About 43% of patients who have laser in situ keratomileusis (LASIK) surgery experience new visual symptoms afterward, though more than 95% are satisfied with their vision postsurgery, researchers reported in JAMA Ophthalmology.

Malvina Eydelman, MD, from the US Food and Drug Administration (FDA) in Silver Spring, Maryland, and colleagues reported the frequency of patient-reported visual symptoms, dry eye symptoms, satisfaction with vision, and satisfaction with the surgery in the PROWL (Patient-Reported Outcomes With LASIK) studies.

The PROWL-1 study included 262 active-duty Navy personnel between 21 and 52 years of age, and the PROWL-2 study included 312 civilians between 21 and 57 years of age from 5 private practices and academic centers. The participants completed a self-administered, web-based questionnaire, before surgery and postoperatively at 1 and 3 months. Participants in the PROWL-2 study also completed the survey at 6 months.

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The overall prevalence of visual and dry eye symptoms decreased, although 43% of patients from PROWL-1 and 46% from PROWL-2 reported new visual symptoms after surgery at 3 months.

The questionnaire showed that 55% of patients from PROWL-1 had normal Ocular Surface Disease Index scores at baseline, 66% had normal scores at 3 months, and 73% had normal scores at 6 months. In addition, 44% of participants from PROWL-2 had normal scores at baseline and 65% had normal scores at 3 months. Of the participants who had normal scores at baseline in both studies, approximately 28% had mild, moderate, or severe dry eye symptoms at 3 months.

The questionnaire also showed that most patients were satisfied with the surgery, with rates of dissatisfaction with vision ranging from 1% to 4% and rates of dissatisfaction with surgery ranging from 1% to 2%.

“Given the excellent visual acuity outcomes with corneal refractive surgery, the next step for refractive surgeons should be to maximize patient satisfaction and quality of life by minimizing the onset of visual and dry eye symptoms, and potentially decreasing the frequency of these symptoms if they are present preoperatively,” stated Alan Sugar, MD, University of Michigan Medical School, and colleagues in a clinical review of the PROWL studies. .

“The PROWL instrument is a starting point to allow ophthalmologists to better measure outcomes in this regard. Larger and longer-term studies are needed to determine the predictors of the new onset of visual symptoms, which would enhance preoperative patient counseling, and identify novel ways to reduce the risk of symptoms.”


  1. Eydelman M, Hilmantel G, Tarver ME, 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. doi:10.1001/jamaophthalmol.2016.4587
  2. Hays RD, Tarver ME, Spritzer KL, et al. Assessment of the psychometric properties of a questionnaire assessing patient-reported outcomes with laser in situ keratomileusis (PROWL). JAMA Ophthalmol. 2017;135(1):3-12. doi:10.1001/jamaophthalmol.2016.4597
  3. Sugar A, Hood CT, Mian SI. Patient-reported outcomes following LASIK: Quality of life in the PROWL studies. JAMA. 2016. doi:10.1001/jamaophthalmol.2016.4587