Is laser eye surgery safer than contact lens wear?
Clearly, this is a controversial statement, and there’s an element of bias depending on who you’re speaking to. I think if you look at the data and you compare the outcomes of modern laser eye surgery with different kinds of contact lens wearers, one can certainly construct an argument for the cumulative risk of contact lens wear outweighing the small risk in laser eye surgery.
The complexity comes in when you consider different patient groups. For example, I met a charming lady two weeks ago who is 58-years-old and beginning to struggle with her content lenses, a minus 4, short-sighted lady, with a crystal clear lens with no sign of cataract at all, but starting to get some dry eye symptoms. For that lady, continuing to wear the contact lenses results in an escalating risk of contact-related infection. For the dry eyes, it is not just an absence of moisture. The reason good tear film is required for safe contact lens wear is not only for the mechanical washing with the tears, but those tears contain antibacterial enzymes that contain antibodies that help clear up bacteria. If they’re not working properly, then that patient is at a potentially significant risk of corneal infection, which can be sight-threatening
I’ve sadly had to look after some incredibly severe infections resulting in a complete loss of vision for patients from contact lens wear. In that scenario, when we create the plan of blended vision, Presbyond LASIK laser eye surgery, I know that I can get through that surgery, and manage the dry eye intensively for a few months after as required. We can take that small, one-off risk for infection, which is less than 1 in 3000, and get her away from that cumulative ongoing risk of contact lens wear and a compromised tear film. That’s one example.
If we go back to, say, a 22-year-old male whose got a minus five prescription with fantastic tear film, in all honesty, wearing modern contact lenses, daily disposable ideally, because young men often don’t look after themselves so well, is incredibly safe. Such a patient is unlikely to get any kind of infection, and you don’t have to look at quite a long period of his life to get that cumulative risk of infection to match the small risks involved with laser eye surgery. Comparing the two does depend on which patient group you’re looking at. They’re both excellent, safe, life-enhancing technologies, but I take issue with the statement: “I’d never considered laser eye surgery, it’s so dangerous. I’m really happy sticking these bits of plastic in front of my eyes, day in and day out.’ They’re both really safe, and they both carry a small risk. That needs to be understood.
I don’t think that the risks associated with wearing contact lenses are talked about enough. I meet patients who only have one eye and who use a contact lens in it, taking a small risk with a very precious only eye, and I occasionally find that there hasn’t been quite enough discussion about the risk they’re taking with that only eye. As a surgeon, whenever I deal with a patient who only has one eye, we have a full and frank discussion about the fact that whatever we do is taking a small risk with something incredibly precious.
Clearly, all vision is precious; both eyes are precious to any patient. When you’re relying on only one eye and there is some problem afterwards, the impact on your life is going to be devastating. If I’m talking to somebody who says ‘I’m concerned about the risks of laser eye surgery, and all I ever do is wear spectacles,’ we can have a sensible discussion about it. I will absolutely emphasise that the risks of laser eye surgery are minuscule, but I think that is a reasonable point of view. If I’m talking to somebody who wears contact lenses and is worried about the risks of laser eye surgery, we need to talk about the risks of contact lenses because they’re both safe, but they both involve small risks.