If you’re considering Lasik surgery for reasons as banal as being irritated at constantly losing your contact lenses or being able to more easily play sport, here’s a cautionary tale worth reading. There’s a conservatively estimated one percent chance you’ll suffer post-operative pain so bad that some sufferers have committed suicide. This risk percentage could rise as awareness of neuropathic corneal pain, post-Lasik-surgery, grows and more people seek help. Ophthalmologists are starting to diagnose this rare condition more frequently as case studies are written up and the literature base widens, increasing clinician-awareness. However, ophthalmologists are not trained to treat neurological disease and neurologists are not trained to treat eye diseases, so too many patients fall between the cracks, going from pillar to post in search of relief. Being told to regularly apply eye drops is enough to send you over the edge on its own. I googled the number of neuro-ophthalmologists in South Africa and came up with two – one in Cape Town and one in Pietermaritzburg. There are five altogether in Africa. One presumes they’d know what to do. Not that specific treatment takes the condition away entirely. Until more research is done, treatment is at best palliative. – Chris Bateman
When routine eye surgery leads to debilitating pain
By Betsy McKay
(The Wall Street Journal) – Kaylee Patterson woke with a sharp pain in her right eye the morning after she had Lasik surgery. She felt a dull ache on one side of her face.
Worried, Ms. Patterson visited her surgeon and her regular eye doctor several times over the next few weeks. They repeatedly told her that everything looked normal, she says. Yet the slightest thing – a draft of air, a ray of light – would cause excruciating pain in her head. “I was in pain and nobody was helping me,” the 33-year-old mental-health counsellor said.
A year and a half after her surgery, Ms. Patterson finally learned why she was suffering. She has a condition known as neuropathic corneal pain, a specialist told her. The nerves in her cornea which had been cut as a routine part of Lasik surgery had become hypersensitive, producing agonising pain.
It’s an unusual and sometimes severe complication of Lasik and other types of eye surgery. One form, called corneal neuralgia, can be hugely debilitating. Some patients report feeling as if they have fireballs or shards of glass in their eyes. Yet their eyes appear normal to most doctors who examine them. Seeing nerve damage requires a more high-powered microscope.
They often diagnose these patients with dry eye, another Lasik complication with some similar symptoms. The treatments usually aren’t enough, leaving many patients frustrated and in despair. Several patients unable to find relief from the pain have died by suicide.
“These patients fall right through the cracks,” said Pedram Hamrah, an ophthalmologist and cornea specialist at Tufts Medical Centre in Boston. “Neurologists are not trained to treat eye diseases, and ophthalmologists are not trained to treat neurological disease.”
He and other doctors and researchers are trying to find better ways to identify patients at risk, raise awareness of the condition, and seek new treatments. It isn’t clear how common neuropathic corneal pain is. No epidemiological studies have been conducted on this specific condition, researchers say, though there have been studies on discomfort in the eyes after Lasik surgery. Some say it is rare, occurring in fewer than 1% of patients who have Lasik surgery, but doctors say they are seeing more patients, possibly as awareness grows.
Stephen Pflugfelder, a cornea specialist and professor of ophthalmology at Baylor College of Medicine in Houston, said he sees a couple of new patients with the condition every month. He guesses it occurs in 1% to 2% of patients who have Lasik surgery. “I think it’s more prevalent than what is acknowledged,” he said.
Dr. Hamrah said he sees up to 200 new patients a year with neuropathic corneal pain. They come from all over the world and the vast majority – 75% – developed the condition after eye surgery, he said. Of them, 20% had Lasik. More patients develop neuralgia after cataract surgery, he said, but the Lasik patients have more severe pain.
These cases have fueled new scrutiny of Lasik surgery, which can lead to other complications such as glare, halos or double vision. Surgeons who perform Lasik regularly say it is safe and bad outcomes are rare. An estimated 774,000 laser vision-correction procedures were performed in the US in 2018, according to Market Scope, a market-research company specialising in the ophthalmic industry. They are on the rise again after peaking at nearly 1.5 million in 2007, then hitting a low in 2013 following the recession, according to Market Scope. An estimated 4.2 million cataract surgeries were performed in 2018.
“Truly modern Lasik is safe and effective,” said Stephen Slade, a surgeon at Slade & Baker Vision in Houston, who has done Lasik procedures since 1991. The field is concerned about neuropathic corneal pain and trying to learn more, Dr. Slade said. “We are trying very hard to find out how we can help.”
The Food and Drug Administration said Lasik is safe, but didn’t respond to a request to comment on neuropathic corneal pain.
Paul Madsen, a marketing manager in Eagan, Minn., developed an ache behind his left eye about six weeks after his April 2018 Lasik procedure. It spread past his ear and down his cheek. His doctor told him he had dry eye, and that it was part of the healing process, said Mr. Madsen, 32. The pain was so bad he had to leave his job for several weeks. “It feels like someone is stabbing you in the eye and shaking the knife around,” said Mr. Madsen, who also had other complications such as “rainbow glare,” in which he would see a spectrum of coloured bands emanating from a light source.
Over the past year, he has spent tens of thousands of dollars on treatments. They include nerve-blocking surgeries, anti-epileptic drugs to calm the nerves as well as eye drops made from his own blood that are intended to stimulate nerve growth. While the condition has improved, “I am still distracted by the pain,” he said.
Ms. Patterson had Lasik surgery in December 2016 because she played sports, traveled often and worried about losing her contact lenses. As her pain grew after the surgery and a follow-up procedure, she had to quit her job, she said. She felt a shooting pain deep inside her head, and her face felt as if it were being shrink-wrapped. “I spent months just in a dark bedroom because lights hurt so much, TV screens hurt, air hurt,” she said. At times, she wanted to end her life. “Living with that pain was not living,” she said.
She finally learned the source of her pain in May 2018, when she traveled to Boston and met with Dr. Hamrah. A scan with a microscope powerful enough to see her corneal nerves revealed clumps in the nerve endings of both corneas, she said.
She has used eye drops made from her blood and says they have helped. Now living in Traverse City, Mich., closer to her family, she is working again. The pain remains “really dull and achy” and isn’t lessening anymore, she said. She has flare-ups. “If I have a really stressful day at work, I will have a pain episode and it will take two or three days to recover,” she said.
Dr. Hamrah said there is hope for patients with neuropathic corneal pain. There are pain drugs and other potential treatments in development, he said. “I am expecting there will be a lot of new stuff coming in the next 10 to 15 years,” he said.
