Hello everyone this is Dr. Audrey Tai, I am a board certified and fellowship trained LASIK and
cataract surgeon, ophthalmologist and cornea specialist. Welcome back to my channel - eye
channel by eye surgeon. In Today's video 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 video.
To learn more about my practice you can follow me on Facebook and LinkedIn @DRAudreyTai. And if
you have learned anything new from this video, don't forget to like and share this video, and
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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 US 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 corneal ulcer.
A cornea ulcer is an infection on the cornea – the clear windshield of the eye. According to the CDC
and previously published studies, eye infection can affect up to 1/500 contact lens 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 properly clean and wear contact lenses? I hope that you remember
those instructions and have been following those instructions while you're wearing contact lenses.
Because NOT following those instructions increases the risks
of getting eye infection from wearing contact lenses. A study published in 2017 reported 99%
of contact lens wearers responding to the study reported at least one behavior that was associated
with an increased risk of eye infection. Some examples of poor contact lens hygiene behaviors
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 biofilm 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 outer most part of the cornea. Therefore the longer the
contact lens stays on the surface of the eye, the bacteria has 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,
it also contains several antimicrobial peptides. Therefore the extended wear 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 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 infection 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 requires 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,
a letter that a normal person can read from 70 feet away, a person with 20/70 vision can
only read that 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 available for overnight or continuous wear up to 30 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 doctor 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 video, 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 are less common
than 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 correction 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 US. One study reported that out of 32,068 laser
vision correction surgeries performed in the US military between the years of 2000 and 2003,
those soldiers who had 20/20 or better vision without glasses or contact lenses was 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 stands for Patient reported outcomes with LASIK 1 and 2, carried out
by the FDA in collaboration with the national eye Institute reported less than 1% of patients who
received LASIK surgery experienced 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 decreased vision of one line on the vision chart, for example, from 20/20 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, night time 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 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 video
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 your eye doctor, and get regular eye exams to monitor the health of your eyes.
If you have dry eye disease and wear contact lenses, or have had LASIK surgery, I've also
listed in the description below (point) some of the eye drops I recommend to use for dry eyes.
Thank you for watching and I hope you find this video helpful
in learning more about contact lenses and LASIK surgery. Let me know in the comments below which
vision correction method you have chosen for yourself and why, whether it is LASIK surgery,
other vision correction surgery, contact lenses or glasses.
If you find this video helpful please don't forget to like and share this video,
and subscribe to my channel to help me bring you more videos about eye health and eye surgery.
To learn more about my practice you can follow me on Facebook and LinkedIn @DRAudreyTai.
Thank you again for watching and I will see you in the next video.