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Implantable contacts are safer than laser eye surgery

Consumer Reports News: May 20, 2010 03:08 PM

About six months ago, after a routine eye test, the optician told me I needed glasses. I have to wear them to drive, but at times when I’d rather go without, I can manage reasonably well. My friends accuse me of wearing them mainly in an attempt to look more intelligent.

If I were more severely short-sighted and wanted to avoid glasses or contacts, one option would have been laser eye surgery. Many people get fantastic results from laser surgery, but it’s not risk free. Some people end up with worse sight, and problems with night vision can make driving in the dark much more difficult. The FDA has a useful checklist for people considering this procedure, describing the possible downsides.

For a few years now, there’s been another option. A surgical procedure can place an artificial lens inside your eye to correct your vision, like an implantable contact lens. Doctors call them phakic intraocular lenses.

There are some advantages to implantable lenses. Unlike laser surgery, which physically removes tissue from the front of your eye, implantable lenses can be changed or removed, meaning the procedure is reversible. And there’s no risk of damaging your night vision. No procedure is risk free, however, and implantable lenses may increase your risk of cataracts.

Researchers have now analyzed all the existing research that compares laser surgery with implantable lenses. The results? Both work about the same, but implantable lenses are safer.

In one of the larger studies, between 12 percent and 21 percent of people had 20/20 vision or better, without glasses, a year after treatment with implantable lenses or laser surgery. Between 59 percent and 88 percent of people had 20/40 vision or better.

Although the benefits were similar, there were fewer problems with implantable lenses. In one 2002 study, a year after treatment, no one with implanted lenses had lost two or more lines of vision (based on the lines they could read on a standard eye chart). However, just over 1 in 10 people who had laser treatment had lost two or more lines of vision.

The researchers also said that the contrast between light and dark was clearer for people with implanted lenses.

One person got a cataract that needed removal after being treated with implantable lenses. Cataracts need to be treated with surgery.

Although the new review is the most up-to-date analysis of the two procedures, some of the largest individual studies are from 2002. Surgical techniques tend to develop quickly, so make sure you get your surgeon’s opinion if you’re considering eye surgery.

What you need to know. All surgery carries a risk. If you are considering any type of eye surgery, make sure you ask your surgeon about exactly what you can expect. Will you still need to wear glasses? Will you be able to drive at night? What are the chances of something going wrong? You can also ask about your surgeon’s own success rates, because these may vary quite a lot between surgeons.

—Philip Wilson, patient editor, BMJ Group has partnered with The BMJ Group to monitor the latest medical research and assess the evidence to help you decide which news you should use.

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