In that paper the answers is only in relationship to lasik and the conclusions are open with results similar for lasik and soft contact lenses; but what is your tought related to more recent and efficient techniques like customized femtosecond assisted lasik in terms of safety and quality of sight?

First define "safer", if you consider "first do not harm" probably CL is better (though long term wear and extended prolonged wear may also reduce oxygene transport into cornea)...

If you can be more specific you may get a more related answer.

But please in general for a normal patient forget expecting long term differences between customised or modern aspheric refractive surgery (but also between stromal and surface ablations)

In my opinion safer means with low rate of side effect not only most severe but also ocular discomfort, quality of vision etc.

in this view i think that intrastromal refractive procedures with femtosecond laser might be preferable to contact lens wearing specially for mild myopia combined with astigmatism

I am not aware of real recent comparative studies of both methods.

Some older references include:

Effect of LASIK and contact lens corneal refractive therapy on higher order aberrations and contrast sensitivity function. Anera RG, Villa C, Jiménez JR, Gutierrez R. J Refract Surg. 2009 Mar;25(3):277-84.

--In general OrthoK is behind LVC

Vision-related quality of life comparison for emmetropes, myopes after refractive surgery, and myopes wearing spectacles or contact lenses. Chen CY, Keeffe JE, Garoufalis P, Islam FM, Dirani M, Couper TA, Taylor HR, Baird PN. J Refract Surg. 2007 Oct;23(8):752-9.

--LVC seems to be better

Comparing contact lens and refractive surgery risks. Schein OD, Katz J. Arch Ophthalmol. 2007 Jun;125(6):853-4; author reply 854-5.

Factors influencing patient choice of refractive surgery or contact lenses and choice of centre. Gupta N, Naroo SA. Cont Lens Anterior Eye. 2006 Mar;29(1):17-23. Epub 2005 Dec 7.

A quality of life comparison of people wearing spectacles or contact lenses or having undergone refractive surgery. Pesudovs K, Garamendi E, Elliott DB. J Refract Surg. 2006 Jan-Feb;22(1):19-27.

--VERY INTERESTING: in general LVC better than CL, but when risks do occur higher impact of related complications

Kersley lecture: eye believe in contact lenses: contact lenses and/or refractive surgery. Vogt U. Eye Contact Lens. 2003 Oct;29(4):201-6.

Contact lens alternatives to laser vision correction. Gupta D. J Ophthalmic Nurs Technol. 2000 Nov-Dec;19(6):295-9.

Attitudes of successful contact lens wearers toward refractive surgery. Migneco MK, Pepose JS. J Refract Surg. 1996 Jan-Feb;12(1):128-33.

Patient preference--contact lens or radial keratotomy? Haverbeke L. Refract Corneal Surg. 1992 Jul-Aug;8(4):315-8. Erratum in: Refract Corneal Surg 1992 Nov-Dec;8(6):following 486.

Cornea, refractive surgery, and contact lens. [No authors listed] Trans New Orleans Acad Ophthalmol. 1987;35:1-326

I hope it can help you further

Interesting piece of discussion.Despite the numerous studies comparing the quslity of life in both scenerios, i think from the clinical point of view, contact lenses should be considered safer for various reasons

the advent of siH lenses has drastically reduced the related complications previously reported by many pxs. In as much as practitioners ensure good hygeine is observed, pxs follow up is ensured, overnight wear is avoided, there isnt much benefits to favor RS over CLs.

Again, have we considered the everlasting dry eyes, coma effects, and the irreparable damage done to the corneal cells post-RS.I will stand on the side of CLs for now, but cases could differ when pxs job discourage the use of CLs, pxs themselves are tired of using CLs, pxs are motivated and clearly understand the risks involved for RS, i would favor RS at this point.

The recent use of OrthK lenses have modified the way CLs are used in myopic correction and with the promising results that have been reported and the fact that effects are reversible, pxs have got several CL options and untill unless d px rejects all of this, I will not advice for RS.

Generally, CLs are considered safer than RS in majority of the myopic correction cases.

This should be a topic of interest to research on.

when a patient ask me about it, i'm used to answer that the only problem of CL is that they are too confortable, and this could lead to an abuse of it, not so much attention to igienic condition and to sleep with it too. more, the CL "allow" the patient some error...but when they start giving problems, usually they are not so simple to solve. that's why i guess that the best answer to the topic is...related to the patient in front of us.

The relative safety depends a lot on patient and lifestyle factors. If a patient is very good with contact lens care, the risk is minimal. Someone who is careless or cavalier and yet needs to wear lenses for long hours occupationally may have increased relative risk for contact lens. A patient who is troubled by dry eyes and is against using lubricants long term is not ideal for corneal refractive procedures. If his occupation requires night driving or exposure to microscopy, I don't think he is also ideal for refractive laser procedures. In short I find these considerations more useful in clinical counselling than studies where lifestyle factors are not scrutinized.

2-to 6 diopter myopia as i call it " a lucky number" for the peoples who are involved in microsurgery in particular and nearwork in general. Why do you snach this blessing? For cosmetic reasons any one can use contact lensed.

In my opinion contact lenses are safer. If problems arise with the lenses they can be removed, thrown away and the patient can easily go back to spectacles with good visual results. However, if refractive surgery goes awry complications can be severe with resultant loss of best corrected acuity, surgery cannot be reversed. The only sight threatening complication with contact lenses are corneal ulcers which have a low incidence when the lenses are used according to recommendations. Treatment is usually effective resulting in minimal if any loss of best corrected acuity. It would be interesting to compare the incidence of corneal ulceration due to contact lens use with complications due to refractive surgery that both result in loss of best corrected acuity.

Contrarly on what is the common thought of the people, sometimes lesions due to corneal damage following to contact lens wearing are more severe and very dangerous for sight. As probably most of ophthalmologists remember some years ago many cases of blindness were caused by acanthameba or fungal keratitis or as experienced by other colleagues after corneal ulcers. The risk of these affection is certainly higher than the risk that corneal problems occurr after refractive surgery.

Hi Enzo. I think the answer to your question depends on which side of the fence you are on. Surgeons look for surgical treatment options while non surgeons will look for non surgical treatment options to correct the refractive error in theses patients, in other words, whose bread gets buttered. If one purely considers safety, spectacles wins hands down especially with the new high refractive index lenses now available on the market in this prescription range. Age of the patient is also a factor to consider, would you LASIK a 50 year old 2D myope? Our lifestyle requires more near tasks than ever before which makes it beneficial to be slightly myopic. Finally, in more than 30 years of practice we have never lost an eye due to contact lens related microbial keratitis but we have certainly seen our far share of refractive surgery complications which required patients to once again wear contact lenses to improve their best corrected acuity. As always many factors need to be considered when deciding on which strategy suits a specific patients needs, it may be refractive surgery, contact lenses or even specs depending on the individuals needs, ocular health and importantly budget.

For Myopia -2.00 to -6.0 D, if there is no contraindication for Femato-LASIK, it is very safe compared to using contact lens whole life as there may be several problems with long term use of contact lens such as allergic conjunctivitis, corneal infection etc.

In my opinion Main indicator should be quality ofsight, customized or wavefront a latino combined with femtosecond flap assures unsuperable results much batter than those reached by glasses or contact lenses specially for sferocylindrical combination, similar results may be achieved by gas permeable contact lenses that are less confortabile for the patient. In my opinion in second floor must be considered patient's age, over 50' patients may benefit of negative correction for nera vision.

Finale even the most recent spectacle lenses present lower results in terms of visual field amplitude and widess, and visual aberrations that are crucial in high performance patients.

This is true specially for mild or low myopia (-2 to -6D) in which retinal carachteristics are batter than in high miopia.

Finally, I have both view some patients prefer surgery some others contact lens wearing. Each year In my department I see at least one patient with visual loss due to corneal damage following contact lens wearing, for kerstitis or ulcer, and have serena also patients with corneal damage for spectacle lens following trauma. So nothing is really 100% guaranteed and safe

From the safety point of view the safest is correction with eye glasses, second level of savety -contact lenses and third one - photorefractive surgery. If saming is named surgery it means that risk is always present it doesnot matter that photorefractive keraectomy or LASIK are outpatient procedures. In case of surgery the operation will be never done at the same day, taken into account the risk of infection

@Marianne, what do you mean by "In case of surgery the operation will be never done at the same day, taken into account the risk of infection"?

Simultaneous bilateral corneal laser refractive surgery is the standard (although delayed is also possible) of care since essentially the beginning of PRK.

I wouldn't say so. A careful refractive procedure, if properly thought and performed, is an excellent answer to mild myopia and does not show the downsides of frequent contact lens usage.

Refractive errors including Myopia are corrected by 1. Eye glasses -the safiest option,

2. Contact lenses 3. Surgery including refractive excimer laser surgery -photorefractive keratectomy and LASIK

Is something is named as a Surgery , which means the rate of complicationes startimg from infection, etc.