Quality of Life After LASIK

LASIK advertisements depict only happy patients, free of their glasses, engaging in sports and recreation—enjoying life to the fullest! There is never mention of the “unhappy patient”.

The unhappy LASIK patient is often misunderstood because most people believe a bad outcome from LASIK can be corrected with another surgery, or that the patient can simply go back to wearing glasses. In fact, a bad outcome from LASIK can result in permanent visual disability which surgery and glasses cannot correct.

Data from FDA LASIK clinical trials demonstrate that approximately 20% of LASIK patients experience some degree of persistent post-LASIK dry eye and night vision difficulty. Most of these patients are considered a “success” by their surgeons and the LASIK industry, based solely on visual outcome in the daytime. However, many of these patients suffer visual impairment at night and chronic dry eye pain.

The impact of dry eye and night vision impairment on patients' quality of life is wide-ranging. Patients may be unable to tolerate wind, air conditioning, or ceiling fans. Patients may require frequent use of artificial tears, eye goggles to seal in moisture, and medication to cope with pain. Night vision problems after LASIK may lead to life-altering disabilities. For example, patients may no longer be able to drive at night, which may affect their ability to work and function. Enjoyment of life may also be severely diminished by poor night vision after LASIK.

In response to reports of LASIK-related suicides, LASIK industry representatives made statements in the media and at an FDA hearing denying any connection between a bad outcome from LASIK and risk of depression or suicide.

“There is simply no scientific basis to support a direct connection between a sub-optimal outcome from eye surgery and suicide.” (1)

“There is no scientific evidence of any direct link between LASIK and the development of depression or suicide.” (2)

“There's no cause and effect.” (3)

These statements lack credibility, as depression is one of the most common problems experienced by people with chronic pain. Furthermore, Cleveland Clinic's website states:

“Functional vision for the normally sighted person is so basic to everyday living that sudden, or even gradual, vision loss can have a devastating impact on quality of life.” (4)

It is no surprise, then, that medical literature yields multiple studies linking vision loss with diminished quality of life, depression, and risk of suicide.

  1. Lindstrom, Richard. (2008, March 12) Letter to the News & Observer: http://www.newsobserver.com/opinion/letters/story/996053.html
  2. Morse M.D., Jennifer (2008, April 25) FDA Special Hearing on Post-LASIK Quality of Life:
    http://www.fda.gov/ohrms/dockets/ac/08/transcripts/2008-4353t1-02.pdf
  3. Schallhorn, Steven C. (2008, February 3) Some link depression, failed LASIK:
    http://www.newsobserver.com/150/story/920341.html
  4. Low Vision Services: http://my.clevelandclinic.org/rehab/services/low_vision.aspx [2008, November 8]

Bibliography

  1. Appollonio I, Carabellese C, Frattola L, Trabucchi M. Effects of sensory aids on the quality of life and mortality of elderly people: a multivariate analysis. Age Ageing. 1996 Mar; 25(2):89-96.
  2. Bailey MD, Zadnik K. Outcomes of LASIK for myopia with FDA-approved lasers. Cornea 2007 Apr; 26(3):246-54.
  3. De Leo D, Hickey PA, Meneghel G, Cantor CH. Blindness, fear of sight loss, and suicide. Psychosomatics. 1999 Jul-Aug; 40(4):339-44.
  4. Hayman KJ, Kerse NM, La Grow SJ, Wouldes T, Robertson MC, Campbell AJ. Depression in older people: visual impairment and subjective ratings of health. Optom Vis Sci. 2007 Nov; 84(11):1024-30.
  5. Jacobs JM, Hammerman-Rozenberg R, Maaravi Y, Cohen A, Stessman J. The impact of visual impairment on health, function and mortality. Aging Clin Exp Res. 2005 Aug; 17(4):281-6.
  6. Kymes SM, Walline JJ, Zadnik K, Sterling J, Gordon MO. Collaborative Longitudinal Evaluation of Keratoconus Study Group. Changes in the quality-of-life of people with keratoconus. Am J Ophthalmol. 2008 Apr;145(4):611-617.
  7. Lam BL, Christ SL, Lee DJ, Zheng DD, Arheart KL. Reported visual impairment and risk of suicide: the 1986-1996 national health interview surveys. Arch Ophthalmol. 2008 Jul; 126(7):975-80.
  8. Wulsin LR, Jacobson AM, Rand LI. Psychosocial correlates of mild visual loss. Psychosom Med. 1991 Jan-Feb; 53(1):109-17.