have better tears. It might be
a pollution problem. Since I am wearing RGPs I have found that I cannot wear
them for jobs involving dust. I know so many people who cannot handle contacts.
They work in dusty and dry ambients, they drink alcohol and smoke. There is no
contact lens for them. If there were perfect contact lenses it would be foolish
to have Lasik. If cleaning the lenses and taking them in and out was the only
problem I would never have looked into RS.
Rebecca
> I seriously doubt that anyone electing for LASIK or any other kind of
> refractive surgery did so because they believed that contacts were too
> dangerous. I believe the primary reason to seek refractive surgery is
> for a permanent relief from glasses or contacts.
I don't believe those are by any means mutually exclusive reasons for
surgery. Of course, refractive surgery is for "relief from glasses or
contacts" at least for some years but this is a very broad description
encompassing motivations ranging from purely cosmetic benefits to
contact lens intolerance to a belief in long-term cost savings to
succumbing to a sales pitch about the convenience benefits and many,
many more reasons.
While I would agree that the primary reason for one's electing LASIK
is unlikely to be a belief that contact lens wear is dangerous,
nevertheless the idea that if they wear contact lenses long enough
they will develop some kind of problem - infections, dry eye or
whatever - is quite commonly held amongst contact lens wearers and in
many cases certainly contributes to their decision.
Glenn Hagele - Council for Refractive Surgery Quality Assurance
wrote:
>Glenn Hagele - Council for Refractive Surgery Quality Assurance <glenn.hage...@usaeyes.org>
>> I seriously doubt that anyone electing for LASIK or any other kind of
>> refractive surgery did so because they believed that contacts were too
>> dangerous. I believe the primary reason to seek refractive surgery is
>> for a permanent relief from glasses or contacts.
>
>I don't believe those are by any means mutually exclusive reasons for
>surgery. Of course, refractive surgery is for "relief from glasses or
>contacts" at least for some years but this is a very broad description
>encompassing motivations ranging from purely cosmetic benefits to
>contact lens intolerance to a belief in long-term cost savings to
>succumbing to a sales pitch about the convenience benefits and many,
>many more reasons.
You are absolutely correct, Rebecca. On our website we very strongly
point out that reasonable expectations are not just limited to whether
or not you will need glasses anymore. We joke that if you think that
being rid of glasses will change your personality, your mother-in-law
will now like you, and you will finally write a great novel, you will
probably be disappointed with your results - even if the surgery is a
technical success. If you know what you really want, then you can
evaluate the probability of getting what you desire.
>While I would agree that the primary reason for one's electing LASIK
>is unlikely to be a belief that contact lens wear is dangerous,
>nevertheless the idea that if they wear contact lenses long enough
>they will develop some kind of problem - infections, dry eye or
>whatever - is quite commonly held amongst contact lens wearers and in
>many cases certainly contributes to their decision.
Some people try to "talk themselves" into LASIK, and that is probably
not wise. The reality of the small risk with contacts is not nearly
so persuasive as using that risk as an excuse to do what you want to
do for less "legitimate" reasons.
Many don't like to use the "C" word, but a part of any refractive
surgery decision is most certainly cosmetic.
Glenn Hagele
Executive Director
Council for Refractive Surgery Quality Assurance
Linda
I chose Lasik because I could not tolerate contact lenses anymore. I
had chronic GPC and couldn't do anything to rid myself of it. In the
end, I was wearing my contacts for about 6 hours a day and putting my
glasses on as soon as I got home from work. I did not want to wear
glasses all the time and my eyes hurt every time I put the lenses in.
Since Lasik, the redness and irritation have disappeared and I am very
happy with my decision. Dr Leukoma has very kindly responded to my
posts in the past and I get the impression from him that I could
probably have tried other contacts and meds for my GPC, in other
words, I could have been handled better. That is probably the case,
but regardless, I am happy with my decision. It's great when holidays
come around too because there is no need to lug around contact lens
case, solutions, glasses, etc....
Regards,
Linda
Bryce Carlson
LASIK after six months are estimated to be about 3%. Significant
complications from LASIK after one year that result in a loss of at
least one line of BCVA and/or GASH troubling enough to affect night
driving are estimated to be about 1%.
Overnight wear of contact lenses designed for this purpose results in
serious infections (bacterial keratitis) at a rate of about 0.2% per
year, of which about 15% result in permanent loss of BCVA or other
serious visual disturbances, for a net rate of about 0.03% per year.
Over a period of ~34 years of such wear, this works out to a risk of
serious eye injury from overnight wear of contact lenses of about 1%
(see >> <<, below) -- which is about the same risk as with LASIK.
So, lifetime, the risk of serious complications from overnight contact
lens wear is at least as great as it is for LASIK.
Bryce Carlson, PhD
>>
The sum of iterations 1 to 34:
0.03% + [(100.00 - 0.03) x 0.03%] + ... = 1.0149657%
<<
Dr. Leukoma
news:14e1a0fe.03071...@posting.google.com:
Great to see somebody actually do the math. Let's add another twist.
Since the study was published in 1999, the data were from patients sleeping
in conventional hydrogel lenses, prior to the introduction of the newer
silicone/hydrogel lenses. Perhaps this is like comparing LASIK performed
with an old ACS Corneal Shaper to modern LASIK, or ALK with LASIK.
But, at the end of the day, not everybody sleeps in their contact lenses,
in which case it would take 300+ years of wear to achieve the same level of
risk as LASIK. One can simply revert from continuous wear to daily wear.
Convenience, cosmesis, etc. seem to have taken center stage in the
conversation about vision care. Well, I say why not revisit bicycle
helmets, seatbelts, not standing under a tree during a lightning storm, and
a whole host of ways we go about protecting ourselves from other rare
events.
DrG
Dr. Leukoma
news:60a75051.03071...@posting.google.com:
Hey, Linda. Glad to see you back.
DrG
Linda
> dj...@optusnet.com.au (Linda) wrote in
> news:60a75051.03071...@posting.google.com:
>
> > rebecca...@lasermyeye.org (Rebecca) wrote in message
> > news:<120ffab4.03071...@posting.google.com>...
> >> Glenn Hagele - Council for Refractive Surgery Quality Assurance
> >> <glenn.hage...@usaeyes.org> wrote in message
> >> news:<ic38hvcos7tupb3s1...@4ax.com>...
> >> > I seriously doubt that anyone electing for LASIK or any other kind
> >> > of refractive surgery did so because they believed that contacts
> >
>
> DrG
Thank you. I never really went away, but things have changed and this
particular topic is always of interest to me. Some people have great
results with contacts, but I was one of the unlucky ones. Since I had
my Lasik, Opticrom has become available without a prescription in
Australia. I saw it on the shelf of my local Chemist shop and it
really brought back bad memories. GPC is a distant memory as far as I
am concerned.
Regards,
Linda
Bryce Carlson
decrease in significant long-term complications, and LASIK (LASEK/PRK)
technology also continues to improve with a corresponding decrease in
significant long-term complications. Both approaches to vision
correction are considered safe and effective by medical standards, but
both assuredly have their risks as well as their benefits. Overall,
the risks are of the same order of magnitude, and it all comes down to
personal preference and which technology is more appropriate for any
particular individual.
DrC
"Dr. Leukoma" <drgN...@leukoma.com> wrote in message news:<Xns93B9DFC5268...@204.127.204.17>...
Rebecca
> Many don't like to use the "C" word, but a part of any refractive
> surgery decision is most certainly cosmetic.
Actually I don't think this is right, based on my own experience or
that of a number of my acquaintance. Don't forget that glasses can be
considered a cosmetic plus or minus depending on the taste and
preferences of the individual. In my own case, I loved glasses,
expected to wear them after surgery and am disappointed that I now
cannot.
When I was first considering LASIK I used to discuss this aspect with
my boss. He too was (at the time) considering LASIK but intended to
get plano lenses for his glasses afterwards because he couldn't
conceive of giving up glasses. What attracted him was the idea of
being able to enjoy the beach or other activities more. I believe
there are many people, especially 40+ who are similarly attached to
their glasses, can't stand the thought of contact lenses, but find the
idea of freedom from dependence on glasses for certain activities
attractive.
Glenn Hagele - Council for Refractive Surgery Quality Assurance
Glenn Hagele
Executive Director
Council for Refractive Surgery Quality Assurance
Dr. Leukoma
lenses.
If the public believes that there is a choice between two treatments of
equivalent safety and efficacy, but one involves daily maintenance and
ongoing expense, while the other requires none, the choice is a no-brainer.
DrG
rebecca...@lasermyeye.org (Rebecca) wrote in
news:120ffab4.03071...@posting.google.com: