ARE YOU CONSIDERING LASER SURGERY ?


"If you don't take the time to learn everything you can about a procedure, hindsight may offer the only 20/20 vision you'll know."
--from the Mayo Foundation's website www.mayohealth.org/

There's a lot of chatter these days about the new eye surgery procedures. Advertisements scream about this supposed "miracle cure" for vision problems, telling us we can throw our glasses and contact lenses away forever. Thanks to increasingly questionable marketing tactics, many people are considering a investment of $3,000-$6,000 in eye surgery, with the mistaken belief that surgery will result in perfect vision.

Before committing your eyes and your dollars, it is important to have a balanced perspective on the potential benefits and the potential risks of laser eye surgery.

Refractive eye surgery, including radial keratotomy (RK), photorefractive keratotomy (PRK) and laser in-situ keratomileusis (LASIK), can indeed offer many patients improved vision. Nevertheless, laser surgeries are not without risk and cannot be considered 100% successful. Even when successful, the procedure does not eliminate the need for other vision correction later in life. Results can differ considerably depending on the patient's age and condition, the doctor's experience, the degree of astigmatism, and the procedure selected.

Eye surgery is serious business; it is essential that a potential candidate not only do his/her homework before considering the procedure, but that he/she weighs the other, less risky and less costly options. After all, these laser surgical procedures are irreversible.

What is refractive surgery?
Refractive surgery is a relatively new procedure involving the eye's cornea, the transparent surface that covers the pupil and iris and provides most of the eye's optical power. These procedures are designed to correct refractive errors, such as myopia (nearsightedness, blurred distance vision) or astigmatism (irregularly-shaped cornea, distorted vision). In the past, refractive surgery was performed only with incisions. Now, laser technology has been developed for a new type of refractive surgery.

What are the types of refractive surgery?

  • LASIK, or laser-assisted in situ keratomileusis
    LASIK is a kind of laser eye surgery designed to improve focus by altering the shape of the cornea. To perform the procedure, a qualified ophthalmologist uses a microkeratome to cut a circular "protective" flap to expose the inner layers of the cornea, which are reshaped with the laser. This procedure has been dubbed "flap-and-zap". To complete the procedure, the ophthalmologist then repositions the flap. This last step is important, for if done incorrectly, it can lead to scarring and optical distortion.

  • Photorefractive Keratotomy (PRK)
    Using an excimer laser with power controlled by computer, PRK is designed to change the shape of the cornea to reduce vision problems. The laser vaporizes microscopic slivers from the outer layer of the cornea to flatten it. The flattening of the cornea is intended to correct myopia (nearsightedness) and astigmatism (uneven curvature of the cornea that distorts vision).

  • Radial Keratotomy (RK)
    Once the most common type of refractive surgery, RK is now considered more difficult to control than newer methods of corrective eye surgeries. During RK surgery, a number of spoke-like incisions are made on the surface of the eye with a small diamond-tipped blade to flatten the cornea so light rays focus directly on the retina. The procedure is designed to correct or reduce nearsightedness.

  • Astigmatic Keratotomy (AK)
    is performed to correct astigmatism. To correct astigmatism, the number, angle, and distribution of the incisions will vary from patient to patient, depending upon the degree and axis (location) of the astigmatism.

  • Automated Lamellar Keratectomy (ALK)
    is a relatively new procedure performed for extremely nearsighted patients. In this procedure, a flap of corneal surface tissue is folded back, a layer of the central corneal tissue is removed, and the surface flap is replaced.

Can I get rid of my glasses or contact lenses after laser surgery?
Read the small print in the laser surgery ads. Only a small percentage of patients who undergo the operation achieve 20/20 vision. And laser surgery can do nothing to correct presbyopia, which hits nearly everyone by age 40, and usually requires contact lenses or reading glasses to correct. Click here for more on presbyopia.

Will laser surgery give me perfect vision?
Not necessarily. While laser surgery is a viable option for some patients seeking vision correction, there is no guarantee that the procedure will be successful. In fact, statistics show that many laser surgery patients end up with 20/40 vision at best, with only 60-65% obtaining 20/20 vision.

How much does the procedure cost?
Time magazine reports that the average cost of LASIK is "upwards of $2500 per eye", and generally not covered under insurance plans (Time, October 11,1999). Keep in mind, too, that many patients still need glasses or contact lenses after the surgery--another cost to figure into the total cost of the procedure.

Can I really get the procedure done on my lunch break?
The whole LASIK procedure takes approximately 15 minutes per eye as long as there are no complications. Time magazine reports, however, that " 10-15% of patients must undergo a second LASIK procedure to get the correction right."

I am nearsighted. Can laser surgery cure my myopia?
The more nearsighted you are, the greater the chance you'll encounter problems with refractive eye surgery. The surgery can, if not correctly performed, convert a nearsightedness problem into a farsightedness problem.

Along with all the ads encouraging us to spend thousands of dollars on laser surgery, I've been hearing a lot of horror stories about laser surgery "gone bad" and permanent side effects. Can you tell us truth?

Perhaps the most intimidating aspect of laser surgery is that the procedure is irreversible. This, combined with the fact that it is too early to determine all possible long-term effects, has convinced many people to stick with their contact lenses and/or spectacles.

Even with its high price tag, laser surgery has lured thousands of people willing to take the risk for better vision. For many, the procedure has been successful, with few or no side effects. Others, however, complain of side effects, and, over time, deterioration in vision.

Side effects may include:

  • Glare and halos (relatively common, but may diminish in 6 months)
  • Night vision may be poor, or reduced
  • Possible variation in visual acuity

    Risks of serious damage to eyes:

  • If the flap is not correctly repositioned, it can lead to scarring and optical distortion (LASIK)
  • In very rare cases, there may be corneal scarring or rupturing
  • Cornea is weakened in RK
  • Chance of infection
  • FDA cites a few instances of severe eye injury requiring corneal transplant

    ALTERNATIVES TO LASER SURGERY

    If you are satisfied with contact lenses or glasses, your best bet may be to stick with your current vision correction. After all, laser surgery is a permanent procedure, and there are documented risks. The procedure and laser technology may become more advanced in the upcoming years.

    It is also important to note that laser surgery cannot correct presbyopia, which affects almost everyone by the age of 40, and usually requires contacts or bifocal contact lenses or spectacles.

    If you do decide to have laser surgery performed on your eyes--

    TAKE YOUR TIME TO FIND THE RIGHT PHYSICIAN, AND FIND OUT EXACTLY HOW MUCH TRAINING THE DOCTOR HAS IN PERFORMING THE PROCEDURE!

    Questions to Ask the Doctor
    From Parade Magazine May 16, 1999

    • What is your success rate for achieved visual acuity (that is, 20/40 or better)?
    • How many operations have you personally performed?
    • May I speak with any of the patients on whom you've done this procedure?
    • How many of them have required second operations? (It should be under 10%.)
    • What is the best correction I can expect?
    • How much will the operation cost me?
    • What are the chances I may not see as well after the operation?
    • Do you operate on both eyes the same day?
    • What are the possible complications?
    • What anesthesia will I receive during the operation?
    • How long will the procedure take?
    • What is the recovery period?
    • When will I be able to return to work?
    • If the operation fails to correct my vision, will I be able to go back to contact lenses?
    • What if, years from now, I develop cataracts? Will this operation prohibit or interfere with later cataract surgery?
    • What are the long-term risks of this surgery?
    • What other questions should I have asked you?