Most LASIK patients are satisfied with their results, but as with any surgery, complications can and do occur. There’s growing concern that many surgeons overpromise and don’t fully inform patients about possible risks.

LASIK Isn’t Perfect

The biggest risk from LASIK is that it weakens the eye and makes it more vulnerable to injury from impacts, especially during the first year after surgery. Complications from infections or irregular healing can also occur. Fortunately, these worst-case scenarios are very rare.

Far more common adverse events from LASIK include dry eyes, double vision, and trouble driving at night.

In July 2022, the FDA issued a draft of new recommendations of info LASIK surgery centers should provide their patients before they undergo surgery. The FDA noted that its “recommendations are being made based on concerns that some patients are not receiving and/or understanding information regarding the benefits and risks of LASIK devices.”

In its draft of disclosure recommendations, the FDA estimated that up to one week following surgery, about 85 percent of patients experience dry eyes. Six months after surgery, about 41 percent report “visual symptoms such as glare, halos, starbursts, and double images,” with around four percent having “very” or “extremely” bothersome symptoms, and around “two percent report having ‘a lot of difficulty’ or ‘so much difficulty that I can no longer do some of my usual activities’ when not wearing glasses or contact lenses.”

Unfortunately, many clinical studies of complications from LASIK tend not to look for problems beyond the first six to 12 months after surgery. Although most problems reported by patients are usually greatly reduced within a few months after surgery, sometimes they’re permanent. In rare cases, LASIK complications impact patients’ abilities to perform daily tasks.

One study of patients five years after LASIK by Steven Schallhorn, M.D., and six other researchers found that 48 percent still suffered dry eyes, 21 percent endured painful or sore eyes, 31 percent had gritty eyes, and 40 percent remained sensitive to light. Most experienced these problems only occasionally, but for two to eight percent they occurred half, most of, or all the time.

On top of that, six to 19 percent had noticed glare, halos, double images, or ghost images in the previous four weeks. Most of these patients said these issues were only a little bothersome or not at all, while one to three percent said they were somewhat to extremely bothersome.

Some surgeons provide clear disclosures about possible complications; the FDA is recommending more standardized language, as it is concerned that “patients may not be receiving information in a format that allows them to make a well-informed decision about whether to have LASIK.”

Part of the reason for the FDA’s push is that the laser-eye surgery industry also tends to overstate the success rate.

The website of the Refractive Surgery Council (RSC), a trade group representing device manufacturers and surgeons, states that “the LASIK success rate—or LASIK outcomes—is well understood with literally thousands of clinical studies looking at visual acuity and patient satisfaction. The latest research reports that 99 percent of patients achieve better than 20/40 vision and more than 90 percent achieve 20/20 or better. In addition, LASIK has an unprecedented 96 percent patient satisfaction rate—the highest of any elective procedure.”

The RSC and many surgeons often rely on research such as a 2009 study by Kerry Solomon, M.D., and nine other researchers, which found that 95 percent of patients are satisfied. That study, sponsored in part by the American Society of Cataract and Refractive Surgery (ASCRS) Foundation, looked at 19 survey-based studies of laser eye surgery patients from around the world. Its authors counted patients as satisfied if they indicated they were everything from “somewhat satisfied” to “very satisfied.” Solomon and two of the other researchers were also consultants to the manufacturers of surgical lasers and others in the optical industry.

More granular research, such as a 2016 study of satisfaction by Malvina Eydelman, M.D., and several other researchers, looked at patient satisfaction with vision after LASIK among patients in the federal government FDA PROWL (Patient-Reported Outcomes with LASIK) studies, based on the varying levels of achieved results. Patients’ satisfaction with their post-LASIK vision was assessed in different ways, and those whose vision after LASIK was 20/40 or better, or who didn’t need glasses, had high satisfaction scores of 88 to 93, on a 0-to-100 scale. By contrast, the five percent of patients who still needed corrective lenses after LASIK had statistically significantly lower scores of 73 to 81. And the less than 1.7 percent of patients who achieved vision of worse than 20/40 had statistically significantly lower satisfaction scores of 57 to 60.

Meanwhile, the Schallhorn study found 91 percent overall satisfaction five years after LASIK. But only 64 percent were “very satisfied,” while 27 percent were more tepidly “satisfied.”

In addition to discussing possible complications and realistic patient satisfaction data, surgeons should also assess whether patients are good candidates for LASIK and discuss possible alternatives, such as PRK (photorefractive keratectomy), which may be better for some patients.

You Likely Will Still Need Glasses

A major reason patients have gripes with LASIK is they thought it would provide them with perfect vision forever. Ads from LASIK surgery outfits often promise “a permanent solution for vision correction.” “Make corrective eyewear a thing of the past.” “You might never need to drop another dollar on eye care at all.” The procedure is “painless.” “More than 99 percent of LASIK patients achieve 20/20 vision or better.” And “over 98 percent of patients are totally satisfied.”

These types of claims stretch the truth.

Although more than 90 percent of LASIK patients attain 20/20 vision or better immediately after surgery, in the long term, clinical trials have found that as few as 54 percent of those with farsightedness retain their perfect eyesight. For nearsightedness, our review of clinical trials data found that, in the long term, on average only about 69 percent of patients achieved 20/20 or better.

There’s more: After LASIK, your vision has a high chance of getting worse because of what doctors call “regression,” the tendency of an eye to return to its original poor vision after surgery. A 2015 South Korean study by Choun-Ki Joo, M.D., and four other researchers, found that 10 years after surgery the nearsightedness of 77 percent of patients treated with LASIK had regressed, on average, by about 1.1 to 1.3 diopters (diopter is the unit of measurement used to determine the power of the lens needed for an eyesight prescription). A -1 diopter regression over 10 years would leave you with 20/125 vision. That is considered “moderate vision loss” by the International Council of Ophthalmology.

In a large 2013 Vision Council survey of 5,056 consumers who had had LASIK less than a year to five or more years prior to the survey, 54 percent reported they had a sight-impairing vision problem. Almost 50 percent of them used some kind of prescription eyeglasses, contact lenses, sunglasses, or readers for near- or far-sightedness or presbyopia. The remaining four percent were “squinters,” industry lingo for folks who don’t use corrective lenses, even though they have vision problems.

Finally, some LASIK patients—six to 10 percent—may need corrective lenses after surgery due to having too much or not enough corneal tissue removed, so-called overcorrection or undercorrection. If not enough tissue was removed, a second LASIK surgery can “touch up” and remove more tissue to improve visual acuity without glasses. But if too much tissue was removed, since it can’t be added back, PRK retreatment, eyeglasses, or contacts may be necessary.

Even if LASIK provides you with 20/20 vision, it’s likely only a temporary fix, and you’ll eventually again need to wear corrective lenses.

Most of the underlying problems that LASIK is used to treat involve the inability of your eyes to focus sharply on objects far away (nearsightedness, or myopia) or up close (farsightedness, or hyperopia). Another one is astigmatism, which is visual distortion or blurriness caused when a football-shaped cornea contorts the images it casts onto a basketball-shaped retina.

All three of these problems result from structural imperfections in the eyeball, which cause light entering the window of the cornea and streaming through the lens to be imprecisely focused on the retina, preventing it from transmitting picture-perfect info to your brain.

LASIK can reshape your cornea to address one type of vision problem—corneal irregularities—but it cannot stop an unrelated and different obstacle: the normal progression of aging that will eventually overcome any gains you get from the surgery.

Your eyes change throughout your life. Nearsightedness tends to start in childhood or adolescence and worsens as kids, and their eyes, grow. Nearsightedness usually stops progressing—and vision stabilizes—by your early 20s.

As you age, new vision problems occur. Your eyes’ lenses, which begin life clear, gradually become more yellow, then more brown. That color shift changes the way light gets bent and focused by the lens, changing your needed corrective prescription.

In your 40s yet another condition—presbyopia—gradually starts affecting almost everyone. Your lens, pliable in youth, hardens, and the muscles that hold the lens in place weaken. Those muscles pull a young, flexible lens taut, or they let the lens relax and contract, so you can almost instantly refocus from far to close-up and back again.

Consequently, the harder older lens and weaker muscles make it increasingly difficult for you to focus on things up close. Standard LASIK doesn’t treat this. “Monovision LASIK” can be a workaround: It corrects one eye to focus sharply at distance and one eye to focus sharply up close, but some patients can’t tolerate the change. Beyond that, the only solution to presbyopia is to wear corrective lenses.

Deterioration in your eyes never stops, whether you wear eyeglasses or get LASIK. But it’s far easier to change up glasses or contacts as your vision changes, or add reading glasses or bifocals, than it is to undergo additional LASIK surgeries—which might not even be an option if prior laser surgery has removed too much tissue from the cornea.