considering laser eye surgery should be warned of risks

People considering laser eye surgery should be warned of risks, says NICE

Laser surgery for short and long sightedness and astigmatism is generally safe and effective, but surgeons should make people aware of the potential risks compared with those of wearing glasses or contact lenses, guidance published last week says.

The guidance, for the NHS in England, Wales, and Scotland, found that the three most common types of laser eye surgery used to treat refractive errors—laser in situ keratomileusis (LASIK), photorefractive keratotectomy (PRK), and laser epithelial keratomileusis (LASEK)—shared similarly high effectiveness in improving visual acuity.

A systematic review of published evidence, commissioned by the National Institute for Health and Clinical Excellence (NICE) to develop the guidance, found that 91% of eyes treated for myopia or astigmatism with LASIK achieved within 1.0 dioptre of the intended correction at 3-12 months, compared with a median of 89% with PRK for myopia and 92% with LASEK for myopia and astigmatism.

A few patients had problems with laser eye surgery, however, including deterioration in visual acuity, development of new visual disturbances, and corneal infection. A median of 0.5% (range 0-20.5%) of eyes treated with PRK, 0% (0-8.2%) of eyes treated with LASEK, and 0.6% (0-3%) of eyes treated with LASIK lost visual acuity (measured as the loss of the ability to read two lines on an eye test chart with best glasses corrected vision). This was more likely to occur in people with severe shortsightedness.

Ectasia, a condition that can result from corneal thinning and that can lead to loss of vision, was seen in a median of 0.2% (0-0.87%) of eyes treated with LASIK, but rates were not reported after PRK or LASEK. The guidance noted, however, that many affected people might have been selected inappropriately for LASIK treatment. The guidance recommended that these risks should be weighed against those of wearing glasses or contact lenses.

Bruce Campbell, the chairman of the advisory committee that developed the guidance, said, “We hope the guidance will help to reassure people thinking of having laser eye surgery either on the NHS or privately. It is still important that patients discuss fully with the surgeon the possible risks and benefits of having laser surgery in their particular case. They need to weigh the risks of the procedure carefully against the inconvenience and possible risks of wearing spectacles or contact lenses.”

Professor Campbell added, “We are not saying that laser eye surgery should be offered to patients routinely on the NHS, because most people’s eye problems can easily be corrected by wearing spectacles or contact lenses.”

The guidance recommended that clinicians should audit and review clinical outcomes of all patients who have laser eye surgery, ideally including data from longer term follow-up. It also advised that clinicians should have adequate training before performing these procedures. Unlike other NICE guidance, guidance on interventions looks at the safety of procedures and at how well they work but does not make recommendations to the NHS about whether or not they should fund them.