LASIK isn’t as safe as you think: Columbia doctor warns it can cause long-term vision loss

LASIK, one of the most popular vision-correction procedures, has long been marketed as a quick, safe way to achieve 20/20 vision. However, Dr. Cynthia MacKay, an ophthalmologist at Columbia University, has raised serious concerns about its long-term safety.

She describes LASIK as “taking a healthy eye and making it sick,” warning that it can permanently alter the cornea and leave patients with worse vision than before. Complications may appear decades later, including loss of distance vision, reduced contrast sensitivity, chronic dry eyes, and corneal bulging. Her critique emphasizes the need for full patient awareness and careful screening before undergoing the procedure.

What happens during LASIK surgery

LASIK (Laser-Assisted In Situ Keratomileusis) is a popular procedure designed to correct refractive errors such as nearsightedness, farsightedness, and astigmatism. During the surgery, an ophthalmologist uses an excimer laser to reshape the cornea, the clear front layer of the eye, in order to improve how light is focused on the retina. The procedure begins with creating a thin corneal flap, which is carefully lifted to allow the laser to reshape the underlying tissue.

Once the reshaping is complete, the flap is repositioned, naturally adhering without stitches.While many patients experience rapid improvement in vision and reduced dependence on glasses or contact lenses, Dr. MacKay warns that LASIK permanently alters the corneal structure. These structural changes can lead to long-term complications such as corneal thinning, ectasia (bulging of the cornea), dry eyes, and loss of contrast sensitivity.

Patients may also experience visual disturbances like glare, halos, or difficulties seeing at night.

Because of these potential risks, it is critical for anyone considering LASIK to have a thorough preoperative evaluation, understand the limitations of the procedure, and discuss possible short- and long-term complications with their ophthalmologist before undergoing surgery.

Several studies and reports outline the possible LASIK side effects:

Disagreement and scientific perspective

While Dr. MacKay emphasizes the long-term risks of LASIK, many ophthalmologists maintain that the procedure is generally safe for the majority of patients when thorough preoperative screening and proper surgical protocols are followed.

The success of LASIK often depends on factors such as corneal thickness, overall eye anatomy, pre-existing eye conditions, and the patient’s healing capacity. Some doctors argue that most complications are mild and temporary, like dry eyes or night vision issues, and that serious long-term effects are relatively rare. Experts agree, however, that patient education, informed consent, and realistic expectations are essential to minimize risks and ensure satisfaction.

Individual variability makes it clear that LASIK is not a one-size-fits-all solution, and ongoing monitoring post-surgery is recommended to catch potential issues early.

Ethical concerns and FDA scrutiny

LASIK marketing campaigns often promise outcomes like “20/20 vision or your money back,” which can give patients unrealistic expectations while downplaying potential risks. Dr. MacKay has criticized the FDA for not issuing stronger public warnings or requiring more transparent reporting of complications.

Ethical discussions in ophthalmology focus on ensuring patients are fully informed about both short- and long-term risks, including chronic dry eyes, visual disturbances, and structural changes to the cornea.

The underreporting of adverse effects and the aggressive promotion of LASIK raise questions about industry accountability. With millions of procedures performed worldwide, it’s increasingly important that prospective patients receive balanced information, including the potential for late-onset complications and the necessity of ongoing eye health monitoring.

Lessons for prospective patients

LASIK can dramatically improve vision for many people, offering freedom from glasses or contact lenses. However, it is not without risk, and patients must approach the procedure with a thorough understanding of possible outcomes. Comprehensive preoperative screening, including corneal thickness measurements and an evaluation of eye health, is crucial. Patients should also discuss long-term risks with their ophthalmologist, including chronic dry eyes, loss of contrast sensitivity, night vision issues, and the rare possibility of corneal bulging or scarring.

By understanding both the benefits and potential complications, individuals can make informed decisions, set realistic expectations, and plan for proper post-operative care to ensure their vision remains healthy over time.