Should I have laser surgery for nearsightedness?

Introduction

This information will help you understand your health care choices and what the results may be, whether you share in the decision-making process or rely on your doctor's recommendation.
Key points in making your decision
Your decision about whether to have laser surgery for nearsightedness will depend on your evaluation of the risks and benefits and on your personal preference. Consider the following when making your decision:
Laser surgery to correct nearsightedness is an elective procedure. There is no medical reason to have this surgery. Nearsightedness does not threaten your vision or your health. You must decide for yourself whether the benefits of surgery outweigh the risks.
Having surgery does not guarantee that you will never have to wear glasses or contact lenses again. Even if surgery fully corrects your nearsightedness, it does not change the normal aging process of the eye (presbyopia), which means that you may need reading glasses after age 40.
Laser surgery is considered a very safe procedure, but it is not risk-free. While most complications are not serious, they may be bothersome. Vision-threatening complications are rare.
The cost of laser surgery varies in different locations, but it can be a significant expense. It is rarely covered by insurance.
Other types of surgery for nearsightedness include radial keratotomy, corneal ring implants, and intraocular lens implants. Talk to your doctor to see if nonlaser surgery is a better option for you.
Medical Information

What is laser surgery for nearsightedness?
Laser surgery for nearsightedness attempts to correct nearsightedness by using a laser to change the shape of the cornea. The goal of surgery is to allow someone who is nearsighted to see clearly without corrective lenses or to be less dependent on corrective lenses.
It is important to keep in mind that the most commonly used surgical procedures to correct nearsightedness cause permanent changes in the eye. They cannot be reversed.
Am I eligible for surgery?
Before you have surgery, an ophthalmologist will examine you to determine whether you are a candidate for the surgery. You may not be eligible for surgery if:
Your vision has not been stable for at least a year.
You have a disease or abnormality of the cornea, such as keratoconus, keratitis, corneal edema, or thinning of the cornea.
You have irregular astigmatism.
You have moderate or severe dry eyes.
You have an uncontrolled autoimmune or connective tissue disease.
You are younger than 18.
You are pregnant or breast-feeding. Temporary changes in the way your eyes focus occur during pregnancy.
What types of laser surgery are available?
There are two main types of laser surgery for nearsightedness:
LASIK (Laser in-situ keratomileusis). Sometimes called “flap and zap,” LASIK makes a small flap in the cornea and removes tissue underneath the flap or in the area exposed by the flap. Most people feel mild irritation for a few hours after surgery. But most people can see well and can return to work the next day.
PRK (Photorefractive keratectomy) and LASEK (laser epithelial keratomileusis). PRK and LASEK use a laser to reshape the cornea. With PRK, the surface of the cornea is removed and then the cornea is reshaped. With LASEK, the cornea surface is loosened and pushed out of the way, and then the cornea is reshaped and the surface replaced. Both surgeries have a longer recovery time than LASIK, and there is usually some discomfort or mild pain during the first few days after surgery. PRK, LASEK, and LASIK have very similar long-term results.
What are the risks of surgery?
Most people who have laser surgery for nearsightedness are very happy with the results. Be sure to weigh the possible risks against the likely benefits.
Side effects and complications may vary slightly depending on which type of surgery you have. In general, side effects or complications of surgery may include:
Clouding of the cornea (haze).
Dry eye symptoms.
Night vision problems.
Glare or increased sensitivity to bright light.
Double vision.
New astigmatism.
Undercorrection or overcorrection.
Unstable vision (regression).
Reduction in best corrected vision, which is the best possible vision you can have using glasses or contact lenses.
Not being able to wear contact lenses as a result of changes in the shape of the cornea.
Serious complications that threaten vision, though rare, may include infection of the cornea (keratitis), ulcers on the cornea, puncture of the cornea or eyeball, elevated pressure inside the eye (intraocular pressure), or retinal detachment.
If you need more information, see the topic Nearsightedness.
Your Information

Your choices are to:
Rely on glasses or contact lenses for clear vision.
Have surgery to correct your nearsightedness. (Some people still need to wear glasses or contacts some of the time after surgery.)
The decision about whether to have laser surgery takes into account your personal feelings and the medical facts.
Making a decision about laser surgery
Reasons to have laser surgery Reasons to not have laser surgery
You want to see well without having to rely on glasses or contact lenses.
You are tired of the inconvenience and discomfort of glasses or contact lenses.
You don't like how you look in glasses.
You feel that your professional or athletic performance would be improved if you did not have glasses (but this may not be a good option if you participate in contact sports).
You want to meet requirements for a job (but some jobs, such as an aircraft pilot, do not allow certain corrective treatments).
You can afford the expense of the procedure.
Are there other reasons you might want to have laser surgery?
You do not want to have surgery.
You do not mind wearing or caring for glasses or contact lenses.
You cannot afford the expense of the procedure, which is usually not covered by insurance.
The possible risks of the surgery outweigh the benefits.
You will only be satisfied if surgery gives you perfect vision.
The long-term effects of surgery are not fully understood, because the procedure is relatively new.
You cannot have surgery because of a medical condition or severe dry eyes.
Are there other reasons you might not want to have laser surgery?
These personal stories may help you make your decision.
Wise Health Decision

Use this worksheet to help you make your decision. After completing it, you should have a better idea of how you feel about laser surgery. Discuss the worksheet with your doctor.
Circle the answer that best applies to you.
Glasses or contact lenses bother me or prevent me from doing things I'd like to do. Yes No Unsure
I am comfortable with the way I look in glasses. Yes No NA*
I am willing to accept the risks of eye surgery. Yes No Unsure
The slight chance of serious complications that threaten vision is enough to keep me from having surgery. Yes No Unsure
Reducing my dependence on corrective lenses would make a big difference in my life. Yes No Unsure
I will be satisfied only if surgery results in perfect vision. Yes No Unsure
I am willing and able to pay for surgery; I know that the procedure is expensive and rarely covered by insurance. Yes No Unsure
*NA = Not applicable
Use the following space to list any other important concerns you have about this decision.

What is your overall impression?
Your answers in the above worksheet are meant to give you a general idea of where you stand on this decision. You may have one overriding reason to have or not have laser surgery.
Check the box below that represents your overall impression about your decision.
Leaning toward having laser surgery

Leaning toward NOT having laser surgery

Return to the topic Nearsightedness.


Author:	Robin Parks, MS	Last Updated July 7, 2007
Medical Review:	Kathleen Romito, MD - Family Medicine Carol L. Karp, MD - Ophthalmology
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