Corrective eye surgeries have been around for decades, and while complications are rare, not everyone understands the risks of the procedures.
After the high-profile suicide of a meteorologist in Detroit who appeared to be struggling with the side effects of a procedure called SMILE, attention increased on the side effects that can come with laser eye surgery.
Jessica Starr was a well-known meteorologist at WJBK-TV Fox 2 in Detroit, Michigan. She was just 35 years old, a wife and mother to two young children. In November, she posted what would be her last Facebook post.
In it, Jessica said, "I am back, but I’m still struggling a little bit."
She explained she had "Lasik SMILE surgery" done the previous month, was still dealing with dry eye and having to use a lot of drops.
"...So that’s kind of the back story, is that I’ve just kind of been back home recovering and trying to take it easy… I am struggling a little bit. So I still do need all the prayers and the well wishes cause this is a hard go, the doctors said it could take up to 3 months or so before I feel like 100% again."
The next day, Starr tweeted, “Update; yesterday was a struggle for me. I really wanted to come back but I need more time to recover. Please keep me in your thoughts during this challenging time. Will keep you updated. 🙏🏻”
Almost a month later, she died by suicide.
Although it’s unclear if there were any other underlying issues that led to Starr’s suicide, there was no doubt she was having a difficult time after her SMILE surgery.
What is SMILE?
SMILE stands for Small Incision Lenticule Extraction. It was approved by the FDA in 2016. Unlike Lasik, it is a flapless technique that is less invasive, using a laser to treat nearsightedness with a tiny incision.
Dr. Robin Ross is a board-certified ophthalmologist at Global Retina Institute and is also a clinical assistant professor at the University of Arizona in the Department of Ophthalmology and the Department of Ethics and Humanism.
“With any surgical procedure there are risks and benefits,” she said.
She also added that it’s very important to have reasonable expectations.
“80 percent of patients who have the SMILE procedure are done with eye drops at about six months, but that means 20 percent are still battling dry eyes and that can be a longer standing issue for them," said Ross. "And if they don’t expect that on the forefront before they sign up for the procedure, that can be immensely depressing and that can be a real struggle for them.”
Dr. Ross said there are 3 key things you need to know before getting SMILE:
- Realize that you still may need glasses, contacts, or another procedure afterward.
- The status of your eye should be stable. You shouldn’t have any other ocular issues like glaucoma, cataracts, lattice degermation, etc.
- Find the right doctor. “I always tell patients when you’re paying out of your own pocket to have a procedure done, you should run from the physician that does every single person that walks in the door.
"Ophthalmologists know there are good candidates and not good candidates,” said Dr. Ross.
The side effects and complications
Dr. Ross has seen patients who are in pain up to a year after they’ve had refractive procedures.
“It’s very debilitating and some of our patients have almost post-traumatic stress from having had a surgical procedure,” she said.
She also explained that 50 percent of patients who have major ocular complications go through depression, so getting help from a doctor or suicide prevention group is important. It’s also another reminder that doctors need to reach out and be more empathic to patients who are suffering.
“It just shows we need to be better explainers with our patients, better communicators,” said Dr. Ross.
On the other hand, Dr. Ed Boshnick is an optometrist from Global Vision Rehabilitation Center. He’s been in practice for more than 50 years and has specialized in caring for post-refractive surgery patients for more than 30 years.
He does not recommend any refractive surgeries at all.
"Because there's too many unknowables and unknowns. I'm seeing these patient populations every day. Why in my wildest dreams, why would I want to refer someone to have this done if I know what's going to happen? And a lot of these problems occur months or years afterward,” said Dr. Boshnick. “I put all of these surgeries in one big basket. These are invasive procedures, it's on your eye. If something goes wrong, you can't go back. It's like crossing the Rubicon. It's a one-way journey. So you better think twice before you have these done, do your research.”
But complications are rare.
A National Institutes Health study showed 1.5 percent of SMILE patients had complications by three months. But their visual acuity was restored in the long term.
And according to a study by the FDA, when it comes to Lasik, less than 1 percent of patients had difficulties performing their usual activities after surgery, while more than 95 percent of participants were satisfied with their vision.
A tale of two procedures
Andrea Peardon, however, wishes she had done more research.
“I woke up thinking this is the worst decision I ever made in my life,” said Peardon.
As a baby photographer in Michigan, her vision is her livelihood. She wore contacts for years and finally decided to undergo the SMILE surgery almost two years ago.
But to this day, she still has trouble with her eyesight.
“It would technically almost be a 20/20 vision, but it's not a crisp 20/20, so there's a lot of blurriness or fuzziness around things that I look at. When it gets dark the vision starts to fail. And I have a lot of random issues. So I have a dry eye, I have halos and starbursts around things, I have really bad night vision. I wear glasses when I'm editing and when it's nighttime and I have floaters, so they kind of just float around my eyeballs all day,” she explained.
She also was frustrated at the lack of compassion from her doctor.
“Every time I was told, 'It's gonna get better, it's gonna get better, it's gonna get better, see it's getting better, your vision is perfect,'" Peardon said. "And I'm like, 'what are you talking about?' And I shouldn't have had this done. I should've been told this shouldn't have been like this.”
Looking back, Peardon believes people need to do their research.
“I absolutely have regrets. I think about it almost every day, how I wish I hadn’t done it. I try not to think about it otherwise it’ll get you really down,” she said.
However, Morgan Lempitsky had Lasik surgery last May. She had been wearing glasses since she was 5.
“It was really bad. I couldn’t see far away, people are like either near sighted or far sighted, they can see far but they can’t see near, or they can see near but they can’t see far, I was both, I couldn’t see either,” said Lempitsky.
Now after getting Lasik, she recommends it and she said, “I have better than perfect vision now.”
According to Dr. Ross, the bottom line is pairing the right candidate for the refractive procedure with the right doctor.
“Just because patients may reach a surgical goal of 20/20 doesn’t mean they’re happy with it. So doctors need to be good listeners,” she said.