Quality of Life in Myopia: Laser-Assisted In Situ Keratomileusis Versus Contact Lenses

Abstract

Background: Laser-assisted in situ keratomileusis (LASIK) and contact lenses are commonly used to correct refractive errors, but their effects on quality of life, patient satisfaction, and dry eye disease remain variable. This study compares these outcomes between LASIK and contact lens users.

Objective: This study aims to bridge the knowledge gaps by evaluating the effects of LASIK versus contact lenses on vision-related quality of life, patient satisfaction, and dry eye disease.

Methods: Our protocol was registered prospectively on PROSPERO (CRD42025636623). A comprehensive literature search was conducted across four electronic databases (Web of Science, Scopus, PubMed, and the Cochrane Library) to find eligible articles. The primary outcome assessed was quality of life, while the secondary outcomes included the prevalence of dry eyes and patient satisfaction. A meta-analysis was conducted using R Statistical Software (version 2024.04.2 Build 764) and the “meta” package (version 7.0-0). The quality of the included studies was assessed using the Newcastle-Ottawa Scale.

Results: Of 1806 initial records, four studies met the inclusion criteria, enrolling 2141 participants, and were included in our meta-analysis. Meta-analysis revealed moderate improvement in quality of life for LASIK users (standardized mean difference [SMD] = 0.45; p < 0.0001), while patient satisfaction was notably higher in the LASIK group (88% vs. 54% for contact lenses). Complication rates were lower in LASIK patients (6.7% vs. 19.9% for contact lenses), although LASIK was associated with a higher incidence of acute dry eye disease.

Conclusion: This meta-analysis demonstrated that LASIK significantly enhances quality of life compared to contact lens use and yields markedly higher patient satisfaction. Moreover, LASIK was associated with lower overall complication rates, though it carried a greater risk of acute dry eye disease.

Graphical abstract

Keywords

contact lens / laser-assisted in situ keratomileusis / laser in situ keratomileusis / laser vision correction / myopia / quality of life

1 Introduction

Vision correction plays a crucial role in enhancing the quality of life for individuals with myopia [1,2]. Myopia is a common refractive error affecting millions worldwide [3], and is expected to continue rising to become a leading cause of permanent blindness [4,5]. Uncorrected refractive error remains a leading cause of vision impairment among children and adults in all countries [6]. Among the most widely used corrective options are contact lenses and laser-assisted in situ keratomileusis (LASIK) surgery [7]. Contact lenses offer a flexible, non-surgical solution that accommodates changing prescriptions, making them a preferred choice for those unwilling or unable to undergo surgery. LASIK, on the other hand, can correct vision long term for over 10 years, although it is costlier short term and has risks of complications [8,9]. While both methods aim to improve visual acuity, their impact on patient satisfaction and overall quality of life remains a subject of debate.

Existing research provides insights into the benefits and drawbacks of each approach. Contact lens wear may cause mild (e.g., dryness, discomfort, and conjunctivitis) to severe (e.g., microbial keratitis) complications [10]. In contrast, LASIK surgery offers rapid visual improvement and convenience but carries risks such as post-surgical dry eye disease, visual disturbances, and potential regression of refractive correction. Studies comparing these interventions have explored aspects such as vision loss and microbial keratitis [11–13].

Despite the available data, significant gaps persist in understanding the effects of these vision correction methods on quality of life. While some studies have assessed dry eye prevalence and post-surgical complications, comprehensive comparisons of patient-reported outcomes, particularly satisfaction and daily-life impact, remain limited. This is the first study comparing these widely used vision correction modalities in terms of patient-reported outcomes. Additionally, variations in study methodologies, follow-up durations, and characteristics of the studied population contribute to inconsistencies in reported outcomes [14,15].

This study aims to bridge these knowledge gaps by evaluating the effects of LASIK versus contact lenses on vision-related quality of life, patient satisfaction, and dry eye disease. By synthesizing existing evidence, this study will provide a clearer perspective on the advantages and limitations of each approach, assisting both patients and healthcare providers in making informed decisions regarding myopia management.

2 Materials and Methods

This study aims to compare the effects of LASIK versus contact lenses on myopic patients, focusing on quality of life, prevalence of dry eyes, and patient satisfaction. This study and meta-analysis were conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines [16]. It was prospectively registered with PROSPERO (CRD42025636623). We adhere to the tenets of the Declaration of Helsinki.

2.1 Eligibility Criteria

The selection of studies was based on predefined Population, Intervention, Comparison, and Outcome (PICO) criteria [17]. The included population consisted of myopic patients of all ages and genders, with no associated eye diseases, undergoing either LASIK surgery or wearing contact lenses for vision correction. The intervention was limited to LASIK and Femto LASIK refractive surgeries, excluding other procedures such as photorefractive keratectomy, laser epithelial keratomileusis, and small incision lenticule extraction. The comparison group included users of both soft and hard contact lenses.

The primary outcome assessed was quality of life, while the secondary outcomes included the prevalence of dry eyes and patient satisfaction. Studies were included if they reported quality of life and patient satisfaction in myopic patients treated with LASIK or contact lenses, included all genders, races, and ethnicities, and contained complete and extractable data on the predefined outcomes.

Exclusion criteria comprised studies on patients with contraindications such as keratoconus, unstable refraction, or chronic eye disease, duplicate publications, animal or in vitro studies, other refractive surgeries (e.g., PRK, LASEK), and therapeutic contact lenses such as orthokeratology lenses.

2.2 Search Methods

A comprehensive literature search was conducted across four electronic databases, including Web of Science, Scopus, PubMed, and the Cochrane Library, up to November, 2024. The search strategy employed keywords related to LASIK and contact lenses. The following search terms were used: ([LASIK OR Laser In Situ Keratomileusis OR Laser Intrastromal Keratomileusis OR Intrastromal Keratomileuses, Laser OR Intrastromal Keratomileuses Laser OR Laser-Assisted Stromal In Situ Keratomileusis OR Laser Assisted Stromal In Situ Keratomileusis OR Laser-In-Situ Keratomileusis OR Laser In Situ OR Laser Intrastromal OR Laser-Assisted Stromal In Situ OR Laser Assisted Stromal In Situ OR Laser-In-Situ] AND [Keratomileuses]) AND (Contact Lens OR Contact Lenses OR Lenses, Contact OR Lens, Contact OR Contact OR Contacts OR [{Lens OR Lenses} AND {Contact OR PMMA OR RGP OR Rigid Gas Permeable OR Plexiglass OR Acrylic OR Polymethylmethacrylate OR HEMA OR Hydroxyethyl Methacrylate OR 2-Hydroxyethyl Methacrylate}]). Additionally, hand-searching of key journal references and citation tracking were performed to ensure the inclusion of all relevant studies (Table S1).

2.3 Study Selection and Data Collection

The selection process involved two reviewers for screening titles and abstracts against each other. Full-text articles were retrieved for further evaluation if they met the eligibility criteria. Any discrepancies were resolved through discussion, with two reviewers (MS and ZW) acting as arbitrators when necessary.

At least two authors, blinded to each other, extracted the data of each study using a standardized form; disagreements were resolved by consensus or by referring to the primary investigator and the senior author (MS and AA). Data extracted involved information on study design, sample characteristics, intervention and comparison details, mean and standard deviation for quality of life (QoL) scores, as well as the incidence of dry eye disease and patient satisfaction scores post-treatment. Extraction sheets were then reviewed thoroughly by the primary investigator and the senior author (MS and AA).

2.4 Strategy for Data Synthesis

The primary outcome assessed was quality of life, while the secondary outcomes included the prevalence of dry eyes and patient satisfaction. In data analysis, continuous variables were reported as mean and standard deviation (SD). All meta-analyses were performed using R Statistical Software (version 2024.04.2 Build 764) and the “meta” package (version 7.0-0) [18]. Continuous data were pooled as mean difference (MD) or standardized mean difference (SMD) with a 95% confidence interval (CI). Heterogeneity across studies was assessed using the I² statistic and Cochran's Q test. An I² value > 50% was considered indicative of moderate to high heterogeneity, and a p-value < 0.10 in the Q test was considered statistically significant. To address heterogeneity, a random-effects model was applied. Where applicable, sensitivity analyses were conducted to explore sources of heterogeneity and assess the robustness of the pooled estimates.

2.5 Risk of Bias Assessment

The quality of the included studies was assessed using the Newcastle-Ottawa Scale (NOS). This tool evaluates study quality based on participant selection, comparability between groups, adjusted to age and refractive error, and outcome assessment. Studies were rated based on predefined criteria to ensure a reliable assessment of the risk of bias. Studies are accordingly classified as poor, fair, or good [19]. Any conflicts between the two authors were resolved by the senior author. The certainty of the evidence was assessed using the GRADE framework.

3 Results

3.1 Study Selection and Screening

An initial database search across PubMed, Scopus, the Cochrane Library, and Web of Science identified 1806 records. After removing 195 duplicates, 1611 articles remained for title and abstract screening. From these, 16 articles were selected for full-text review. Ultimately, 4 studies met the predefined inclusion criteria and were included in this study: Pesudovs et al. [14], Price et al. [15], González-Pérez et al. [20], and Queirós et al. [21]. The study selection flowchart for this study is shown in Figure 1.

3.2 Quality Assessment

In this study, study quality was assessed using the NOS, which rated three studies as good quality and one (Pesudovs et al. [14]) as fair, largely due to limited adjustment for confounding variables (Table 1).

3.3 Study Characteristics

Among the included studies, three were prospective cross-sectional in design, while one (Price et al. [15]) was a longitudinal, parallel-group survey. Together, these studies enrolled a total of 2141 participants, with 1275 in the LASIK group and 866 in the contact lens group. The mean age of participants was 32.3 ± 6.3 years for LASIK users and 26.7 ± 8.1 years for contact lens users, with some variation in gender distribution, including one study (González-Pérez et al. [20]) with an exclusively female contact lens cohort. Tables 2 and 3 summarize the baseline characteristics and the summary of the studies included in this study. The GRADE framework showed a low-to-moderate certainty level of evidence (Table 4).

3.4 Meta-Analysis

3.4.1 Quality of Life Outcome

In terms of quantitative synthesis, a meta-analysis was conducted on QoL outcomes. The analysis compared LASIK and contact lenses across three studies with 341 participants (169 in the LASIK group and 172 in the contact lens group). The common effect model demonstrated a statistically significant moderate effect (SMD = 0.4484; 95% CI = 0.2298–0.6670; p < 0.0001). By contrast, the random effects model yielded an SMD of 0.2115 (95% CI = −0.7551 to 1.1781; p = 0.668), which was not statistically significant. Two studies—Pesudovs et al. [14] (SMD = 0.59) and Queirós et al. [21] (SMD = 0.79)—favored LASIK, while González-Pérez et al. [20] (SMD = −0.82) favored contact lenses (Figure 2).

Heterogeneity analysis showed substantial variability across studies, with τ² = 0.6770 and I² = 90.5%. A statistically significant Q test (Q = 21.04, p < 0.0001) confirmed high heterogeneity. To further investigate the source of heterogeneity, a sensitivity analysis was conducted excluding the study by González-Pérez et al. [20], which included only female participants. This decision was informed by existing evidence suggesting that females may be more susceptible to dry eye disease and may engage in different activities, potentially influencing QoL outcomes [22–24]. When limited to the two remaining studies—Pesudovs et al. [14] and Queirós et al. [21]—the analysis demonstrated a consistent and statistically significant moderate effect favoring LASIK (SMD = 0.65; 95% CI = 0.40–0.89) under both the common and random effects models. Notably, heterogeneity was eliminated (I² = 0%), indicating that the demographic composition of the excluded study likely contributed substantially to the observed variability (Figure 3).

3.4.2 Patient Satisfaction and Dry Eye

Despite uncertainty in QoL outcomes, satisfaction rates clearly favored LASIK. Across the studies, 88% of LASIK users reported being satisfied, compared to 54% of contact lens users. Remarkably, 97% of participants who transitioned from contact lenses to LASIK preferred the surgical option. Contact lens users experienced higher complication rates. Price et al. [15] reported adverse effects in 19.9% of contact lens users compared to 9.5% in the LASIK group. Pesudovs et al. [14] reported a 6.7% LASIK complication rate, though data on contact lenses were not provided in that study. Additionally, chronic dry eye was reported by 71% of contact lens users, whereas LASIK-induced symptoms—primarily acute—affected 50%–58% of patients, particularly in the early postoperative period.

3.4.3 Adverse Events

Based on available data from Pesudovs et al. [14] and Price et al. [15], the frequency of adverse events differed between LASIK and contact lenses. Pesudovs et al. [14] reported a 6.7% LASIK adverse event rate (7 out of 104), but no data were available for contact lenses. Price et al. [15] reported an adverse event rate of 9.5% (94 out of 986) in the LASIK group versus 19.9% (114 out of 572) in the contact lens group. Reported events included abrasion, infection, or ulcer.

4 Discussion

This study evaluates the impact of LASIK surgery versus contact lenses on vision-related quality of life, patient satisfaction, and dry eye disease in myopic patients. The findings reveal notable differences between these two widely used vision correction methods, with implications for both patients and healthcare providers when choosing the most suitable intervention.

The meta-analysis demonstrated a moderate improvement in quality of life among LASIK patients compared to contact lens users, with a statistically significant benefit under the common effect model (SMD = 0.4484; 95% CI = 0.2298–0.6670; p < 0.0001), indicating that LASIK may lead to better quality of life compared to contact lenses. However, the random effects model did not reach statistical significance, highlighting uncertainty due to study heterogeneity. Given the high heterogeneity, the random effects model would typically be more appropriate for interpretation. However, the wide confidence interval and lack of statistical significance in this model reflect the need for further research to provide a more definitive understanding. Future studies should aim for greater methodological consistency and larger sample sizes to better assess the comparative effectiveness of LASIK and contact lenses in improving quality of life.

While LASIK generally enhanced the quality of life, individual experiences varied based on factors such as preoperative expectations, refractive outcomes, and post-surgical complications. Patient satisfaction was also a key consideration, with LASIK recipients reporting high satisfaction overall, though some experienced persistent dry eye disease, or visual disturbances. In contrast, contact lens users appreciated the flexibility and non-invasiveness of their correction method but faced discomfort, maintenance burdens, and risks of dry eye and infections. These findings align with prior research, indicating that while LASIK provides a permanent correction, its potential risks may deter some individuals who prefer the reversibility of contact lenses despite their ongoing management requirements [12,13].

Overall, LASIK was associated with 34% higher satisfaction and lower complication rates, which may be attributed to the standardized nature of the surgical procedure. In contrast, QoL outcomes were more variable, likely due to differences in measurement tools. The Quality of Life Impact of Refractive Correction (QIRC) instrument, which was used in studies like Pesudovs et al. [14], generally favored LASIK, emphasizing its lifestyle benefits. On the other hand, the NEI RQL-42, used by González-Pérez et al. [20] and Queirós et al. [21], was more sensitive to dry eye disease, which are common after LASIK, especially in the early postoperative period. The discrepancy highlights how measurement tools can shape perceived outcomes. The González-Pérez et al. [20] study uniquely favored contact lenses, possibly reflecting a highly symptom-aware or dry eye–sensitive participant population. These findings highlight inconsistencies in the study results, warranting caution in drawing firm conclusions. This variability underscores the challenge in generalizing QoL findings, especially with a small number of studies and inconsistent outcome tools.

The study also examined the impact of LASIK and contact lenses on ocular surface health and adverse events. LASIK-induced dry eye disease, attributed to corneal nerve disruption, was a common complication that could persist for months or years. Similarly, contact lens users frequently experience dry eye disease due to prolonged lens wear and tear film instability. These findings suggest a potential advantage of LASIK over contact lenses regarding adverse event frequency, particularly in the study by Price et al. [15]. However, the significant difference in sample sizes and lack of adverse event data from the other studies (González-Pérez et al. [20] and Queirós et al. [21]) limit the ability to draw firm conclusions. Additionally, inconsistencies in reporting adverse event definitions and durations across studies may affect comparability. Further standardized and comprehensive reporting is recommended to better understand the safety profiles of these vision correction methods.

However, high heterogeneity among studies (I² = 90.5%), differences in study design, follow-up durations, and non-standardized patient-reported outcomes limit the ability to draw definitive conclusions. To further explore the source of heterogeneity, we performed a sensitivity analysis excluding the González-Pérez et al. study [20], which consisted of an exclusive female cohort. Literature suggests that there is a notable difference in the tear film between females and males as well as significant difference in lifestyle and thus the needs of each gender, with females being more susceptible to dry eye and responding differently to vision correction methods due to hormonal or lifestyle factors [23,24]. The refined analysis of the remaining two studies showed a statistically significant improvement in QoL for LASIK users (SMD = 0.65; 95% CI = 0.40–0.89) with no observed heterogeneity (I² = 0%) (Figure 3). This finding reinforces the importance of accounting for demographic variables in meta-analytic comparisons and supports the notion that gender-related physiological and behavioral differences may significantly influence patient-reported outcomes. Contributing factors included variation in measurement tools (QIRC vs. NEI RQL-42), unaccounted confounders such as occupation or pre-existing ocular conditions, and demographic imbalances—notably, the all-female contact lens group in one study. The relatively small number of included studies (n = 4) further reduces the robustness of findings, underscoring the need for future large-scale, randomized controlled trials with standardized outcome reporting to improve comparability and generalizability.

Our meta-analysis aligns with previous studies evaluating quality of life and patient satisfaction across different refractive treatments, but also highlights key distinctions. Similar to Queirós et al. [21] and González-Pérez et al. [20], our findings indicate that LASIK generally improves quality of life compared to contact lenses, though individual experiences vary based on expectations and postoperative complications. Both studies used the NEI RQL-42 questionnaire and noted that while LASIK patients reported higher scores in several domains, they also experienced issues such as dry eyes and night vision disturbances—concerns that our review also emphasized. Pseudovs et al. [14] further support this by demonstrating that spectacle wearers had the lowest quality of life scores, while refractive surgery patients fared better, a trend observed in our study. Additionally, Price et al. [15] reported significantly higher satisfaction among LASIK patients compared to contact lens users, echoing our findings that LASIK recipients were generally content with their choice despite potential side effects. Previous systematic reviews by Alzimami et al. [25] and Peyman et al. [1] have demonstrated improvements in QoL following LASIK alone, but they did not include contact lens wearers as a comparator group. Alzimami et al. [25] also demonstrate the positive impact of LASIK on patient satisfaction. Our findings provide important context for interpreting those results by highlighting that, when directly compared, LASIK may offer superior patient-reported outcomes overall—though the variability in QoL data underscores the need for more standardized assessment in future research.

However, our review also underscores the significant heterogeneity across studies, a challenge similarly encountered in prior research. Like González-Pérez et al. [20] and Queirós et al. [21], we noted the limitations of cross-sectional study designs and subjective survey-based assessments, which may not fully capture long-term outcomes or objective visual measures. Additionally, Pseudovs et al. [14] highlighted the difficulty in stratifying patient groups due to the broad inclusion of myopia, hyperopia, and astigmatism, which parallels our challenge in accounting for differences in LASIK techniques and contact lens types. Furthermore, Price et al. [15] raised concerns about the Hawthorne effect and cognitive dissonance in self-reported outcomes, factors that may also have influenced patient satisfaction scores in our included studies. Overall, while our meta-analysis reinforces prior conclusions about the benefits and drawbacks of LASIK and contact lenses, it also underscores the need for more standardized, longitudinal studies with objective outcome measures to improve comparability and generalizability.

Given these findings, screening for dry eye risk should be a routine part of LASIK candidacy assessment. LASIK may be particularly beneficial for individuals with poor contact lens compliance or frequent contact lens–related complications. However, greater standardization in QoL measurement tools and long-term follow-up (> 5 years) is urgently needed in future research. Additionally, the incorporation of objective dry eye tests (e.g., tear osmolarity or Schirmer's test) in future studies would enhance the reliability of reported outcomes.

5 Conclusion

Overall, this study underscores the trade-offs between LASIK and contact lenses in terms of quality of life, satisfaction, and ocular health. This study supports the superiority of LASIK in terms of satisfaction and safety, but findings on quality of life remain inconclusive, primarily due to variability in assessment tools and study designs. While LASIK may offer improved convenience and fewer long-term complications, it is associated with an increased risk of post-surgical dry eye disease and other visual disturbances. Contact lenses provide a reversible and adaptable solution but require ongoing maintenance and carry a higher cumulative risk of complications. Given the variability in individual experiences, personalized patient counseling—grounded in both the scientific evidence and the individual's values and ocular health—remains essential in guiding myopic individuals toward the most suitable vision correction method based on their lifestyle, preferences, and ocular health status.

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