Contact Lenses vs LASIK Eye Surgery - Which one is safer?

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In today's post, I would like to answer a question I often get from my patients. Is it safer to wear contact lenses or have LASIK surgery to correct vision?

A lot of people who wear contact lenses have considered getting LASIK surgery to correct their vision. If you wear contact lenses, you are probably one of them. But we often assume that having eye surgery is riskier than wearing contact lenses every day. Is this true or is this a myth? I will answer this question in today's article.

Contact Lenses vs LASIK Eye Surgery

There are a lot of people who wear contact lenses on a daily basis for vision correction. The CDC has estimated about 45 million people in the U.S wear contact lenses. Although a lot of people wear contact lenses on a daily basis, many of them are unaware that wearing contact lenses is associated with risks of vision loss from certain complications. One of the common risks associated with contact lens wearing is infectious keratitis or a corneal ulcer.

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A cornea ulcer is an infection of the cornea, the clear windshield of the eye. According to the CDC and previously published studies, eye infection can affect up to
1/500 wearers per year. Do you recall the first time when your eye doctor gave you your contact lens prescription?

They also went over with you how to probably clean and wear contact lenses? I hope that you remember those instructions and have been following those instructions while you are wearing contact lenses. Because not following those instructions increase the risk of getting an eye infection from wearing contact lenses.

A study published in 2017 reported 99% of contact lenses wearers responding to the study reported at least one behaviour that was associated with an increase of eye infection. Some examples of poor contact lenses hygiene behaviours are improper cleaning of the contact lenses. wearing the same pair of contact lenses beyond the recommended disposal time, topping off contact lens cleaning solution, etc.

And the biggest risk factor associated with getting an eye infection is wearing contact lenses overnight. Wearing contact lenses overnight can increase the risk of getting an eye infection by 3 to 5 times regardless of the type of contact lenses worn according to previously published studies. Studies have shown that bacteria tend to form a layer of filbiom on the backside of the contact lens, and the backside of the contact lens is in direct contact with the epithelial layer of the cornea. Which is the outermost part of the cornea. Therefore the longer the contact lens stays on the surface of the eye, the bacteria have more opportunity to cause infection.

Also, contact lenses can interfere with the tear fluid exchange that happens naturally on the surface of the cornea. The normal tear fluid not only washes away bacteria and other pathogens but also contains several antimicrobial peptides. Therefore the extended wear of contact lenses and overnight wearing of contact lenses both provide more time for the pathogens to cause infection on the eye and also lowers the natural ability of the cornea to fight against infection. 

Typically the incidence of eye infection associated with contact lens wearing is reported as an annual incidence. And the longer you wear contact lenses, the cumulative risk of getting eye infections also increases. Studies have estimated for someone who wears contact lenses daily for 30 years, the lifetime risk of eye infection becomes one in 100. About 5% of eye infections related to contact lens wearing can result in vision loss to 20/70 or worse.

To put that in context, in California the DMV vision screening requirement for driver's license required one eye's vision to be better than 20/40, while the other eye's vision is better than 20/70. 20/70 vision means that when reading an eye chart or Snellen chart or a letter that a normal person can read from 70 feet away. A person with 20/70 vision can only read the letter from 20 feet away. so 20/70 vision is less than a 1/3 as sharp as 20/20 vision.

The higher the denominator of recorded vision, the worse the vision is. Extended wear contact lenses are available for overnight or continuous wear up to 3o days. Are recognized by the FDA as a Class III medical device. Class III medical devices typically have increased risks of illness or injury. some examples of class III medical devices include implantable pacemakers, breast implants, and extended wear contact lenses.

As a cornea specialist, I have treated many corneal infections related to contact lenses. Typically, the sooner the infection is diagnosed and treatment is initiated, the less long-term vision loss occurs. Unfortunately, I have seen many cases where people continue to wear contact lenses and do not seek care from an eye specialist despite having eye irritation or vision symptoms until the infection is very serious. I have performed many corneal transplant surgeries in cases where the infection is too severe to be controlled with antibiotics.

And I also perform many corneal transplants for severe corneal scars left behind by infection. So if you only remember one thing from this post, it is this:
Do not sleep in your contact lenses or wear contact lenses overnight. There are other complications related to contact lens wearing that is less common than an eye infection such as corneal inflammation, cornea swelling, or abnormal blood vessel growth in the cornea due to damage to the corneal stem cells. That's why it is important to have regular eye exams with your eye doctor to monitor your eye health if you wear contact lenses regularly.

That being said, one of the alternatives to contact lenses for vision correctness is laser vision correction surgery. LASIK surgery is the most commonly performed laser vision correction surgery worldwide. About 10 million people in the US have already received LASIK surgery since its FDA approval in 1999. and it is estimated around 1 million new laser vision correction procedures are performed each year in the U.S.

One study reported that out of 32,068 laser vision correction surgeries performed in the US military between the years 2000 and 2003. Those soldiers who had 20/20 or better vision without glasses or contact lenses were 85.6% with 92.4% having vision better than 20/25 and 98.2% better than 20/40.

And two large studies called PROWL1 and 2 which stand for patient-reported outcomes with LASIK 1 and 2, were carried out by the FDA in collaboration with the national eye institute reported less than 1% of patients who receive LASIK surgery experience difficulty performing their usual activities following LASIK surgery and more than 95% of people were satisfied with their vision after Lasik surgery.

This is not to say LASIK and other laser vision correction surgeries do not have any risks. The study that I mentioned reported an incidence of decreased vision of 1 in 1250 soldiers after laser vision correction surgery. In my experience, the vast majority of such cases experience the decreased vision of one line on the vision chart. For example, 2o/20 to 20/25.

Another large study reported an infection rate of 1 in 800 cases with moderate vision loss resulting from infection in one in 3200 cases. Most infections after LASIK surgery occur from few days to a week or more after the surgery. During this post-operative period, patients are monitored closely by their eye doctors. So it is likely that any sign of infection will be diagnosed and treated right away.

In addition to the risk of eye infection, Lasik surgery can cause corneal ectasia, nighttime glare, dry eye disease and there can be complications with the flap. Although it is difficult to have a direct study comparing individuals who have had LASIK surgery with individuals who wear contact lenses daily for decades, the published data from large and peer-reviewed studies strongly suggest that cumulative risk of eye infection and vision loss with decades of daily contact lens wearing is much higher than the risk associated with having LASIK surgery.

Of course, if someone only wears contact lenses for six months or a year, the risk of getting an eye infection from wearing contact lenses is low, probably lower than getting LASIK surgery. But most people who wear contact lenses wear them for years and decades. In addition to LASIK surgery, there are other vision correction surgeries that might be right for you such as ICL surgery. To learn more about ICL surgery you can check out my post on ICL surgery versus LASIK surgery (point).

To find out which vision correction method is best for you, whether it is LASIK surgery, contact lenses, or glasses. It is important to consult with your eye doctor or eye surgeon. As I mentioned earlier, If you do wear contact lenses regularly, it is important to follow the proper care instructions given by the eye doctor and get regular eye exams to monitor the health of your eyes. 

If you have a dry eye disease and wear contact lenses, or have had LASIK surgery. I have also suggested some of the eye drops that I recommend for dry eyes. 

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