Q&A: The LASIK myths that won't go away, and how doctors are fighting back

LASIK has been available for more than two decades, but the surgeons performing it today say the public conversation around the procedure has not kept pace with the technology itself. Diagnostic tools like advanced topography, tomography, and ray-tracing based ablation planning have changed candidate selection and outcomes significantly since LASIK's early years, yet much of what patients encounter online still reflects outdated assumptions about risk, longevity, and cost.

That gap is becoming more pressing as marketing campaigns turn toward reintroducing LASIK to Gen Z and Millennial patients, a generation that grew up researching medical decisions on social media rather than through in-person consultations. Ophthalmology Times previously covered Alcon's digital-first LASIK awareness campaign for younger adults, which pairs social media creators with targeted digital media to close that same awareness gap. These patients bring different lifestyle factors into the candidacy conversation, including screen habits that affect blink rate and tear film health, along with a stronger expectation of transparent, non-promotional education before they will commit to an elective procedure.

To understand how practicing refractive surgeons are approaching this shift, Ophthalmology Times spoke with Vance Thompson, MD, founder of Vance Thompson Vision and immediate past president of the American Society of Cataract and Refractive Surgery (ASCRS), who discussed the misconceptions he encounters most often, the diagnostic advances he believes remain underappreciated by both patients and referring optometrists, and how candidacy screening is adapting for younger patients. He also addressed a question increasingly relevant to any physician participating in a public-facing campaign: how much oversight surgeons have over the accuracy of creator-generated content once it reaches social platforms.

You mentioned people's perceptions of LASIK are often based on outdated information. In your practice, what are the most common misconceptions you hear from younger patients specifically, and how do you address them during consults?

Vance Thompson, MD: I am amazed at how excited people are who come in for a LASIK consultation. They have done their research and understand the high success rate and precision of modern-day LASIK. In my practice, it's not the people coming in for consultation who have misconceptions—I believe it's more the people online who are not doing real, quality research or being educated in a quality way, and who are not coming in for the consultation. We know, with any elective surgery, fear is the number one reason people do not do it, and patients who talk to other happy LASIK patients, or learn about the advancements in diagnostics that lead to quality patient selection, and learn about all their options—such as phakic implants for patients who are too high for LASIK, or lens replacement for older patients—are the ones who, if they are ultimately selected to be great candidates for LASIK, are confident in proceeding. That's why I wish we doctors would complement our promotion of LASIK with putting in the extra work to do quality education.

Dry eye and the longevity of LASIK (think: my dad/friend/boss wound up back in glasses) continue to be challenges to the LASIK decision, and we need to educate the people doing research about how our understanding of diagnosing and treating dry eye prior to LASIK has evolved significantly. Education also allows us to teach how the internal eye still changes with lens aging, and that doesn't mean their LASIK wore off. Teaching about presbyopia and eventual cataracts is important to anyone doing LASIK research. There are also financial concerns that continue to confuse prospects, specifically the lack of insurance coverage, as well as the perception the procedure is expensive compared to other vision correction options. When patients understand the value modern-day diagnostics and treatment technology bring to reducing LASIK risk and increasing precision, they are more willing to invest in those advanced technologies.

This is why we have had great success with reintroducing patient seminars in our office or surrounding communities. The Refractive Surgery Council (RSC) has found this also in their research. They have found a significant increase in patients researching LASIK online, and they have found those same patients want to hear more about LASIK education versus LASIK promotion.

What's changed technologically or diagnostically in LASIK over the past decade that you think the public, and even some referring optometrists, still underestimate?

Thompson: I think the main reason modern-day LASIK is considered the most accurate surgical procedure to correct vision known to man is because of our understanding of: 1. The hazards of eye rubbing, or pushing one's eye into a pillow all night, and making sure we do not operate on these people unless they change their behavior. These people do not realize they are changing their own correction, and that LASIK can last a long time if they take good care of their eyes. 2. Our ability to rule out early keratoconus with modern-day topography and tomography, and not operate on corneas at risk that shouldn't have LASIK. 3. Our ability to diagnose and treat dry eye, making our preoperative measurements, laser treatment, and postoperative healing more accurate. 4. We now understand the sweet spot of the most accurate LASIK corrections, and how certain refractive errors are best treated with other approaches like PRK, phakic IOL, or lens replacement. Patients being taught their options, and also being taught LASIK is often used to enhance PRK, SMILE, phakic IOL, or lens replacement (RLE or advanced cataract surgery)—learning these things builds their confidence in this precision procedure. 5. Treatment technology advancements like ray tracing, and its use of manifest refraction, keratometry, wavefront, anterior corneal topography, tomography, pachymetry, anterior chamber depth, axial length, iris registration, and cyclotorsion to create a 3-D digital twin for personalized calculations of the ultimate ablation profile, are revolutionizing the accuracy of LASIK corrections.

All these advancements, and more, are so helpful to patients and referring doctors to help them realize what modern-day LASIK precision has grown to.

With a campaign aimed at reintroducing LASIK to Gen Z and Millennials, how do you think about candidacy screening for a younger population that may have different lifestyle factors (screen time, contact lens habits, etc.) than the patients who made up the original LASIK boom?

Thompson: I think, besides the routine advanced diagnostics that should be used in all LASIK evaluations, I do believe folks spending a lot of time on their mobile phones and computers need to be educated on the importance of blinking. We are supposed to blink 12–15 times a minute for optimal ocular surface health, but when staring at a phone or computer, this can go down to zero to five times a minute, and it just isn't enough to maintain surface health. This can not only affect LASIK measurements, it can significantly impact postoperative healing. Since our tear film plays a significant role in eye comfort, and patients who stare all day can rub their tired eyes more, we need to educate them on the hazards of both reduced blinking, surface dryness, and how eye rubbing can ruin their corneas.

As a surgeon collaborating with campaigns like this one, how involved are physicians in vetting creator content for clinical accuracy, and does that concern you at all given how informal social platforms tend to be?

Thompson: When an educational campaign is being done by a reputable company, that brings me great joy, because I know the content will be handled responsibly. But when content shows up online that is not factual and has not been vetted by knowledgeable people, that is concerning. But it is also the reality of this day and age, and we have to respect it. The best we can do is be sensitive and caring in our education of the public, and get the word out on the advancements in modern-day LASIK diagnostics, treatment technology, and how our knowledge of who is and who isn't a good candidate has evolved. And if LASIK surgeons keep up with and invest in the most modern technologies, our results will speak for themselves, and content generated by our happy patients will have a great influence on the folks who truly value organic testimonials by people and patients they follow.