Employment: How will laser eye surgery affect you at work?

(Posted: Dec 2004)

Introduction: Why it is so important to consider your employment before having laser eye surgery
There are really three key aspects of your current or future employment which are important considerations in your decision to have laser eye surgery. One, any specific restrictions about laser eye surgery itself that may be imposed by an employer. Two, any specific requirements with respect to demonstrable vision performance that may be imposed by the employer and which a less than perfect outcome might compromise your ability to meet. And three, the practical requirements of your job. Laser eye surgery can make the performance of your job easier or more difficult, either because of vision changes or changes to eye comfort or both. Our experiences with thousands of laser eye surgery patients have taught us that even mild side effects can affect your job performance or comfort in unexpected ways. Where your occupation of choice and your livelihood are concerned, you need to be particularly vigilant to ensure you understand the risks.

1. Do you have (or might you later pursue) a job with specific vision requirements? YES / NO
Some occupations or employers have rigid vision requirements. These might have to do with your prescription or whether you wear glasses or contacts, or they may extend to things such as night vision. Examples of jobs with these requirements include some military jobs, law enforcement officers, firemen, or pilots. Some people get laser eye surgery specifically to meet the qualifications for a particular occupation; some, sadly, have found themselves excluded from their occupation of choice because of a side effect of surgery. Make sure you know what the requirements in your current or future occupation are.

2. Do you have, or might you later pursue, a job with restrictions about eye surgery? YES / NO
Some occupations have specific regulations about having eye surgery. For example, US navy pilots reportedly are not permitted to have had LASIK, though they may undergo a surface ablation procedure such as PRK. Make sure you know the regulations in your current or intended employment.

3. Does your job involve any activities performed in moderate to poor lighting or in the dark? YES / NO
One of the most frequently reported side effects of laser eye surgery is loss of contrast sensitivity. This is particularly true for patients with higher prescriptions. LOCS basically means that it is more difficult to see clearly in anything other than medium bright light. If you have a moderate to high prescription and your job involves routinely doing things in less than excellent lighting, this should be a consideration for you. For example, we had a report of a telephone company field engineer who was unable to do a lot of his routine work even with glasses until he underwent further surgery.

4. To perform well in your job, is it important for you to see people's faces quite clearly? YES / NO
Moderate reduction in contrast sensitivity, and/or ghosting, can mean that although you can read print (and the eyechart) with ease you might have a little more difficulty making out the detail on people's faces, particularly in dim lighting. In jobs involving many social events or mixing in crowds this may be a consideration. For example, we had a report of a politician who had to get an experimental corrective surgery because after his original LASIK procedure he lost confidence in his campaigning skills - he could not see people's faces clearly and therefore public speaking became much more difficult.

5. To perform well in your job, is it important for you to see clearly at a distance? YES / NO
Sometimes the tradeoff for being less dependent on glasses or contacts is that you do not see quite as clearly afterwards - even with glasses. There may be slight blurring or what's called ghosting. Some people don't mind this, but others may mind a great deal or it may make their job performance more difficult.

6. Does your job require a lot of reading? YES / NO
There are short- and long-term considerations with respect to reading. First of all, while many patients do have the fabled spectacular results within a day or days, many other patients take much longer to heal and may experience fluctuations in the first weeks or months that make it more difficult to read for prolonged periods. Secondly, the dryness experienced by all patients in the short-term (and by some in the long-term) may make eyes uncomfortable or sore when reading. Thirdly, patients who are approaching (or are in) the presbyopic years need to have a specific strategy for managing the needs of distance and near vision and the tradeoffs involved in laser eye surgery.

7. Does your job require frequent or heavy computer use? YES / NO
The considerations for reading all apply to heavy computer users. However the additional consideration is dry eye. Computer use dramatically reduces your blink rate - the essential mechanism to keep your eye surface properly lubricated - and therefore even without laser eye surgery can cause dry eye symptoms. In the first weeks and months after surgery (particularly after LASIK which severs many more nerves than surface procedures, and even more so with high prescriptions) heavy computer users may experience more dry eye symptoms than other people and excessive dry eye (particularly if not treated properly) may even have a detrimental effect on the healing process. Frequent computer users who already have dry eye symptoms or contact lens intolerance need to be aware that they may be at higher risk of severe chronic dry eye following surgery.

8. Does your job expose you to noxious fumes, wind, or excessive heating or air conditioning? YES / NO
Laser eye surgery (and LASIK much more than other procedures) severs nerves in the cornea which causes a significant reduction in tear production in the period following surgery. Less tears means your eyes may be more sensitive to irritants and more vulnerable to a hot or very dry or windy environment. This may be a short-term consideration for most patients and a long-term consideration for some patients, particularly those who have any predisposition to dry eye.

9. Do you need to drive yourself to and from work in the dark during part or all of the year? YES / NO
One of the most frequently reported side effects of laser eye surgery is night vision problems such as starbursts and haloes. Sometimes this is caused by residual refractive error (undercorrection) and can be compensated for by wearing glasses at night, but many times there is a less easily corrected cause. The most common activity that NVD affects is driving at night. Mild NVD may not be a problem at all. Moderate to severe NVD may make driving at night impossible. An important part of preparing for laser eye surgery is exploring your personal risk factors for NVD (such as your dark-adapted pupil size and your prescription) and ensuring your understand the risks. Examples: We have had reports from patients who have literally had to give up their jobs because the severity of their night vision symptoms made them unable to drive in the dark. More commonly, patients with moderate to severe NVD end up trying to manage it with temporary pupil-constricting eyedrops or gas permeable contact lenses. Some pursue experimental surgery in hopes of eliminating or reducing the symptoms.