An analysis of the global peer-reviewed literature found that more than 95% of patients were satisfied with the outcome of their LASIK surgery.1 The retrospective literature review was done in preparation for the prospective study to be conducted by the FDA, the ASCRS, the AAO, and the National Eye Institute. Both the completed retrospective study and the future prospective study are a part of the Joint LASIK Study Task Force's mission to provide insight into the incidence of patients' dissatisfaction with modern LASIK, the causes of their dissatisfaction, and possible treatments.
The literature review included all articles published on LASIK in peer-reviewed journals from 1988 through 2008. At the outset, investigators identified 2,915 LASIK-related abstracts. Following multistage, systematic elimination, they selected 309 articles that represented peer-reviewed, well-designed, properly conducted, randomized clinical trials or case-controlled and cohort studies. Nineteen of these articles reported on patients' satisfaction. Published from 1996 through 2007, the articles represent surgeries performed from 1995 to 2003 on 2,198 patients. Follow-up lasted from 1 month to 5 years in these studies. Patients' ages reportedly ranged from 18 to 67 years. The spherical equivalent treated ranged from -22.75 to +7.00 D.
Overall, patients' rate of satisfaction after primary LASIK surgery was 95.4% (2,097 of 2,198 patients; range of satisfaction, 87.2% to 100%). The rate was 95.3% (1,811 of 1,901 patients) after myopic LASIK and 96.3% (286 of 297 patients) after hyperopic LASIK. The overall rate of dissatisfaction was 4.6% (101 of 2,198 patients; range of dissatisfaction, 0% to 12.8%).
"Although LASIK generates the highest level of patient satisfaction of any elective surgical procedure, there still remains 4% to 5% of patients who are dissatisfied with their outcomes," Richard L. Lindstrom, MD, said in an e-mail to Cataract & Refractive Surgery Today. "According to this extensive global review of the literature, the primary reasons for patient dissatisfaction following LASIK are residual refractive error, dry eye, and night vision symptoms." Dr. Lindstrom is a founder and attending surgeon at Minnesota Eye Consultants, PA, in Bloomington, Minnesota. He is also a co-chair of the Joint LASIK Study Task Force and a co-author of the literature review.
"In most cases, residual refractive error can be treated with a laser enhancement," Dr. Lindstrom explained. "According to this study, dry eye following LASIK rarely leads to patient dissatisfaction. I find post-LASIK dry eye difficult to predict preoperatively. Fortunately, it can usually be mitigated with medical therapy, and should be treated aggressively. Newer studies suggest that wavefront-driven custom treatment and expanded optical zones can reduce night vision symptoms, but some patients complain of these symptoms, and no preoperative test including pupil size measurement is predictive of this complaint. It is appropriate that these primary causes of reduced post-LASIK satisfaction are disclosed [to] patients preoperatively."
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