Corneal Refractive Surgery in the Right Patient at The Right Time.

BACKGROUND: Despite their proven level of safety and patient satisfaction, laser-assisted in situ keratomileusis (LASIK) and other corneal refractive surgeries have faced scrutiny in the media recently as they have been linked to suicides following poor outcomes. Between 1998 and 2006, the Food and Drug Administration (FDA) received 140 official complaints linked to LASIK surgery, spurring the development of a Patient-Reported Outcomes With LASIK (PROWL) questionnaire to measure quality of life-related outcomes after LASIK. Dry eye symptoms are the most common complication after LASIK, but the overall patient satisfaction rate after surgery remains around 95 percent with around 1 million surgeries performed in the U.S. each year. Three cases involving completed or attempted suicide after corneal refractive surgery are discussed. Considerations and recommendations including preoperative screening and counseling to help prevent similar outcomes in the future are provided. OBJECTIVE: We seek to discuss the facts surrounding LASIK surgery, and the factors that may contribute to a purported connection between corneal refractive surgery and mental illness. CONCLUSION: Patients will continue to pursue refractive surgery with high expectations. Prevention by proper screening and setting of realistic expectations paired with early recognition and treatment may help minimize the effect of complications. Less-than-perfect cases must be reported to build a more robust body of literature on the topic. This will help highlight the procedures' safety and efficacy while improving management when complications occur. Performed for the right patient, at the right time, refractive surgery has the potential for consistently transformative results.