Lance Kugler, MD will begin answering questions on May 20, 2016 at noon and will end today.

**My short bio: Ophthalmology provides a tremendous opportunity to allow people live life to the fullest! Laser vision correction is my specialty and am passionate about using today’s most advanced technology to improve lives. I brought the latest state-of-the-art LASIK and cataract surgery technology to Nebraska at Kugler Vision. I also serve as Director of Refractive Surgery for the University of Nebraska Medical Center, where I'm in charge of resident education and research programs to advance the field of laser vision correction.

My Proof: ***More Proof!!:

***Disclaimer Even though Lance Kugler, MD of this IamA is medical professional, you are taking his advice at your own risk. This IamA is not a replacement for seeing a physician. If you have any concerns please be sure to follow up with your LASIK specialist if you’d like more information. A reply does not constitute a physician/patient relationship.

Comments: 1335 • Responses: 93  • Date: 

SquishFaceMcGee641 karma

Hello, I got laser eye surgery about two years ago but I think something went wrong.. I can see just fine now but so far I cannot figure out how to shoot the lasers from my eyes.. Does this develop naturally over time or should I get a refund?

Kugler_Vision790 karma

You obviously are still in training. The laser power emerges from within. Trust your master.

cloudcity173 karma

Are there any big advances coming in laser surgery over the next two or three years? I want to get laser surgery, but I'm always worried there will be something better about to be available...

Kugler_Vision270 karma

The technology we have now is so good that any advancements are incremental and not significant. In the US we know what is coming because technology is always approved in Europe several years before the U.S. So when we look toward Europe we do not see anything revolutionary on the horizon. There are some new technologies that may help people who cannot have LASIK currently, but for people who are already good candidates there is nothing worth waiting for!

thedead24120 karma

I know I'm a bit late to the party here.

When you mention new technology and it affecting people who can't have Lasik yet, is there anything for people who keep having really minor changes in their eyes?

I'm told I need to keep my vision at a steady level, but it always keeps on changing by the smallest degree up and down. It's super annoying!

Kugler_Vision18 karma

If you are only changing small degrees up and down then by definition you are stable. You should see a lasik surgeon and see if you are a candidate!

thehostilehobo144 karma


I have always wanted lasik, but am too chicken (and cash poor haha)

What "maintenance" is generally required after lasic? Like, do you need to go back in every X years for more procedures?

What side-effects or issues should the average person really worry about?

Kugler_Vision176 karma

People who are nervous before LASIK almost universally say "That was so easy. I can't believe I was so nervous about that." after the procedure. It's very comfortable and no need to be scared!

In terms of maintenance, we recommend regular eye exams every few years after LASIK to check your eye health, but in terms of vision quality no maintenance is necessary.

LASIK does not wear off and 97% of people never need an enhancement.

More info here:

SaintVanilla180 karma

I had LASIK done.

I was in and out of the office in literally 20 minutes.

Other than eye drops for a few weeks, there was ZERO upkeep or maintenance.

My eyesight is now 20/15 and has stayed there for a year. I can not recommend LASIK enough. Best money ever spent.

where_is_the_cheese101 karma

I had LASIK as well, but it didn't go as smoothly for me. The suction ring kept popping off my eyes. Apparently I have very strong brow muscles. After trying it a bunch of times, I sat in their special dark soothing waiting room for about an hour while the swelling went down. They did manage to get it done on my left eye, but not my right. It was too bruised to continue, so I had to wait a week and come back. It didn't hurt at all, but my eyes were completely red. Like something out of a horror movie. There was no white. It did suck having one eye with 20/20 and the other so blurry it's useless for a week. Driving with one eye is tricky. When I came back the next week, they tried one more time with the suction ring, and it popped off. They then went to the blade for PRK rather than using the laser to cut the flap.

Both eyes came out great. 20/20 both eyes. Some dryness for a month or two afterwards but I just used drops. After that they're as good as new. Even with the complications mine had, I still love it and would do it again.

buhnyfoofoo23 karma

Interesting that you had PRK for one eye and Lasik with another - did you notice any differences in healing time? Did one heal faster, maybe was less irritated?

I got LASIK done 2 years ago, but my choices were PRK, which was cheaper, or LASIK which was more expensive.

where_is_the_cheese19 karma

The quality of my eye site in both eyes is 20/20, so they were just as effective so far as I can tell. There was a little more pain while healing with the PRK. Nothing bad, just took a couple ibuprofen every now and then the first couple of days. They gave me a scrip for Oxycodone but I didn't need it. The PRK eye also took a little longer to heal, but again, nothing bad. I don't recall any difference in irritation or dryness between the two.

Kugler_Vision13 karma

It's true PRK and LASIK have equivalent results in terms of vision. The biggest difference is the healing time and comfort!

Kugler_Vision9 karma

This is what we hear everyday!

wholesalewhores23 karma

I had PRK which is a form of laser eye surgery. I loved it and am glad that I got it, but don't be fooled. The 4 days that I spent recovering was some of the most painful days of my life. I was unable to open my eyes and was crying from the pain. Again, I am glad that I did it, but be aware that it can be painful and awful.

Kugler_Vision6 karma

PRK has great results but the recovery is definitely not pleasant! There is a reason why LASIK is so much more popular. :)

emperor_stewie127 karma

I have been wearing glasses for a few years and just recently switched to contact lens. I really enjoy not having to deal with glasses so am starting to look into LASIK. However, when I leave the optometrist for my latest eye exam, I always second guess myself if I correctly answered the questions on "Is lens A or B clearer?".


Is the procedure for LASIK similar where I will have to pick the "best lens/prescription" for the surgery? The thought I having surgery on my eyes where I "picked" the wrong lens is a scary thought.

Kugler_Vision127 karma

This is a common question! The techniques we use to determine the treatment pattern are very sophisticated and not based completely on your answers. So there is nothing you can do to mess it up, and no wrong answers

sialIdan127 karma

Can Lasik treat astigmatism? If yes, are there any potential drawbacks?

Kugler_Vision125 karma

Yes lasik can treat astigmatism. Approximately 80% of people have some degree of astigmatism, and LASIK corrects it remarkably well.

More info here:

umbro_tattoo87 karma

I had lasik about 4 weeks ago. It is amazing aside from that after staring at a screen for any length of time it renders my long sight exceptionally blurry. Driving home after work almost feels hazardous. My optometrist explained why it happens, and that he has it too, but not whether it'd ever go away. His only solution was for me to remember to adjust my vision (look up away from screen and out the window) ever so often during times when i am staring at a screen, but i can't say it was really the solution i was looking for.

Will this improve as healing finishes or is the reality of lasik?

Kugler_Vision116 karma

Some patients' eyes to feel dry and tired after starting at a computer for the first few weeks after LASIK. Those symptoms should improve within the first 3-4 months.

We advise everyone (regardless of whether they have had lasik) to rest their eyes and look away from the computer every 20 minutes or so.

MadePancakesOnce65 karma

I've heard it as the 20/20/20 rule: every 20 minutes, look at something 20 metres(feet?) away for 20 seconds

Kugler_Vision28 karma

Yes that is a common expression. And good advice in general

umbro_tattoo13 karma

thanks. I will try to rest my eyes a little more often from now on.

Kugler_Vision27 karma

And use artificial tear drops. The other thing you can consider is taking Omega-3 fatty acids (fish oil). Studies show they help dry eyes.

Black10577 karma


Kugler_Vision49 karma

There was recently a study published that showed LASIK surgeons were more likely to have LASIK than the general public. So most have had it, and over 90% have recommended it to a family member. There are certainly people who have been unsatisfied with their results, but those are by far a minority as the procedure has a 97% satisfaction rate. Most of the other 3% had procedures done with older technology.

The safety profile of modern treatments is extraordinarily high and exceeds the safety of wearing contact lenses. This means you are more likely to have vision loss from contact lens wear than lasik.

There is no reason to do one eye at a time.

Black10522 karma


Kugler_Vision65 karma

Modern lasik should be done with: -- Femtosecond laser to make the flap and -- an excimer laser that uses a wavefront-optimized or wavefront-guided ablation profile. Topography-guided is OK too.

Endyd17 karma

Can you post the actual study? and not a link to the lasik website

Kugler_Vision40 karma

conclusion of this study: "Ophthalmologists who perform LVC were significantly more likely than the general population to have LVC in their own eyes. The prevalence of refractive errors was significantly higher among ophthalmologists performing refractive surgery than in the general population."

TheAllInclusive17 karma

Every ophthamologist I have ever seen, wears glasses. There is a reason for that.

Kugler_Vision41 karma

You need to read the science:

conclusion of this study: "Ophthalmologists who perform LVC were significantly more likely than the general population to have LVC in their own eyes. The prevalence of refractive errors was significantly higher among ophthalmologists performing refractive surgery than in the general population."

atworkmeir75 karma

I had Lasik done in 2006. I remember crunching noises when they pried my eyes open. To this day I have to use eyedrops daily because of dry eyes, specially when I first wake up (where they are burning). I never had this issue before. Also this was a eye flap procedure I dont know if all Lasik is like this or not.

The place I had this done at told me for a year it would go away, up until they wernt responsible anymore and then said theres nothing they can do about it. The last eye doctor I went to said "you probably always had dry eyes"....

I tried restasis or w/e and they works but only if I used it daily, which kinda makes it pointless.

Anyway - what happened? Is there anything I can do, ever?

Kugler_Vision62 karma

I would recommend seeing a dry eye specialist. Dry eyes are a concern for 1.8% of lasik patients but not the other 98.2% so there is likely an underlying problem unrelated to the surgery that needs to be explored.

nick_diesel58 karma

I'm around a good amount of people frequently and the thickness of my lenses usually bring out conversations about laser eye surgery, and nearly every person that's had it done:

Had it done in the last ten years or so.

Nearly all have dry eyes.

Over half report degrading vision.

Over half report halos around lights.

Could you offer some amount of explanation? I wear contacts and would much rather keep wearing these because as I see it, there are zero side effects for corrective lenses. But most everyone has side effects (at least these people) from laser eye surgery. I can afford a reputable, high quality doctor/procedure...I just want either A. A perfect operation, or B. The safe way out by using glasses/lenses.

Kugler_Vision73 karma

The anecdotal reports from your associates are different that what the scientific studies show. Over 97% of LASIK patients are satisfied with their results and it is considered the most successful elective procedure done in all of medicine. There will soon be an updated study published that showed 99% of LASIK patients would recommend it to a friend or family member.

Regarding the specific symptoms, it is a myth that lasik causes dry eye. Certainly eyes feel dry for a few months, but then they do back to baseline. Dry Eyes from contact lenses are a major reason people have lasik and therefore are already dry, so there is confusion about this point. The most recent study showed a 1.8% chance of Dry Eye from lasik.

Halos were a problem with early lasik, but in recent years patients report LESS halos afterwards than they had before the procedure.

It is also important to note that contact lenses have more risks than LASIK and are more likely to cause vision loss or long-term problems.

There is no such thing as a "perfect" procedure, but modern LASIK is extraordinarily safe and effective.

Read more:

nick_diesel22 karma

I like relieving news.

Kugler_Vision18 karma

Sorry you had a rough experience. That is not typical. I'm glad it turned out well in the end though!

NetTrap43 karma

Hi, I have some questions:

  1. Is there any risk after LASIK when performing high intensity physical activities? E.g. hockey, soccer, powerlifting etc...?
  2. How common is dry eye, haloing or any other complications from LASIK?
  3. Is there any maintenance that can result from having the surgery done?
  4. How would a job as a programmer (staring at a computer screen 40 hours a week) affect my post-surgery eyes?


Kugler_Vision51 karma

  1. High intensity physical activities are not a problem, but if you engage in sports such as MMA or boxing then a procedure such as PRK or ICL is probably a better idea.
  2. Dry eye is 1.8%. Halos were very common in the early days, much less now.
  3. We advise regular eye exams to monitor eye health long term
  4. Computer programmers and IT professionals are common lasik patients!

Unpopular_But_Right16 karma

Can you explain prk and icl and the connection to sports like mma and boxing and why which procedures are recommended?

Kugler_Vision17 karma

With LASIK a flap is made on the surface of the eye. If hit with significant force the flap could move out of place. This is rare (less than 1:10000) but for MMA fighters it's a consideration.

FirstForFun445 karma

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Kugler_Vision8 karma

LASEK is the same thing as PRK. The concept with LASEK was to remove the epithelium and then put it back in place, but it turns out that doesn't really work. So it ends up being PRK.

TheDevilsFair40 karma

I had lasik 10 years ago and loved the results. I am 34 years old now and notice my vision is starting to blur again, nowhere near as bad as presurgery tho. I read somewhere that you could not do the regular Lasik a second time. Is that true? What are my options?

Kugler_Vision46 karma

It is uncommon to change between ages 24 and 34, though it is possible in <3% of people. There could be other reasons for a change in your vision. If you do need an enhancement it can be done with a laser. There are lots of different ways to approach it, including PRK (surface treatment) or another LASIK. But I would recommend a thorough evaluation from a LASIK surgeon to see what, if anything, you need.

Recoveringfrenchman14 karma

Would the halo effect diminish with a second treatment?

Kugler_Vision20 karma

Often yes. Sometimes we can demonstrate what your vision may look like using contact lenses or glasses beforehand.

nick_diesel37 karma

So let's say this post brings people like me to look into surgery.

Now what?

On our end how can a patient/customer choose the best doctors to have this done? What sort of questions should we be armed with so we can feel the most comfortable with X doctor? Are there machines of different ability/hardware/capabilities/function that make a noticeable difference? Should we be on the lookout for any type of words or sales gimmicks? I understand that while doctors should be upfront and honest about their equipment and personal skill, that is not always the case, and while we may not be capable of truly deducing who is best - is there anything you feel is notable to mention when making the decision?

Kugler_Vision35 karma

This is a common question.

The good news is that most reputable lasik practices are going to deliver good results for you, so you can remove a lot of anxiety by realizing that it's hard to go wrong. There are differences in technology and customer experience, however.

It is never a bad idea to get a couple of opinions and see where you feel most comfortable. Customer reviews are also valuable.

If you are looking for a list of top-quality centers, the refractive surgery alliance ( has a list of reputable centers.

gabtoofelytseerf34 karma

Does excessive use of cannabis affect the results of the surgery? (negative or positive)

Kugler_Vision26 karma

No effect.

kebirek31 karma

I understand that a patient that got LASIK and then develops cataract, will face problems with determining the correct intraocular lense graduation. Is this correct?

Kugler_Vision22 karma

The calculations are more complex, but we are really good at it. Consider that 16,000,000 people have had LASIK and all of them will one day develop cataracts. So this is not a concern.

funkengruven35 karma

16,000,000 people have had LASIK and all of them will one day develop cataracts

I'm pretty sure you're not saying that "everyone who has LASIK gets cataracts", because that sounds really bad! Can you clarify that statement?

Kugler_Vision87 karma

Ha! you're right that sounds bad.

What I meant is that everyone gets cataracts eventually (if they live long enough). LASIK has nothing to do with it.


Everyone will everydog get cataracts unless they die first

biscuitpotter28 karma

Everyone will everydog get cataracts

Wise words. Everydog indeed.

Kugler_Vision22 karma

Yes every dog gets cataracts too. If they live long enough.

katoshi26 karma

Are there any procedures that don't cut (create a flap) or move the epithelium aside, basically any procedure that can be done just by shooting the lasers in and not actually touching the eye at all?

I'd like to get my vision fixed but am very queasy about anything coming close to my eye, let alone touching it. So queasy I can't even wear contacts and no doctor has been able to get a contact lens in my eye so far.

So are there any procedures that can be done without actually touching my eye? Sorry if this is a stupid question.


Kugler_Vision28 karma

This is not a stupid question at all! In fact, the majority of LASIK procedures done these days are all-laser. There are soft instruments used to hold your eye open but you do not feel anything as numbing drops are given beforehand.

No one likes things touching their eyes, so everyone feels this way. We are really good and making people comfortable!

nellenelli24 karma

I have t2 diabetes. Does this kill my chances for LASIK?

Kugler_Vision16 karma

If the diabetes is well controlled and your blood sugars are stable then it can be a good treatment.

BraunDog23 karma

I had PRK done back in early December of 2015. As of today, my vision is still not 100% back although it being almost at the 6 month mark already. Is this normal? And if my vision never gets to 20/20, would you recommend I get PRK again to correct it even further? Thanks!

Kugler_Vision30 karma

It is hard to know why you are not seeing 100% yet without seeing you myself. Typically PRK is healed by 3-9 months so you are still in the range of normal healing.

BraunDog12 karma

Awesome, I was told 6 months.. maybe thats because its right in between 3 & 9, thanks!

Kugler_Vision17 karma

Have you seen your surgeon since the procedure? If not you should see them and make sure they are doing everything they can to help your healing process.

johnlatv18 karma

Is there an age where you don't recommend getting LASIK? I am 46 i've heard that it would be a waste for me to get it at this point in my life.

Kugler_Vision20 karma

Lasik is a great option at age 46! Not too old at all.

jayjay74717 karma

is there any sort of warranty period provided on the vision ?

Kugler_Vision16 karma

Most practices will provide an enhancement procedure at no charge within a reasonable timeframe if required.

tkim913218 karma

What is a reasonable timeframe to you and your practice?

Kugler_Vision13 karma

Typically 1 year. By then the eyes have healed.

padamil17 karma

Is there a limit to how bad your eyesight can be and have the surgery? Every time I've asked an opthamologist about it in the past, my eyes keep outpacing what Lasik can do.

Kugler_Vision11 karma

yes there are limits to LASIK. The good news is that there are other procedures (such as implantable lenses) that can help people that are beyond the limits.

Kugler_Vision11 karma

Surgeons have different opinions on this point, but in general lasik is a reasonable option up to a -8.00 - -9.00 range. Beyond that the results are not nearly as good.

Onlysilverworks5 karma

How bad are your eyes? I have a - 2 in my left, and - 19 in my right. Always wondered if laser surgery was an option

Kugler_Vision8 karma

-19.00 is beyond the range of LASIK but there are other options such as lens implants

Trolloc16 karma

I just had Lasik on both my eyes a little over a month ago.

The vision in one of my eyes is perfect. However in the other which has astigmatism, the vision only improved slightly and likely will still require corrective lenses.

On my check up appoints I get mixed answers from optometrists on what is going on. One believes the eye is still healing and the vision will improve another suggests there is a slight prescription. What are possible reasons this has occurred? Is it possible for vision to still improve over a month after surgery?

Kugler_Vision21 karma

Since it has only been 1 month, it is likely that your eye will catch up to the other one. If not then an enhancement may be an option to correct any residual astigmatism that was not fully corrected. Approximately 2.7% of eyes heal differently and benefit from an enhancement.

Homeyjosey16 karma

Would you trust Lasik through a groupon coupon? What is the minimum you'd spend to get Lasik?

Kugler_Vision20 karma

In general there are no deals or shortcuts in the world of LASIK. You generally get what you pay for in terms of service, technology, and attention to detail.

Price works itself out for people because LASIK is so much less expensive than contact or glasses over time.

Homeyjosey9 karma

So, you're saying dont buy the groupons, got it

Kugler_Vision16 karma

I'm saying if you are buying on price then read the fine print. If you are looking for value and experience then you probably aren't going to find it on groupon.

For example Walmart has good products at a cheap price, but there is no service or expertise. Nordstroms has great products at higher prices but you also get service and expertise. Neither one is necessarily better than the other, but buyer beware.

Endyd9 karma

How about medical tourism for LASIK? I got it done in Korea when I was there for a quarter of the price I saw in the US. Did I get a lower quality procedure?

Kugler_Vision12 karma

Not necessarily. There is really good quality LASIK being done all over the world.

Endyd3 karma

So... tell me why one should get it done in the US when he can fly to Asia or Europe and get the procedure for $1,200... I guess you need a hotel when you're there (or hostel if you want to go cheap) and it will cost $3,500 max with flights, food, procedure, and lodging... The financing option from the website you're posting looks like $179 for 24 months, which is $4,296.

Kugler_Vision4 karma

You could go to Europe or Asia and likely have a very good result. Economics differ all over the world, so I do not know how a $1200 procedure outside the U.S. compares.

canada_mike12 karma

I had LASIK with custom wave front. What does that mean? I didn't actually ask my doctor they just said I needed the custom wave front and that cost almost 5 times as much

Kugler_Vision21 karma

"Custom" is the term given to advanced LASIK treatment patterns. In the early days of lasik (15-20 years ago) we used "conventional" patterns that were good but had some side effects such as night glare. For the past 10 years or so we have been using almost exclusively "custom" patterns which provide a higher quality of vision and exceptional results.

It is uncommon for there to be a price difference for custom treatments as most centers offer only custom treatments.

canada_mike6 karma

is it normal for the cost to be higher as the prescription is higher? What's the justification for that, isn't it the same laser?

Kugler_Vision15 karma

Some corporate centers do this because it allows them to advertise a lower price then they are actually charging. Most private lasik centers do not charge based on prescription.

erie_bound12 karma

I am 34 years old. During and after my teen years, my contact lens prescription had to be increased from around -3.50 to -4.25. Over the last five years, however, my ophthalmologists have slowly reduced my prescription to about -3.75, saying that it appears that my eyesight has improved. How might this development impact my suitability for LASIK?

Kugler_Vision22 karma

If you went from a -4.25 to -3.75 then most likely your prescription was too strong for a few years. You likely have really been a -3.75 all along. At age 34 you are definitely stable and there is no reason to wait.

snottyrocket11 karma

I had LASIK 15 years ago as a present from my parents when I turned 21. My prescription back then was ~-4.25/-4.75.

Despite using the antibiotics and steroids provided I caught an MRSA infection in both eyes that ruined my corneas, and i ended up having to have bilateral cornea transplants after spending six months blind (could tell if it was nighttime or daytime).

Have you seen this happen? How often would you say this kind of infection occurs?

Edit: My prescription now is -8.25/-9.25, CYL -5.5/-3, and Axis 61/26

Edit 2: Picture of my cornea scars

Kugler_Vision8 karma

Wow I am really sorry to hear that. The last statistic I read on lasik infections was 1:10,000, so it's somewhere in that range. MRSA is a bad bacteria and very difficult to treat.

ufufbaloof11 karma

Is Lasik an option for someone with keratoconus?

Kugler_Vision16 karma

No. But there are other technologies to consider such as lens implant, intacs, and crosslinking.

GooseRace10 karma

What is a good age to get LASIK done? I heard from friends that you should wait until you are at least 23 years old.

Kugler_Vision19 karma

Approximately 90% of eyes reach the milestone of Ocular Maturity (meaning the eye is no longer developing or changing) between ages of 15 and 21. A good rule of thumb is that "graduation" is a good time for lasik, such as high school graduation, college, grad school. In fact, lasik is a common graduation gift! There is a small percentage of people (~3%) who have some change in their prescription in their 20s, but 97% have no significant change and therefore low change of vision worsening.

There is nothing special about age "23."

More info here:

neonpinata10 karma

I'm almost 27, and my vision won't seem to stop deteriorating. Every year when I go renew my contacts prescription, I need a stronger one. Am I just one of those people who's eyes keep developing late, or do some people's eyes never stop worsening? And if that's the case, would I never be able to reliably get LASIK?

Kugler_Vision3 karma

It's unusual to have continued changes at age 27, but it is possible. If you haven't seen a LASIK surgeon yet I would recommend seeing one so that they can document your current eye optics and see if there is really change.

outrayge9 karma

My optometrist said that getting Lasix doesn't guarantee 20/20 vision. My glasses are -7.0R and - 7.5L. He told me to don't come into Lasik expecting perfect vision and it does degrade over time. Is that true?

Kugler_Vision20 karma

It does not degrade over time. This is a myth. It is true that your lens inside the eye changes over time in everyone, which is where much of the confusion arises, but lasik itself is a permanent change.

It is true there is no guarantee of 20/20, but the vast majority reach that point and over 95% have no need for glasses after the procedure.

Thinkiwas8 karma

Not sure if I am too late for this, but here goes. I had LASIK back in 2006 on both eyes. My contacts prescription was -9.5 and -8.5 in my right and left eyes, and the constant usage ( 10 years) was drying out my eyes. I was advised seek LASIK Or revert back to glasses. After a successful surgery, I enjoyed great vision, but it seemed to get a bit worse as the year progressed. After a full year, the Dr did a touch up in my left eye, but not my right. Said my right will strengthen to match the right (?)

Fast forward to 6/2012 and the birth of my first child, I had difficulty seeing at night, and thought it was from the pregnancy. However my vision slowly creeped up the "getting worse" scale until 2014 when I saw an ophthalmologist because I was unable street signs to see to safely drive. Eye tests came back normal, they seemed to stabilize at -1.50 in my left eye and -2 in my right. Two years later I'm at -2.50 in both eyes. My right eye tests at a weaker prescription, however it doesn't work and I can't see, so I do the terrible thing and use a stronger prescription.

the doctor I saw in 2014 said I can do LASIK again, but I'm obviously nervous. Do I just stick with glasses and contacts for the rest of my life? I also have dry eye issues from the LASIK as well. :/ thanks so much!

Kugler_Vision4 karma

Hard to know without seeing you myself, but you may be one of the 3% or so of highly-nearsighted people who have some drift over time. I would recommend getting another opinion from a lasik surgeon.

peachesbkeen8 karma

At what age do you suggest someone get laser eye surgery? I'm still in college and I hear that it's best to wait till after you're done with schooling because your vision deteriorates while at school due to all the close readings, etc. Is this true?

Kugler_Vision9 karma

Approximately 90% of eyes reach the milestone of Ocular Maturity (meaning the eye is no longer developing or changing) between ages of 15 and 21. A good rule of thumb is that "graduation" is a good time for lasik, such as high school graduation, college, grad school. In fact, lasik is a common graduation gift! There is a small percentage of people (~3%) who have some change in their prescription in their 20s, but 97% have no significant change and therefore low change of vision worsening.

KaleidoscopicBullet8 karma

Is there anyway you can give patients calming medication (like laughing gas) before the surgery?

Kugler_Vision17 karma

We keep you comfortable! Approximately 50% of our patients take valium or similar medication prior to the procedure to prevent anxiety. It is really comfortable and quick.

xavyre7 karma

If someone blinks, do you burn their eyelid? Or if they look to the side, to you get the wrong part of the eye? Tell us a story.

Kugler_Vision11 karma

Great question! The lasers use tracking systems that follow the eye 1000 times per second. If the eye moves the laser moves along with it so it is always perfectly centered. If you move beyond the range of the tracker the laser stops. There is NO WAY you can mess it up.

As for blinking, your eyes are held open with a device that makes it impossible for you to blink. So you can't mess that up either!

fatdogmendoza7867 karma

Hi, is LASIK surgery possible for someone who has had a corneal graft?

Kugler_Vision10 karma

In some cases, yes. It really depends on the graft quality, shape, and degree of correction necessary. But in theory it is possible and can be a big help for people

rockacha137 karma

My son is 17 and his eye sight is around -4.5. What are recommended criteria for Lasik surgery?

Kugler_Vision10 karma

It would be a good idea for him to see a lasik surgeon now so that they can get some baseline measurements. LASIK is FDA approved for ages 18 and up.

Crikien5 karma

I have 20/15 in my left eye and stable 20/200 in my right. Wearing glasses or contacts gives me headaches.. will getting lasik make the headaches worse or will they get better as my brain adapts to the new vision? Is it likely to help my depth perception? Finally, would you anticipate an outcome equal to my left eye's native ability or somewhat worse given the quality of the right eye?

Thanks for doing this!

Kugler_Vision5 karma

It depends on why you are getting the headaches... it's hard for me to answer without knowing all the specifics. In general you should expect lasik to provide vision that is similar to what you see with glasses or contacts.

InstantPizzaa5 karma

Why is this procedure so expensive if it takes 20 minutes?

Kugler_Vision3 karma

The actual procedure takes minutes, but the process of evaluation, planning, procedure, and post-op care is very labor intensive. The technology is really expensive too.

TrumpSRB4 karma

Hi! My right eye's vision is very blurry even with glasses. Can that be fixed with LASIK?

Kugler_Vision10 karma

It depends on what the problem is with your right eye. In general, LASIK is able to give you vision that is as good or slightly better than glasses. But if you have Amblyopia (aka "lazy eye") then LASIK is not going to fix that problem as it is a problem within the vision center of the brain.

AbaDooby4 karma

Is it true that you need to be a certian age to get lasik?

Kugler_Vision13 karma

The FDA has approved LASIK in people ages 18 and above, so that is the age at which we start to consider it.

Trees_like_a_Boss4 karma

How effective is LASIK? What are issues a person could have that would keep them from ever getting the surgery?

Kugler_Vision11 karma

LASIK is the most successful elective procedure in the history of medicine. The satisfaction rate exceeds 95-97% which is astounding. So it is very effective.

LASIK is a good solution for ~85% of the new patients that we see. The other 15% are better suited for other technologies such as implantable lenses or corneal inlays..

Reasons why other options may be better than lasik include thin corneas, high prescriptions, age, ocular diseases, etc.

wasabisabi4 karma

I had a scleral buckle procedure to fix a retina detachment - would I still be able to get Lasik? Are there more complications?

Thanks for doing this AMA!

Kugler_Vision4 karma

Eyes that have had a scleral buckle may have lasik.

Robo-boogie4 karma

Im 32, i feel like my prescription has changed in a four year period. should i consider getting lasik?

Kugler_Vision7 karma

It is very unlikely for prescriptions to change in your 30's. It's more likely that your prescription wasn't accurate the past few years. You should definitely consider LASIK.

Jejihu4 karma

I always wanted Lasik, and I know how likely it is for a successful procedure.

However, I have read a lot of stories about people's eyes becoming permanently dry and several failure cases. 97% success rate sounds great, but that is also 1 in every 30 people or so with a negative experience.

How bad can it get for those in that 3%?

Also, my most important question: Lasik is a fairly new procedure. I'm not sure when it was invented, but even if it were invented 30 years ago, it's still fairly new. How can you be sure of the life long side effects if there has been no testing involved? For example, I am 22, how can I be confident that Lasik will not affect my eyes negatively when I am 72?

Kugler_Vision4 karma

97% is higher than anything known in medicine...higher than glasses, contact lenses, plastic surgery, etc. It is higher than almost any product anyone could purchase. So it's a tremendous testament to its success.

As for the 3%, most of them have very treatable conditions and we can make them better and get them into the 97%. It just may not happen right away.

It's important to realize that modern lasik is safer than wearing contact lenses. You are much more likely to loose vision from contact lenses than LASIK. So a better question is "how bad can it get from wearing contacts?"

We have data on laser surgery going back to the late 1980s. The technology was in its infancy at that time and yet the long-term data is still positive. We have data on contact lenses going back to the 1950s and the data is not as positive.

LETSgoPENS20134 karma

Is there an eye test prior to the procedure or does the surgeon use the laser to correct any deficiencies in the lenses of the eyes? I wear contacts and without them the vision in my left eye is way worse than in my right eye, however with the contact lenses the vision in my left eye is perfect but my right eye can never seem to get to 100%, no matter the prescription. Would this issue be alleviated with LASIK?

Kugler_Vision6 karma

Probably not. It depends on why your left is worse, but you should not expect the lasik to be better than your contacts.

optionsquare3 karma

Thank you for doing this AMA. What are some possible human errors that could incur during the procedure? Also, what are the odds I end up blind or severely debilitated? I'm seriously considering trying LASIK, but I don't particularly live in a very professional country.

Kugler_Vision5 karma

The odds of blindness and severe debilitation are less than 1:1000 (probably even less than that now). Human error can definitely occur, but most centers have checks and balances to reduce them. The most likely human error is entering the wrong information into the laser. If that happens it is usually fixable later. Fortunately it's extremely rare and unlikely.

AwkwardlyAwesome202 karma

I have bad vision and have been told to wait a while before getting LASIK surgery, when would you say is the best time to get LASIK? What are the chances that my vision would go bad again?

Kugler_Vision8 karma

Approximately 90% of eyes reach the milestone of Ocular Maturity (meaning the eye is no longer developing or changing) between ages of 15 and 21. A good rule of thumb is that "graduation" is a good time for lasik, such as high school graduation, college, grad school. In fact, lasik is a common graduation gift!

There is a small percentage of people (~3%) who have some change in their prescription in their 20s, but 97% have no significant change and therefore low change of vision worsening.

More info here:

spikes20202 karma

I had it done but when they gave me the valume to calm my nerves it didn't do shit. They gave me 1 pill and i felt nothing and gave me a second 20 min later. After the second they said that they couldn't give me any more. They had to hold me down for the sergury.

I don't do any drugs but I have raced motercycles and skydive and after they said this was the cause. Does this happen much?

Kugler_Vision3 karma

Some people are resistant to anxiety meds for unknown reasons. Perhaps you are one of those people! Approximately 50% of patients use the anxiety meds before lasik, and the other half don't need any

MooseLips_SinkShips2 karma

Two questions if possible:

  1. I had LASIK surgery. While under the laser, I could smell a burning type of smell. Was that my eyes? Or, was it in fact the "Laser gas" that they told me to not be alarmed by.

  2. I sometimes get ghosting when looking at white text on a dark background, sort of like this. During my last checkup, the doctor said there's not much which can be done. He could fix it but it would reduce my vision. Might there one day be a way to repair it while keeping my accuracy?

Kugler_Vision2 karma

The aroma that you noticed is caused by proteins in the air. There is no burning in lasik but proteins are aerosolized.

Hard to know for sure why you are having ghosting, but it is likely from some residual astigmatism. That is often treatable.

Luke0942 karma

Can i get lasik if I'm only 22 years old or should I wait more? My vision have been stable for about 2 years

Kugler_Vision3 karma

Approximately 90% of eyes reach the milestone of Ocular Maturity (meaning the eye is no longer developing or changing) between ages of 15 and 21. A good rule of thumb is that "graduation" is a good time for lasik, such as high school graduation, college, grad school. In fact, lasik is a common graduation gift! There is a small percentage of people (~3%) who have some change in their prescription in their 20s, but 97% have no significant change and therefore low change of vision worsening.

Age 22 is an ideal time for LASIK.

Dirt_E_Harry2 karma

Are there any age limits to this procedure, meaning when is a person too old for this procedure?

Kugler_Vision3 karma

There is no hard and fast age limit. However, once DLS starts to develop, there may be other options that will deliver the results you are looking for. Once someone is in their 50's-60's then Lens Replacement is often a better solution

Arriettys_mom2 karma

My mom had Lasik, and her farsighted vision is incredible now! But, now her near-sited vision, which wasn't bad before, is legitimately worse. How often does that kind of effect happen?

Kugler_Vision3 karma

She has DLS which happens to everyone in their 40's and beyond.

DudeyMcSean2 karma

Is it true that if you are short sighted and have it corrected, you've become long sighted?

Kugler_Vision3 karma

Everyone in their 40's starts to develop Dysfunctional Lens Syndrome which means they have trouble seeing up close. This occurs regardless of whether someone has LASIK.

You can read more about it here:

The_Lord_Chicken1 karma

I had Lasik in 2003. In 2011 I ended up with an infection that got under my Lasik flap. After a round of antibiotics the infection was gone, but it left some residue under my Lasik flap. This causes problems with my vision in that eye. Are there any ways to correct that?

Kugler_Vision3 karma

Wow how did you get an infection? That is really rare. It's hard for me to answer without seeing you myself but I would recommend seeing a corneal specialist to discuss options

Johnny_Lowjack1 karma

I am pretty far sighted with an astigmatism, I was told this makes me less than ideal for LASIK. How true is this?

Kugler_Vision2 karma

We can treat farsightedness with LASIK but it's true that it is less predictable than nearsightedness and also more limited range of farsightedness than we can treat. So if you have moderate or severe level of farsightedness then there may be better options.

grshirley1 karma

Is there an optimum age to get Lasik done? My eyesight went from great to disastrous in a very short time frame when I was about 19 and my ophthalmologist suggested two times you shouldn't get it are end of puberty and around 40. That advice was quite a few years ago though.

Kugler_Vision2 karma

Approximately 90% of eyes reach the milestone of Ocular Maturity (meaning the eye is no longer developing or changing) between ages of 15 and 21. A good rule of thumb is that "graduation" is a good time for lasik, such as high school graduation, college, grad school. In fact, lasik is a common graduation gift! There is a small percentage of people (~3%) who have some change in their prescription in their 20s, but 97% have no significant change and therefore low change of vision worsening.

fukincrucial1 karma

I got lasik about two years ago, during the daytime my vision is perfect, but when I'm out at night or in a dark room, LED's and regular lights give me some sizeable halos. What can I do to alleviate this?

Kugler_Vision2 karma

You may consider asking your doctor if eye drops would help. There are drops that can make your pupil slightly smaller and help with those symptoms.