Seeing the Whole Picture

An evidence-based response to the documentary Broken Eyes (2024)

Dr Mark Deist, Ophthalmic Surgeon | October 2026

Broken Eyes tells the real stories of people who have been harmed after laser vision correction, and those patients deserve to be heard.

But the film presents the worst outcomes as if they were typical, quotes complication rates that large prospective studies do not support, and leaves out the FDA’s own data, the FDA’s rejection of the central petition it features, and the risks of the alternatives.

The right response to the film is not to defend bad practice, but to show what careful, honest refractive surgery looks like.

About the film

Broken Eyes is a 78-minute documentary by Minnesota filmmaker Dana Conroy, who experienced complications after LASIK.

Its executive producer is Dr Cynthia MacKay, an ophthalmologist who has campaigned against laser eye surgery for many years [20].

It features Dr Morris Waxler, a former FDA branch chief who now opposes LASIK; Paula Cofer, founder of an advocacy group for people with LASIK complications; and members of an online LASIK complications support group [19, 20]. It was broadcast on PBS and shown at several film festivals.

A documentary made by people who have been harmed, about people who have been harmed, will naturally be powerful and painful to watch. That is also its central weakness as a guide for anyone deciding whether to have surgery: it has no denominator.

It shows the people who had bad outcomes, but not the much larger number who did well, and it never asks how often each problem actually occurs.

What the film gets right

A credible rebuttal has to start by acknowledging the legitimate points. Refractive surgeons should accept these without reservation:

•Complications are real. Dry eye, glare, halos, ectasia, epithelial ingrowth and chronic corneal pain all occur. The patients in the film are not imagining their

symptoms.

•Corneal neuropathic pain is under-recognised. In one prospective study, 11% of patients reported persistent ocular pain (at least 3 out of 10) at 3 and 6 months after refractive surgery [15].

Severe corneal neuralgia is much rarer, reported in about 1 in 900 LASIK patients in one series [21], but when it happens it can be disabling and is poorly served by "your eye looks fine".

•Marketing that promises "99.9%" or "100% safe" is indefensible. No surgical procedure is risk-free, and any clinic that sells it that way deserves criticism.

•Doctors under-hear symptoms. The FDA’s PROWL studies found that patients were more than twice as likely to report visual symptoms on a questionnaire as to tell their doctor [2]. This supports the film’s complaint that some patients feel dismissed.

•Consent must be real. Handing over a risk form on the day of surgery, as one patient in the film describes, is not informed consent.

Where the film misleads

It presents the exceptions as the rule

The film’s own news footage estimates that LASIK had been performed on about 20 million Americans [19]. A support group of "thousands" is a real and important group of people, but it represents a small fraction of that population.

The most rigorous independent data come from the FDA’s PROWL studies, run jointly with the US National Eye Institute and Department of Defense. They found that more than 95% of participants were satisfied with their vision, and fewer than 1% had difficulty with usual activities because of any one visual symptom [2]. A systematic review of the world literature found 95.4% satisfaction across 2,198 patients in 19 high-quality studies [4].

The PROWL studies also found that up to 46% of patients without visual symptoms before surgery reported at least one new symptom, usually halos, three months later [2]. That is an honest number, and it belongs in every consent discussion. What the film leaves out is that these symptoms were usually mild, and that many patients who had symptoms before surgery (with glasses or contact lenses) had fewer afterwards [1].

Its statistics do not survive scrutiny

The table below sets the film’s main claims against the published evidence.

What the film says	What the evidence shows
"At least 50% will have a gritty feeling like sand in the eyes"	In the FDA’s own PROWL studies, about 28% of patients with normal scores before surgery reported dry-eye symptoms at 3 months, and the share of patients with normal OSDI scores actually rose after surgery (55% to 73% at 6 months in PROWL-1) [1, 2]. Most post-LASIK dryness peaks in the first weeks and settles over 6 to 12 months; in a prospective military cohort, chronic dry eye at 12 months occurred in 0.8% of LASIK eyes [8, 9].
"At least 60% will have fluctuating vision"	No prospective study supports this figure. In PROWL, 96% to 99% of patients achieved binocular uncorrected vision of 20/20 or better at 3 months, and fewer than 1% had "a lot of difficulty" with usual activities because of any one visual symptom [2, 3].
Complication rates of "20 and 30%" (former FDA reviewer)	Dr Morris Waxler petitioned the FDA in 2011 to withdraw LASIK lasers on the basis of his re-analysis. The FDA reviewed the petition, the literature and adverse-event reports and denied it in June 2014, stating that it had found no new safety concerns [5]. Dissatisfaction with vision in PROWL was 1% to 4% [1].
"The FDA warned that patients may be left with dry eyes, double vision, night-driving problems and persistent pain"	This was a 2022 draft labelling guidance, which the film itself notes was not final. The FDA withdrew it on 24 November 2025, and it no longer represents the agency’s current thinking [6].
The flap "only has 2 to 3% of its original strength"	Correct for the central flap interface (2.4% in the Emory cadaver study), but the flap edge heals to about 28% of normal strength, which is why late traumatic flap dislocation is uncommon [10]. Where this is a concern (contact sports, military, eye rubbing), surface ablation (PRK) or lenticule extraction (SMILE) avoids a flap altogether.
The suction ring "crushes the eye in a vice" and "damages the retina"	Pressure does rise transiently above 65 mmHg during suction. Studies of the retinal nerve fibre layer show no thinning in healthy eyes, and measurable macular changes return to baseline within a day [11, 12]. This is why glaucoma and optic-nerve disease are screened for and treated as relative contraindications.
Post-LASIK ectasia as a common outcome	In a series of 30,167 LASIK eyes followed for 2 to 8 years, the incidence of ectasia was 0.033% [13]. Reported rates have fallen from about 0.66% in early series as corneal tomography screening and tissue-altered (PTA) limits were adopted [14].

What the film says	What the evidence shows
LASIK as a driver of suicide	Every death is a tragedy and must be taken seriously. However, there is no clinical evidence establishing a causal link between laser vision correction and suicide [17]. The most widely cited case, Jessica Starr, actually had SMILE rather than LASIK [16].

It leaves out the FDA’s actual conclusions

The film’s regulatory story rests on Dr Waxler’s view that the FDA was misled and that LASIK should be withdrawn. Viewers are not told that the FDA formally examined his petition, including his re-analysis of the approval data, and rejected it, concluding that the approved lasers remain reasonably safe and effective when used as labelled [5].

The film also presents the 2022 draft labelling guidance as an impending FDA warning. That draft was withdrawn in November 2025 [6]. Improving patient information is a worthwhile goal regardless, but the film gives a misleading picture of where the regulator stands.

It ignores the risks of the alternatives

The choice is not between LASIK and perfect natural vision. It is between LASIK (or another procedure) and a lifetime of glasses or contact lenses. Contact lenses carry their own sight-threatening risk: in the Australian national surveillance study, microbial keratitis occurred in about 2 per 10,000 daily soft lens wearers per year, and in 19.5 to 25.4 per 10,000 overnight wearers [18].

In a three-year comparison of 1,800 patients, those who had LASIK were more satisfied than those who continued with contact lenses, found night driving easier, and reported infections and abrasions less than half as often [7].

It treats 1999 and 2026 as the same operation

Several patients in the film had surgery 15 to 20 years ago. Since then, corneal tomography, ectasia risk scoring and limits on the percentage of tissue altered have sharply reduced the risk of ectasia [13, 14].

Femtosecond flaps, wavefront- and topography-guided treatments, and flap-free alternatives such as PRK, SMILE and implantable contact lenses now let surgeons match the procedure to the eye, or advise against surgery altogether. Criticising today’s surgery with the outcomes of early-generation technology is like judging modern cataract surgery by the results of the 1970s.

It turns individual tragedies into causal claims

The film’s treatment of suicide is its most emotive and least supported element. Persistent pain and visual disturbance can contribute to depression, and patients with these symptoms need prompt, compassionate care and access to mental-health support.

But there is no clinical evidence establishing that laser vision correction causes suicide [17], and the best-known case the film cites involved SMILE, not LASIK [16]. Notably, research shows that depressive symptoms and ocular pain before surgery are among the strongest predictors of persistent pain afterwards [15]. That is an argument for better screening, not for abandoning the procedure.

It blames a procedure for problems of practice

Many of the film’s strongest criticisms, such as discount "specials", high-volume "flap and zap" clinics, consent signed on the day and dismissing complaints, are criticisms of poor practice, not of laser vision correction itself. They apply equally to any elective procedure done badly. The solution is higher standards, not a blanket rejection of a treatment that most patients are glad they had.

What responsible refractive practice looks like

The most persuasive rebuttal to Broken Eyes is a practice that already meets its fair criticisms. In this practice, that means:

•Careful selection: corneal tomography and ectasia risk assessment for every patient, and a willingness to say no, or to recommend PRK, SMILE or a lens-based option instead.

•Treating the eye surface first: assessing and treating dry eye and eyelid disease before surgery, because pre-existing dry eye is the strongest risk factor for severe dryness afterwards [9].

•Screening for pain risk: asking about existing eye pain, depression, chronic pain conditions and allergy medication, which predict persistent pain after surgery [15].

•Honest numbers: written information given well before surgery, using real figures such as the PROWL rates of new halos and dry-eye symptoms, with time to read, ask questions and change one’s mind.

•No sales pressure: no "specials", no same-day consent, and no promises of perfect vision.

•Listening after surgery: using validated questionnaires such as PROWL-SS so that symptoms are captured even when patients do not volunteer them, and taking pain seriously even when the eye looks normal.

•Auditing outcomes: tracking this practice’s own results and complications so patients can be told the surgeon’s rates, not just the literature’s.

Conclusion

Broken Eyes is a sincere film made by people who have suffered, and its call for honesty about risk is justified.

But as a picture of laser vision correction it is incomplete and one-sided. It relies on anecdote rather than incidence, repeats statistics that large prospective and FDA-run studies do not support, and omits the regulator’s actual conclusions and the risks of the alternatives.

The evidence shows that, for well-selected patients who are properly informed, laser vision correction is safe, effective and highly satisfying, and that most of the harms shown in the film can be reduced by careful screening, honest consent and attentive aftercare.

Patients deserve both sides of the story.

References

[1] Eydelman M, et al. Symptoms and satisfaction of patients in the PROWL studies. JAMA Ophthalmol. 2017;135(1):13-22 (FDA abstract). https://www.accessdata.fda.gov/scripts/publications/search_result_record.cfm?id=56253

[2] US Food and Drug Administration. LASIK Quality of Life Collaboration Project. https://www.fda.gov/medical-devices/lasik/lasik-quality-life-collaboration-project

[3] American Academy of Ophthalmology EyeWiki. LASIK for myopia and astigmatism: safety and efficacy. https://eyewiki.aao.org/LASIK_for_Myopia_and_Astigmatism:_Safety_and_Efficacy

[4] Solomon KD, et al. LASIK world literature review: quality of life and patient satisfaction. Ophthalmology. 2009;116(4):691-701. https://pubmed.ncbi.nlm.nih.gov/19344821/

[5] FDA response denying citizen petition FDA-2011-P-0022 (Waxler), 23 June 2014. https://downloads.regulations.gov/FDA-2011-P-0022-0008/attachment_1.pdf

[6] FDA CDRH. Withdrawn or expired guidance (LASIK Lasers – Patient Labeling Recommendations, withdrawn 24 Nov 2025). https://www.fda.gov/medical-devices/guidance-documents-medical-devices-and-radiation-emitting-products/withdrawn-or-expired-guidance

[7] Price MO, et al. Three-year longitudinal survey comparing visual satisfaction with LASIK and contact lenses. Ophthalmology. 2016;123(8):1659-66 (Healio summary). https://www.healio.com/news/ophthalmology/20170406/lasik-provides-higher-patient-satisfaction-than-contact-lenses

[8] Bower KS, et al. Chronic dry eye in PRK and LASIK: manifestations, incidence and predictive factors. https://pmc.ncbi.nlm.nih.gov/articles/PMC5702539/

[9] Refractive surgery and dry eye – an update. Indian J Ophthalmol. 2023. https://pmc.ncbi.nlm.nih.gov/articles/PMC10276666/

[10] Schmack I, et al. Cohesive tensile strength of human LASIK wounds. J Refract Surg. 2005;21(5):433-45. https://pubmed.ncbi.nlm.nih.gov/16209440/

[11] Retinal nerve fibre layer thickness after LASEK and high-pressure femtosecond LASIK. Clin Ophthalmol. 2018. https://pmc.ncbi.nlm.nih.gov/articles/PMC6038866/

A response to Broken Eyes (2024) Page 4 of 5

DR MARK DEIST | MBChB FCS (Ophth) | Ophthalmic Surgeon Sandhurst Eye Centre, 53 Saxon Road, Hurlingham, Sandton 2196 | 011 217 7520 | www.drdeist.co.za

[12] Effect of suction on macular thickness and RNFL in femtosecond and microkeratome LASIK. Int J Ophthalmol. 2015. https://pmc.ncbi.nlm.nih.gov/articles/PMC4539638/

[13] Bohac M, et al. Incidence and clinical characteristics of post-LASIK ectasia: a review of over 30,000 cases. Semin Ophthalmol. 2018. https://pubmed.ncbi.nlm.nih.gov/30359155/

[14] Assessment of preoperative risk factors for post-LASIK ectasia development. Clin Ophthalmol. 2023. https://pmc.ncbi.nlm.nih.gov/articles/PMC10706063/

[15] Ocular pain after refractive surgery: interim analysis of frequency and risk factors (prospective cohort). https://pmc.ncbi.nlm.nih.gov/articles/PMC10293021/

[16] People. Family of meteorologist Jessica Starr speaks out (procedure identified as SMILE). https://people.com/tv/meteorologist-jessica-starr-suicide-family-speaks-out/

[17] Oxygen. Statement on Jessica Starr’s death: "no clinical evidence linking suicide to laser vision correction surgery". https://www.oxygen.com/crime-time/detroit-meteorologist-jessica-starr-husband-dan-rose-opens-up-on-her-eye-surgery-suicide

[18] Stapleton F, et al. The incidence of contact lens-related microbial keratitis in Australia. Ophthalmology. 2008;115:1655-62. https://pubmed.ncbi.nlm.nih.gov/18538404/

[19] PBS Pioneer Specials. Broken Eyes (2024), programme and transcript. https://www.pbs.org/video/broken-eyes-61hxsq/

[20] PRWeb. Broken Eyes press release: director Dana Conroy and executive producer Dr Cynthia MacKay. https://www.prweb.com/releases/groundbreaking-documentary-on-lasik-dangers-accepted-at-silicon-beach-film-festival-302244680.html

[21] Long-term evolution of chronic neuropathic ocular pain and dry eye after refractive surgery (citing Moshirfar et al., 1 in 900 LASIK patients). 2025. https://pmc.ncbi.nlm.nih.gov/articles/PMC12249925/