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Refractive surgery safety: what you need to know

25 years of clinical experience, 40 million procedures worldwide, a serious complication rate below 0.1%. Here is a precise, source-backed overview of the safety of LASIK and other refractive techniques.

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Safety is the first question patients ask when considering refractive surgery. It is a legitimate concern: the procedure operates on a fully functioning organ. This page brings together the hard data, the objective eligibility criteria, the course of post-operative follow-up, and answers to the most frequently asked questions, so that you can approach your consultation with Dr Tourabaly with a clear understanding of what is at stake.

Background

Written and medically reviewed by Dr Moïse Tourabaly · Last updated: August 23, 2026

Why is LASIK safe today?

LASIK benefits from more than 25 years of clinical experience. Over 40 million procedures have been performed worldwide since it was approved by the Food and Drug Administration (FDA) in 1999. This technological and surgical maturity explains the level of safety achieved today.

Three major advances have reinforced the safety of LASIK:

  • Femtosecond laser: Replaces the mechanical microkeratome to create the corneal flap. Micrometer precision, high reproducibility. Dr Tourabaly uses the VisuMax 800 (Carl Zeiss) at the Clinique Laser Victor Hugo (Paris 16).
  • High-frequency eye-tracker: The Schwind Amaris 750S excimer laser tracks micro-movements of the eye at 1,050 Hz. If the eye moves, the laser stops automatically. The risk of a decentred treatment is therefore greatly reduced.
  • Wavefront customization (aberrometry): The treatment is not standardized; it is calculated from the optical aberration map specific to each eye. The result: optimized post-operative vision quality, particularly in low-light conditions.

Dr Tourabaly’s refractive procedures are performed at the Clinique Laser Victor Hugo (27 bis avenue Victor Hugo, 75116 Paris). Pre-operative assessments take place at the Cachan practice (94230).

Hard data

Complication statistics: what the studies show

Three major scientific publications currently serve as references for assessing the safety of LASIK and related refractive techniques.

  • Sandoval HP, et al. Modern laser in situ keratomileusis outcomes. J Cataract Refract Surg. 2016;42(8):1224-1234. PMID 27531300. Literature review of more than 67,000 eyes operated on between 2008 and 2015. In the subgroup in which acuity was measured, uncorrected acuity better than 20/40: 99.5% (59,503 of 59,825 eyes). Refraction within ±1.0 D of target: 98.6%. Loss of two or more lines of corrected acuity: 0.61%.
  • Eydelman M, et al. (PROWL study). Symptoms and satisfaction of patients in the Patient-Reported Outcomes With Laser In Situ Keratomileusis (PROWL) studies. JAMA Ophthalmol. 2017;135(1):13-22. Prospective FDA study. Dry eye at 3 months: 28% among patients whose ocular surface score (OSDI) was normal before surgery, PROWL-1 and PROWL-2 combined; new visual symptoms reported by 43% (PROWL-1) to 46% (PROWL-2) at 3 months; vision dissatisfaction = only 1 to 4%. PMID 27893066.
  • 2025 Review. PMID 40197080. Synthesis of 2016-2023 data. Rate of serious complications (irreversible loss of visual acuity ≥ 2 lines, corneal ectasia, sight-threatening infection): below 0.1%.

To put these figures in context: the risk of a serious complication after LASIK is considerably lower than the risk of corneal complications linked to prolonged contact lens wear (infectious keratitis: 1 case per 500 wearer-years according to international registries). The prevention of infections after refractive surgery is precisely the subject of a French national survey led by Dr Tourabaly (JCRS, 2021), which documents current prophylaxis practices.

Eligibility

Strict eligibility criteria = maximum safety

The safety of refractive surgery depends first and foremost on the rigor of patient selection. A patient who is not eligible is directed toward another technique or a non-surgical solution. The pre-operative assessment is the step that makes this objective decision possible.

  • Minimum age 18, ideally 21 and over: To ensure refractive stability. Before this age, myopia may still progress.
  • Stable refraction for at least 12 months: A change in correction over the past year is a contraindication to the procedure.
  • Sufficient corneal thickness: Measured by ultrasound pachymetry and Scheimpflug imaging (Sirius+). Below an individually calculated threshold, LASIK is contraindicated and PRK is offered instead.
  • Normal corneal topography: Absence of early or subclinical keratoconus. Screening uses Sirius+ mapping (anterior surface + posterior surface + thickness).
  • No progressive ocular conditions: Severe dryness, uveitis, uncontrolled autoimmune disease, current pregnancy, or recent breastfeeding.

Around 10 to 15% of LASIK candidates are redirected after their assessment to another technique (PRK, SMILE, phakic implant) or to monitoring without surgery. This selection is the patient’s first line of protection.

Techniques

Techniques matched to your profile = personalized safety

There is no single refractive surgery: there are four main techniques, each suited to a specific patient profile. The right technical choice is the condition for optimal safety.

  • LASIK: Normal corneal thickness, moderate to high refractive error, patients wanting rapid recovery (24-48 h).
  • PRK: Thin cornea, contact sports, professions with a risk of trauma (police, military, athletes). No corneal flap, corneal strength preserved.
  • SMILE: Myopia, astigmatism and hyperopia, the latter being a more recent indication. Minimally invasive technique, less post-operative dryness than LASIK.
  • Phakic implant (ICL): High myopia (typically beyond -8 D), and lower degrees of myopia when corneal laser surgery is not possible: a cornea that is too thin, irregular or at risk. High astigmatism. Reversible intraocular lens.

No technique is universally “the safest”. The safest one for you is the one that matches your anatomical profile and your lifestyle. See the Refractive surgery: an overview page for a detailed comparison.

Assess your profile in consultation

Post-op follow-up

Post-operative follow-up: monitoring safety

Safety does not end on the day of surgery. Close follow-up allows the rare complications to be detected early and confirms the stability of the result. The schedule depends on the technique:

  • The next day (Day 1): after LASIK or SMILE, check-up at the Clinique Laser Victor Hugo; after a phakic ICL implant, a check-up also takes place the next day. Verification of the flap’s correct position after LASIK, visual acuity measurement, first assessment of recovery.
  • Day 3 or Day 4 after PRK: check-up at the removal of the bandage contact lens, once surface healing is under way. After a phakic ICL implant, an additional check-up takes place at Day 7.
  • At one month: a check-up common to all four techniques. Measurement of corrected and uncorrected visual acuity, check of the tear film, search for persistent halos.
  • Beyond the first month, no appointment is scheduled in advance: refractive stabilization is assessed over the months that follow, and a follow-up topography is performed only if the clinical course warrants it.
  • Beyond the first year without complications, the risks specific to the procedure are considered resolved, with no routine consultation scheduled at that point. Further appointments are added at any time if your progress requires it.

Between the scheduled consultations, any unscheduled visit is possible and strongly recommended if unusual pain, a sudden drop in vision, persistent redness, or purulent discharge appears. The Cachan practice can be reached at +33 1 45 47 08 11.

Standard post-operative treatments: anti-inflammatory eye drops (tapering-dose corticosteroids over 3 weeks), antibiotic eye drops (7 days), preservative-free artificial tears (1 to 3 months). The full prescription is provided on the day of the procedure.

FAQ

Frequently asked questions about refractive surgery safety

Serious complications capable of causing a significant loss of visual acuity are rare: a review of the studies published between 2016 and 2023 puts them at 0.07% of operated eyes (PMID 40197080). Rigorous post-operative follow-up makes it possible to detect and treat them.

The refractive result of LASIK is stable over time for the great majority of adult patients. Long-term post-operative changes remain below 0.5 diopters over 10 years in most published series. Presbyopia, a natural age-related change that begins around 45, remains independent of LASIK: it may require specific correction for near vision (PresbyLASIK, progressive lenses, etc.).

A partial regression can occur, especially in patients with high initial myopia or a strongly “healing” cornea. If it is clinically significant, an enhancement (re-treatment) is technically possible after 3 to 6 months, provided the residual corneal thickness allows it. Dr Tourabaly systematically discusses this possibility during the initial assessment.

A speculum holds the eyelids open comfortably during the procedure. The Schwind Amaris 750S excimer laser features an eye-tracking system at 1,050 Hz: if the eye moves by more than a few microns, the laser stops automatically and then resumes at the exact spot where it left off. Treatment of an unintended area thereby becomes extremely unlikely.

Transient dry eye is the most common side effect after LASIK. According to the PROWL-1 and PROWL-2 studies combined (Eydelman et al., JAMA Ophthalmol 2017;135(1):13-22), about 28% of patients whose ocular surface score (OSDI) was normal before surgery develop dry eye symptoms at 3 months. It is treated with preservative-free artificial tears and resolves spontaneously in the great majority of patients by 12 months. For patients with pre-existing dryness, PRK or SMILE may be preferred.

Halos and nighttime glare are common in the first weeks after surgery, especially for high corrections and large pupils. They gradually decrease over 1 to 3 months and rarely remain bothersome after 6 months. Aberrometry-customized lasers (used by Dr Tourabaly) have significantly reduced the incidence and severity of this symptom.

Non-contact sports (swimming away from chlorine, cycling, running): permitted from Day 7. Sports with a risk of indirect eye trauma (football, basketball, tennis): from Day 30. Direct-contact sports (boxing, martial arts, rugby): from 3 months, with eye protection recommended. For the athletes concerned, PRK is a flap-free alternative to discuss.

Not during pregnancy or breastfeeding. Hormonal changes can temporarily alter refraction and the quality of the tear film. It is recommended to wait at least 3 months after the end of breastfeeding before carrying out the pre-operative assessment. If refractive surgery is being considered, it is better to plan it before a pregnancy, or after breastfeeding has ended.

Well-controlled diabetes (stable HbA1c below 7%, no active retinopathy) is not an absolute contraindication to LASIK. A dilated fundus examination is systematically performed to screen for any diabetic retinopathy. In the case of progressive retinopathy, LASIK is postponed. Dr Tourabaly’s Diabet’ Paris 13 practice specializes in diabetic eye monitoring.

A refractive enhancement is possible in about 2 to 5% of cases depending on the series. It can be carried out after a stabilization period of at least 3 to 6 months, provided the residual corneal thickness is sufficient. Two technical options exist: re-lifting the original flap, or converting to a surface PRK. The choice depends on the patient’s profile and will be discussed in consultation.

Next step

Assess your candidacy in consultation

The only way to know with certainty whether refractive surgery is indicated, and which technique, is the pre-operative assessment. It lasts about 1 hour 15 minutes, includes 7 complementary examinations, and concludes with a detailed consultation with Dr Tourabaly. At the end of the assessment, you have an objective medical decision: eligible, eligible for another technique, or not eligible for refractive surgery.

Dr Moïse Tourabaly is a former Chef de Clinique (Hôpital des Quinze-Vingts / Sorbonne), holds the inter-university diploma (DIU) in Refractive Surgery, and is a member of the Société Française d’Ophtalmologie. Over 1,100 Google reviews, average rating 4.9/5. Consultations at the Cachan practice (1 Ter rue Camille Desmoulins, 94230 Cachan) and at the Paris 13 practice (12 rue du Moulin des Prés, 75013 Paris).

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This article is for informational purposes. A personalized ophthalmological opinion remains essential for any treatment decision.

Scientific references

  • Sandoval HP, et al. Modern laser in situ keratomileusis outcomes. J Cataract Refract Surg. 2016;42(8):1224-1234. PMID 27531300
  • Eydelman M, et al. Symptoms and satisfaction of patients in the Patient-Reported Outcomes With Laser In Situ Keratomileusis (PROWL) studies. JAMA Ophthalmol. 2017;135(1):13-22.
  • Susanna BN, Mohan N, Santhiago MR, Randleman JB. Laser in Situ Keratomileusis Outcomes and Complications: 2016 to 2023. J Refract Surg. 2025;41(4):e391-e403. PMID 40197080.
  • Haute Autorité de Santé (HAS): Chirurgie réfractive : fiche d’information patient. has-sante.fr
  • Société Française d’Ophtalmologie (SFO): Refractive surgery guidelines. sfo.asso.fr

Written by Dr Moïse Tourabaly

Ophthalmic surgeon · Former Chef de Clinique, Quinze-Vingts National Eye Hospital (Sorbonne University) · RPPS 10101444676

Page reviewed and updated on August 23, 2026

Sources: French Society of Ophthalmology (SFO), French National Authority for Health (HAS), PubMed.