Photo by Maxime Caron

LASIK, SMILE and Cases of Suicide

As far back as 2008, patients who underwent LASIK surgery have reported struggling with vision impairment following their procedure. Similarly, JAMA Opthalmology found that “a substantial percentage of participants reported new visual symptoms after surgery,” which included double vision, glares, halos, and dry eyes.  

Perhaps even more surprising is the prevalence of post-surgery reports citing social isolation, depression and intense pain. For some, this pain may eventually result in suicide.

Detroit meteorologist and public personality, Jessica Starr, died by suicide after undergoing LASIK surgery in 2018, prompting concern from others surrounding the complications of what once was a seemingly innocuous procedure. Starr’s blurred vision and dry eyes reportedly led to her depression and ultimate suicide. 

The popular meteorologist, wife and mom of two had undergone SMILE (small incision lenticule extraction) just two months prior to her death. This variation of LASIK is a newer procedure in which two small cuts are made to remove eye tissue. In this way, the SMILE procedure is slightly different from standard LASIK surgery, which requires a large flap-like incision. One might presume that the larger incision with LASIK means longer recovery time, but studies have shown the opposite to be true.

In a report published by the American Academy of Opthalmology, Ronald Luke Rebenitsch, MD explains, "the visual recovery for SMILE is slower. Appropriate expectation management is therefore of paramount importance." Some believe that Starr was not expecting such a slow recovery with her SMILE procedure.

While she tried to return to work in November, a month following her procedure, she found she wasn't ready. In an emotional Facebook post to her fans, Starr wrote that she was “still healing." She added, “I am struggling a little bit, so I do still need all the prayers and well wishes because this is a hard go.”

No one expected Starr's "hard go" to spiral into suicide, but her loved ones now believe the eye surgery affected her brain.

Photo by Ahmed Carter

Informing Patients About the Risks of LASIK

Dr. Cynthia MacKayis a New York City-based ophthalmologist who is opposed to LASIK and has seen dozens of patients coping with the complications of it. “Many were suicidal,” she said. Trained at Harvard and Columbia Presbyterian, Dr. MacKay is now retired from her practice but still continues her LASIK advocacy.

Unfortunately, despite action from MacKay and others who warn about the lasting complications, LASIK complications may be permanent and untreatable for those who have already undergone the surgery. Dr. MacKay explains that many patients have “100 percent loss of contrast sensitivity,” while “50 percent” have “severe eye pain, which has caused at least 25 documented suicides.” 

Other complications include glare, halos around lights, double, triple, or quadruple vision, cataracts, and bulging of the cornea—which ultimately results in blindness.

Photo by Aryan Dhiman

Stories of LASIK and Suicide

For Terri Stovall, much of this rings true. After her painful LASIK surgery in 2017, she had to have an inlay removed in order to gain some of her eyesight back, though her vision hasn't returned entirely. 

“The mental torture was the worst,” she said. 

Stovall's vision continued to deteriorate after surgery until she eventually lost the ability to drive and even cook for herself. She admitted feeling as though she “lost her freedom and independence.” 

Unable to apply the same makeup she had worn for over 40 years, she added, "I gave up on trying to feel good about myself. The fact that I chose to have this surgery was the worst part.”

With time's passage, Stovall learned how to cope and is now able to read while wearing one contact and reading glasses. Still, her work life is not what it once was. 

“I am still suffering from depression but I am working very hard to not let it control my life,” she said.

Another consumer who has experienced LASIK complications first-hand is Joe Tye. He had his LASIK surgery in 2008 and claims that his second touch-up procedure only made his “double vision, impaired visual acuity, and blistering 24/7 eye pain” worse.

Prior to LASIK, the surgeon informed that he was a perfect candidate for the surgery. At the time, however, Tye was not informed that he had a significant contraindication—which means that a drug, surgery or procedure can be harmful to a person. 

Tye explains that the doctor kept this information from him—preventing him from fully understanding the risks and prompting him to go through with the surgery.

“What was even more disconcerting was the way they completely ignored me once it became clear that my problems would not be fixed with more eye drops, even knowing that double vision made me a hazardous driver,” he said.

Since his LASIK surgery, Tye must wear corrective prism eyeglasses for his double vision while driving, custom reading glasses for seeing long distance and another set of glasses to look at a computer. 

“I have spent far more money on eyeglasses in the decade since LASIK than I did in the five decades preceding it," he said. 

Though Tye did not experience improvement in eyesight using eyedrops, some LASIK patients do rely on their eyedrops to assist them after surgery. Jessica Starr was one of them. She claimed she had to apply eye drops every five minutes just to briefly restore her vision.

Interestingly, fluoroquinolones are antibiotics that treat bacterial infections and are often included in eye drops. This type of antibiotic treats surface infections like corneal ulcers or conjunctivitis. Common risks of this antibiotic are permanent disabling side effects that affect muscles, joints, nerves, and the central nervous system. This type of antibiotic can enhance feelings of suicide, anxiety, and depression.

It remains unknown whether Starr's eyedrops contained the antibiotic.

Is Every Patient a Candidate for LASIK surgery?

For many affected by the complications of the eye procedure, this seems to be the case. The patients simply shouldn’t have been candidates for the surgery. The Food and Drug Administration (FDA) and healthcare providers still refrain from stepping forward and warning patients of the procedure's potential risks. Subtle action has been taken, however, toward improving understanding of the topic.

In Oct. 2009, the FDA created the LASIK Quality of Life Collaboration Project, which aims to assess how many patients are negatively affected by the surgery. Following its launch, they issued warning letters to 17 surgical centers for inspections. 

The FDA also created the LASIK Patient Docket where patients can publicly post comments or concerns surrounding the procedure. Those who undergo the procedure may still be unaware of it potentially life-threatening effects continue to face complications.

“These patients fall right through the cracks” since “neurologists are not trained to treat eye diseases, and ophthalmologists are not trained to treat neurological disease,” ophthalmologist and cornea specialist, Pedram Hamrah, told the Wall Street Journal. Hamrah is working with other medical professionals to raise awareness of the issue and find better ways to determine which patients are most at risk.

Morris Waxler, a former FDA official who approved LASIK in 1999, is now trying to outlaw the procedure and calls it a “mistake.” Unlike Hamrah, who believes the problem lies in lax regulation of who is eligible for the procedure, Waxler claims that “the problem is not so much the surgery, but with the recovery.” He believes the outcomes are subject to variance because everyone heals differently.

Photo by nrd

Still a proponent of greater public warnings on LASIK, Waxler told Consumers Digest that the FDA initially looked the other way when it came to side effects. “The heat from Congress was tremendous, and the agency didn’t want to have a fight with the high­ powered ophthalmological group. We tried to accommodate their interests. Who got hurt were the patients. Patients don’t have a voice at the agency. Patients are an afterthought,” he explained. 

While LASIK does wonders for hundreds of thousands of people around the globe, it’s essential that patients know the complications and possible concerns that can accompany the procedure. The future may offer pain medications, reversal surgery or other potential treatments. For now, those affected must attempt to cope with glasses, contacts, and eye drops—which are largely insufficient.

For many doctors, the recent attacks on LASIK are not justified, but for those who have paid the cost with their lost vision and even lives, it most definitely is.