A meteorologist's death has raised questions about the safety and potential side effects of the popular vision treatment.

By Amanda MacMillan
December 18, 2018

A Detroit community is in mourning after a popular meteorologist for the city’s Fox television affiliate died by suicide last week. Colleagues and fans reacted with shock and sadness as they shared the news that Jessica Starr, 35, took her own life, leaving behind a husband and two young children.

With that sadness also comes confusion and questions: Starr underwent laser eye surgery in October and had previously spoken about how she was struggling with her slow recovery and side effects like dry eye. And while Starr’s loved ones have not spoken out about her suicide or what factors may have contributed to it, the timing of the two events has people wondering whether they could have been connected.

According to the U.S. Food and Drug Administration, most patients are “very pleased” with the results of refractive eye surgeries like LASIK and SMILE. (The two procedures are similar but use different types of lasers; Starr had the latter, but had described her surgery as both SMILE and LASIK, a more commonly known term.)

But, as with any surgery, risks do exist—and Starr’s is not the first suicide to be linked to these procedures. Here are seven things that anyone considering refractive eye surgery should know in the wake of this scary and tragic story.

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What happens during LASIK or SMILE surgery?

LASIK, which stands for Laser-Assisted In Situ Keratomileusis, and SMILE, which stands for Small Incision Lenticule Extraction, are both procedures that reshape the cornea, John Vukich, MD, associate clinical professor of ophthalmology at the University of Wisconsin, Madison tells Health. Dr. Vukich, also a board member for the American Society of Cataract and Refractive Surgery, did not treat Starr but has performed both types of surgery on hundreds of patients over the years.

“They both use lasers to remove a microscopic amount of tissue,” says Dr. Vukich. With LASIK, he says, an incision on the surface of the cornea creates a thin flap, which is folded back to provide access to the deeper layers. After the cornea is reshaped using a laser, the flap is folded back over and left to heal.

With SMILE, a different type of laser is used, and the procedure is also slightly different: A tiny keyhole incision is made in the cornea, and excess tissue is removed through that opening.

SMILE is newer and more recently approved by the FDA, says Dr. Vukich, but both procedures have similar safety profiles. There’s also a lot of overlap in which patients are good candidates for each procedure. Patients often choose a procedure based on what their doctor offers, says Dr. Vukich, although there are some cases when people may benefit from one over the other.

Most patients are happy with the results

FDA studies suggest that about 95% of patients who have had LASIK are happy with their vision after surgery. According to the American Academy of Ophthalmology, 90% of LASIK patients see their vision improve to somewhere between 20/20 and 20/40. And in a clinical trial of the SMILE procedure, all but one of 328 patients had vision of 20/40 or better at six-months post-operation.

“I’ve had more than one patient say that they never realized they had a 'wet blanket' over them, and now it’s been removed,” says Dr. Vukich. “They have the freedom of not bringing appliances and cleaners and spare lenses when they travel. And for some people—like military or police officers—you could even argue that the change could be life-saving.”

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But side effects can occur

With either of these procedures, there is a chance of side effects and complications, says Dr. Vukich. For example, about 2% of people who undergo these procedures may require a second procedure. “The technology for reshaping the cornea is extraordinarily accurate,” he says, “but since we’re doing it on living tissue, there’s going to be a biological response that can cause microscopic changes.”

Another subset of people—studies suggest about 7%—may notice a glare around lights that was not present before their operation. “Usually it’s part of the healing process and it just happens for a short period of time,” says Dr. Vukich. “And for a vast majority of those patients, it doesn’t really bother them anyway.”

Some LASIK and SMILE patients will notice that their eyes are drier than normal after surgery, says Dr. Vukich. Eye doctors can recommend tear-replacement drops to relieve dryness and irritation, he adds, and these symptoms usually go away within the first three months after surgery.

In 2009, the FDA launched a study to understand the potential risks of severe problems that can result from LASIK. It found that up to 46% of patients reported at least one visual symptom (like glare or blurred vision) at three months post-surgery. Up to 28% of patients reported dry eye symptoms, and less than 1% experienced “a lot of difficulty” with or inability to do usual activities because of side effects from their surgery.

There’s also a risk of infection after laser eye surgery. One recent study shows that this risk is somewhere between 1 in 15,000 and 1 in 30,000, says Dr. Vukich. The risk of infection from contact lenses, by comparison, is about 1 in 400.

If you had dry eyes before, your chances of complications may be higher

When patients ask about laser eye surgery, Dr. Vukich says it’s important to find out their motivations for wanting the procedure. “If they’re no longer able to wear contact lenses because they say their eyes are too dry, then we want to find out the cause of that dryness,” he says.

If it’s allergies or normal irritation that’s causing their problems, they may be good candidates for LASIK or SMILE, he says. But if they have an underlying medical condition that’s causing unusually dry eyes, surgery may not be a good solution for them. “We know that if you have profoundly dry eyes before, that’s one of the things that can create challenges post-op,” he says.

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Cases of serious, persistent pain—and, yes, suicide—have been reported

A small percentage of patients who get LASIK or similar eye surgeries do experience chronic discomfort for months or even years afterward—a condition that’s recently been named corneal neuropathy. Dr. Vukich says this risk appears to be about 1 in 10,000 and that doctors have just recently begun to gather data and understand why—and to which patients—this happens. (They suspect that something goes wrong when nerves grow back after surgery.)

“LASIK has been around for 20 years, and when you have a risk that is as low as this, it can go unnoticed for years,” he says. “You can have a busy refractive surgeon who goes their entire career and never sees one patient with a problem like this.”

Critics of LASIK say, however, that the risks of these surgeries have been understated—and that reports of serious pain and vision problems have been around for years. The advocacy group LASIK Complications is dedicated to two other individuals who died by suicide after undergoing laser eye surgery. Some news sites have reported that at least 17 people have died under similar circumstances.

When asked about these reports, Dr. Vukich says those patients and families deserve a voice—and that their stories are worth learning from. “Literally millions of people have had refractive surgery and the risk of complications is not zero,” he says. “I think that certainly there are individuals who, for a variety of reasons, are truly unhappy after surgery—and as physicians we try to do our best to find solutions or mitigate their difficulties.”

As to whether there’s a definitive link between suicide and LASIK, Dr. Vukich calls this a “complex” issue. “Suicide is a multifactorial mental health issue,” he says. And while he can’t speak to any one person’s mental state, he says, “I don’t think it’s possible—or even reasonable—to try to assign it to any one factor.”

Patients should always understand the risks

Dr. Vukich says he tries to help patients see the risks and benefits of laser eye surgery in perspective. “We want them to understand the relative risks of what we’re talking about and let them make an informed decision,” he says.

“If you understand that you could die getting into a car, would you still find it expedient and convenient and worth the risk? The answer for almost everyone is yes,” he adds. “When patients say they want to be free of glasses, we tell them that there’s a way—but it is surgery, and we do outline the risks.”

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If you're having trouble after surgery, tell your doctor

People should be comfortable going back to their surgeon if they’re experiencing difficulties after eye surgery, says Dr. Vukich—or getting a second opinion. He also reminds anyone suffering from side effects that these are often temporary, and that many problems resolve themselves within the first few months.

“We are here to do what we can to make sure patients get the absolute best results,” he says. Doctors may be able to prescribe eye drops for dryness, medication for post-surgical pain, or recommendations for further treatment. “For many of these patients, there are lots of options.”

Finally, if you or someone you know is thinking about suicide—whether eye surgery is involved or not—mental health professionals can help. Call the toll-free National Suicide Prevention Lifeline at 1-800-273-TALK (8255) to speak with someone right away.

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