* Infectie (risico 0,29% – 0,98% per jaar, ernstiger bij extended wear contactlenzen)
* Op lange termijn verdunning en vertroebeling van het hoornvlies steunweefsel
* Beschadiging van het hoornvlies
* Kwetsbaarheid en functievermindering bij verlies
* Afname van contrast en beeldscherpte afhankelijk van kwaliteit en reinheid van de lens en traanvocht
* Halo’s en glare bij nachtzicht ten gevolge van verplaatsen van de contactlens en vergroting van de pupil
Laser in situ keratomileusis versus long-term
contact lens wear: Decision analysis
Hall T. McGee, MD, MS, William D. Mathers, MD
PURPOSE: To compare the risk for vision loss from laser in situ keratomileusis (LASIK) versus
long-term contact lens wear using decision analysis.
SETTING: Oregon Health & Science University, Portland, Oregon, USA.
METHODS: Based on previously published data, a decision tree was constructed using Markov
modeling to calculate the probability of vision loss from LASIK versus contact lenses over time.
An outcome variable, visual acuity–adjusted life-year (VALY), was defined to account for timing
and severity of vision loss. The VALYs were tallied over a 30-year simulation to determine whether
the risk for vision loss with contacts exceeded that with LASIK. Sensitivity analyses were performed
to test the effect of changes in key variables including probability of contact lens–related keratitis,
probability of ectasia after LASIK, and probability of early post-LASIK vision loss.
RESULTS: The model’s conclusions were highly sensitive to changes in several variables tested,
especially risk for post-LASIK ectasia, risk for early vision loss after LASIK, and risk for contact
lens–related keratitis (which correlated with type of lenses worn). Rigid gas-permeable lenses
were safer than LASIK in every analysis. The safety of LASIK exceeded that for daily-wear soft lenses
only when assumptions were most favorable to LASIK, whereas the safety of LASIK always
exceeded that for extended-wear lenses except when assumptions were least favorable to LASIK.
CONCLUSION: This decision analysis found that the risk for vision loss associated with LASIK and
with long-term contact lens wear might be closer than generally assumed.
J Cataract Refract Surg 2009; 35:1860–1867 Q 2009 ASCRS and ESCRS
Presented at: American Academy of Ophthalmology Meeting Paper, October 2014, Chicago, Ilinois (interim results).
To assess patient satisfaction and perceived outcomes with different methods of refractive error correction through annual surveys administered over a 3-year period.
Prospective, longitudinal, parallel-group, multicenter survey.
A total of 1800 subjects, aged 18 to 60 years, who had LASIK or continued using contact lenses.
Twenty sites across the United States enrolled subjects who completed a study-specific baseline survey during a contact lens examination or while being evaluated as a candidate for LASIK. Links to follow-up surveys were emailed annually for 3 years. Between-group differences were assessed by analysis of variance, and associations were assessed by logistic multivariate regression.
Main Outcome Measures
Of 1800 subjects, 694 (39%) comprised the control group who continued contact lens wear, 819 (45%) wore contacts at baseline and had LASIK, and 287 (16%) wore glasses at baseline and had LASIK. Most contact lens users had worn them successfully ≥5 years. The proportion expressing strong satisfaction with their current vision correction method decreased from 63% at baseline to 54% at year 3 in the contact lens control group, whereas 88% of former contact lens wearers and 77% of former glasses wearers were strongly satisfied with LASIK at year 3. Patients 40 years of age or younger when they had LASIK were somewhat more likely to be strongly satisfied than older patients. LASIK significantly reduced difficulties with night driving and nighttime visual disturbances among former contact lens users and former glasses users. The proportion with dry eye symptoms at 1, 2, or 3 years after LASIK was not significantly increased relative to baseline contact lens wear but was significantly increased relative to baseline glasses use, consistent with many glasses users having tried and abandoned contact lenses because of latent dry eye problems. Compared with continued contact lens wear, LASIK significantly reduced the self-reported rates of eye infections, ulcers, and abrasions each year.
Compared with contact lens wear, current LASIK technology improved ease of night driving, did not significantly increase dry eye symptoms, and resulted in higher levels of satisfaction at 1, 2, and 3 years follow-up.
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