Our preliminary analysis questioned whether refractive surgery may be as safe, or even safer, than long-term contact lens wear. It is not a simple question. We are stymied by the lack of adequate data to assess the risks of either refractive surgery or contact lens use. The large contact lens studies do not report final visual acuity or the incidence of corneal transplantation following infections. The US military refractive study is a good start but is not large or broad enough to answer the questions definitively either. Broader information on refractive outcomes may be glimpsed from recent eye bank data on corneal transplantations performed for vision loss related to refractive surgery. These data reflect the broad spectrum of problems across the country but likely include many older patients who have undergone radial keratotomy. In 2004, the first year for which we have data, 46 of 31 139 transplantations were performed for refractive surgery complications in the United States. During that same year, there were nearly 1 400 000 refractive procedures performed, 1 corneal transplantation for every 32 000 refractive procedures. These numbers are rough approximations, but they still provide a ballpark figure for the whole country that is in line with our previous estimates.
Mathers WD. Comparing Contact Lens and Refractive Surgery Risks—Reply. Arch Ophthalmol. 2007;125(6):854–855. doi:10.1001/archopht.125.6.854
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