The problem with LASIK patient satisfaction surveys

I always found it weird that, despite LASIK patient satisfaction surveys being so positive (95%+ satisfaction rates), so many LASIK doctors wear glasses.¹ And I always found it weird that everyone I spoke with knew of at least a few friends with painful side effects.

My curiosity aroused, and I started researching the real data of LASIK side effects. I made some interesting discoveries, which paint the “95%+ satisfaction rates” data point as highly misleading.

• In one study,² 24% of patients reported eye pain six months after the operation, compared to 7% before it. Despite that, satisfaction rates were 93%, implying that at least 62% of the patients reporting that the operation created persistent eye pain still rated the operation as satisfactory. On the one hand, this indicates that patients consider the pros of LASIK to be significant, but on the other hand, it also indicates that high patient satisfaction scores cannot be taken as evidence of low risk.

• In another study,³ 63% of patients who developed nighttime vision problems six months after the operation would still recommend the operation to friends. Again, an indication that high patient satisfaction scores cannot be taken as evidence of low risk.

• In a third study,⁴ about 45% of patients reported new visual symptoms after surgery. Despite that, the reported dissatisfaction rates were only about 1.5%. Again, this is an indication that we shouldn’t interpret low dissatisfaction rates as evidence of low risk.

I could go on, but hopefully, you get the point. LASIK is way riskier than reported satisfaction rates imply, and anyone claiming that high satisfaction rates are evidence of low risk is a dangerous charlatan and should be called out as such.

Footnotes:

Footnotes

1. As an anecdote, I googled "top LASIK doctors in my town", and five out of the top ten pictures of named doctors had glasses. This is of course just an anecdote, not a solid study, but you understand why it would raise my suspicion. ↩

2. Betz J, Behrens H, Harkness BM, Stutzman R, Chamberlain W, Blanco MP, Hegarty DM, Aicher SA, Galor A. Ocular Pain after Refractive Surgery: Interim Analysis of Frequency and Risk Factors. Ophthalmology. 2023 Jul;130(7):692-701. doi: 10.1016/j.ophtha.2023.02.016. Epub 2023 Feb 19. PMID: 36809816; PMCID: PMC10293021. ↩

3. Bamashmus MA, Hubaish K, Alawad M, Alakhlee H. Functional outcome and patient satisfaction after laser in situ keratomileusis for correction of myopia and myopic astigmatism. Middle East Afr J Ophthalmol. 2015 Jan-Mar;22(1):108-14. doi: 10.4103/0974-9233.148359. PMID: 25624684; PMCID: PMC4302464. ↩

4. Eydelman M, Hilmantel G, Tarver ME, Hofmeister EM, May J, Hammel K, Hays RD, Ferris F 3rd. Symptoms and Satisfaction of Patients in the Patient-Reported Outcomes With Laser In Situ Keratomileusis (PROWL) Studies. JAMA Ophthalmol. 2017 Jan 1;135(1):13-22. doi: 10.1001/jamaophthalmol.2016.4587. PMID: 27893066. ↩