Contact Lenses vs. LASIK: Understanding the Long-Term Risks

By Your Health Magazine Contributor

Your Health Magazine Contributor

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Contact Lenses vs. LASIK: Understanding the Long-Term Risks

Emma Marsden was mucking out her horses on a February morning when she slipped and fell headfirst into a wheelbarrow full of dirt and water. She washed her face and hands immediately. She did not remove her contact lenses until later that evening. Within a few days, her right eye began to sting. She lost vision in it. Doctors diagnosed her with Acanthamoeba keratitis, a parasitic infection caused by a microscopic organism living in tap water that had burrowed through her cornea while her lens held it in place. She also developed fusarium keratitis, a severe fungal infection, and corneal ulcers. Her eyelids were sewn together to promote healing. She now faces a corneal transplant.

NationalWorld reported Emma’s case in full. She is a mother of three from the UK. She did nothing reckless. She wore contact lenses, as millions of people do every day, and she washed her face without thinking about it.

Her case is not unique. Marie Mason, 54, from Leicestershire, contracted the same infection in 2015 after showering while wearing her lenses. She received three corneal transplants. None of them saved her sight. The decision was eventually made to remove her left eye entirely. She told the BBC: “It would have got under the lens then multiplied. My eye was riddled with it.” She now wears a prosthetic eye.

These are individual cases at the severe end of the spectrum, not a representative picture of contact lens wear. They do, however, point to a category of risk that is worth understanding alongside the risks of the surgical alternative.

Comparing the Available Risk Data

Professor John Dart of the UCL Institute of Ophthalmology and Moorfields Eye Hospital, a leading UK authority on Acanthamoeba keratitis, places the annual UK incidence at 150 to 200 cases per year. That figure has been climbing. Research from UCL and Moorfields identified a three-fold increase in Acanthamoeba keratitis cases since 2011 across South-East England. Moorfields alone treats over 35% of all UK cases. According to clinical outcome data from the hospital, one in four patients with Acanthamoeba keratitis ends up with less than 25% vision or loses their sight entirely, and one in four requires corneal grafting.

Acanthamoeba is the severe end of a broader problem. Microbial keratitis, the general category of serious contact lens-related corneal infection, affects between 2 and 4 per 10,000 daily wear users every year, rising to 13 to 21 per 10,000 for extended overnight wearers, based on data published across multiple peer-reviewed epidemiological studies.

The UK has approximately 3.9 million contact lens wearers according to the Association of British Dispensing Opticians.

The rate of serious, sight-threatening complications from laser eye surgery at properly accredited clinics sits between 0.07% and 0.3% depending on the study and how complications are defined.

A meta-analysis published in the Journal of Cataract and Refractive Surgery compared microbial keratitis rates between contact lens wearers and post-LASIK patients. It reported that over extended periods, extended wear soft contact lenses were associated with roughly three times as many cases of microbial keratitis as LASIK. At one year, the risks were broadly comparable. Over longer follow-up periods, the cumulative contact lens figure exceeded the post-surgical one.

These are population-level figures drawn from different study designs and populations, and they are not a substitute for an individual risk assessment.

Factors That May Shape Public Perception

Public perception of LASIK does not necessarily track the procedure as it is performed today, and a couple of factors may help explain the gap.

The first is timing. LASIK became available in the UK in the mid-1990s. The technology then was more limited. A mechanical blade called a microkeratome created the corneal flap, aberrometry was less refined, and outcomes were less predictable. Patients who experienced complications during that era are now in their 40s and 50s, and their accounts appear in forums and features about medical regret. Those experiences were real, but they reflect an earlier generation of the technology.

Public perceptions of LASIK may also be influenced by the fact that surgical complications are often associated with a single identifiable procedure, while risks associated with contact lens wear can accumulate over time and may be less visible to consumers.

What Recent Clinical Data Shows

Femtosecond lasers have become widely used for flap creation and have reduced some complications associated with mechanical microkeratomes. Advances in aberrometry have also improved the precision of the correction. Modern pre-operative screening can identify risk factors that may make some patients unsuitable for LASIK.

The Sandoval et al. 2016 meta-analysis, published in the Journal of Cataract and Refractive Surgery across 67,893 eyes and 97 studies, found over 96% patient satisfaction and 90.8% of treated eyes achieving 20/20 uncorrected vision. The FDA’s LASIK Quality of Life Collaboration Project, covering the PROWL-1 and PROWL-2 studies between 2011 and 2014, found 98% and 96% satisfaction respectively. A 2025 systematic review in the Journal of Refractive Surgery analysing outcomes from 2016 to 2023 across 95 studies found 92.6% satisfaction and 99% of patients saying they would recommend the procedure.

Satisfaction scores measure how patients rate their experience and are not the same thing as complication rates. Both are worth looking at.

Who May Not Be a Candidate for LASIK

Pre-existing dry eye disease is among the most common contraindications. The procedure temporarily reduces corneal nerve sensitivity and tear production, and in patients with significant pre-existing dry eye, this reduction can be lasting. Keratoconus, a condition causing progressive corneal thinning and irregular shape, is an absolute contraindication. Unstable prescriptions are generally a reason to wait rather than a permanent barrier. Thin corneas limit what can be safely ablated.

Suitability is determined case by case, and a proportion of people who present for assessment are found not to be appropriate candidates.

What to Ask Before Choosing a Clinic

How do you determine whether someone is an appropriate candidate for LASIK? Ask what screening is performed for corneal thickness and shape, dry eye, prescription stability, and other factors that may affect safety or outcomes.

What is your enhancement or retreatment rate for patients with prescriptions similar to mine? Ask whether additional treatment, if needed, is included in the original fee, and get the answer in writing.

NHS ophthalmology waiting lists are among the longest of any treatment category in England, with hundreds of thousands of patients waiting for a first appointment. Laser eye surgery for refractive error is not funded on the NHS in the vast majority of cases, meaning private treatment is the standard route for people who are suitable candidates.

Patients considering refractive procedures can find information from providers offering Eye Surgery in London and in other major UK cities, but suitability, risks, expected outcomes, and alternatives should be discussed during an individual clinical assessment.

The Bottom Line

The risk of a serious contact lens infection is low, and for most wearers nothing will happen. The point is not to create fear of lenses.

The broader point is that both contact lens wear and laser eye surgery carry risks. Comparing those risks requires looking at the type of contact lens use, duration of exposure, individual eye health, surgical candidacy, and the specific procedure being considered.