Each year, more than 700,000 people undergo Lasik eye surgery in an effort to see clearly without help from glasses or contact lenses. Lasik, which stands for laser-assisted in situ keratomileusis, uses a high-powered laser to reshape the cornea and improve vision. Back in the 1990s, when the surgery was first introduced, surgeons used a scalpel to make a flap in the cornea and access the stroma, or middle section of the eye, to perform the laser reshaping. Today, lasers are often used for the whole procedure.
This summer, the Food and Drug Administration released preliminary findings from a study on long-term satisfaction among Lasik eye surgery patients. While most respondents reported improved vision, 1 percent said that new symptoms, such as triple vision, worsened night vision and chronic dry eyes, interfered with their daily activities. Eye-care professionals have argued that people experiencing complications from Lasik represent a vocal minority. But patients dealing with these side effects believe the procedure should be pursued with more caution.
What should people considering Lasik eye surgery know before committing to the procedure? How do doctors decide which patients are good candidates to go under the laser? We asked five ophthalmologists to weigh in. Here’s what they had to say.
Associate professor of ophthalmology, Wake Forest University, Winston-Salem, North Carolina
I would caution your readers to understand that there are two different kind of Lasik: the blade procedure, which was the old kind, and the all-laser. Lasers are more stable and have fewer complications. If you have a cousin who told you he got Lasik and now has a problem, chances are he had the blade kind. Some doctors or vision centers do that because it’s cheaper. What you want is a surgeon who’s been doing the laser version for five or 10 years and has at least 500 or 1,000 operations to their credit.
The other thing to understand is that Lasik eye surgery does not eliminate the need for reading glasses or bifocals. This is true particularly if you’re over 40. If you wore glasses or contacts and then had bifocals for reading, then Lasik will eliminate the need for the glasses only. The most common complaint by far is that patients wish they had done it sooner.
Ophthalmologist, Clear Choice Custom Lasik Center, Cleveland
There is definitely an ideal patient for Lasik eye surgery. Sometimes patients have very thin corneas, and then the procedure is not advisable. We do something called corneal topography where we look at the shape of the cornea and determine whether someone is a good candidate. The problem comes when a person goes to a facility that just knows how to do Lasik and nothing else. They might not be a great candidate for it, but the office doesn’t have other options for them. A comprehensive surgeon will have six or seven solutions. Just because they might not be right for Lasik doesn’t mean they can’t be treated. We have other procedures to correct vision, so someone with thin corneas or irregularities on their topography might be eligible for an implant or corrective lenses.
One reason people might hesitate is the financing. It’s not typically covered by insurance. We provide a payment plan, but I also see people coming in during January because they’ve set money aside in their health savings account. Depending on their tax bracket, they could be saving up to 25 percent.
Ophthalmologist and clinical spokesman for the American Academy of Ophthalmology, Baltimore
The minimum age is 18, but there’s no maximum. I’ve done patients in their 70s. What some people might not understand is that cataract surgery can be corrective as well. We’re all born with a lens in our eye that gets cloudy over time, kind of like a frosted window pane. When we put a clear lens in place during cataract surgery, there’s no chance of reoccurrence and it can resolve vision issues that would normally be addressed with Lasik. If a patient is still unhappy with their vision following that procedure, I can go in and do Lasik.
As far as anxiety over the procedure — look, when a blade is coming at your eye, you should be nervous. That’s one of the reasons the blade version of the procedure has fallen by the wayside. I tell patients to think of it in relation to other technology. When I had my own procedure done in 1999, the iPod hadn’t come out. Look how far that technology has come since then. I migrated to the all-laser type 10 years ago, and unless someone has a very dense corneal scar from a contact lens that requires a blade, laser is better.
Director of refractive surgery, department of ophthalmology and visual science, University of Chicago Medicine and Biological Sciences, Chicago
I think there are a significant number of people who think Lasik eye surgery will improve or enhance their visual function more than what they currently have with glasses or contact lenses. It’s important for potential patients to understand that Lasik will only give them the same vision they have with their current prescription. The other thing is that patients think this is like a “getting a haircut” type of procedure. It’s important for them to know that this is a surgery that has its share of potential risks. But under the care of a proper surgeon, the success rate of refractive surgery is quite good. In fact, the risks of vision problems with refractive surgery have been shown to be less over time than potential vision problems with long-term contact lens wear, as per the scientific literature. So patients should feel confident that if they qualify clinically for Lasik, they have a high probability of doing well, provided they follow instructions and appropriate postoperative follow-up and care.
It’s also important for patients to realize after the age of 40 or 45, presbyopia [normal loss of near focusing] will kick in, and there may be a need for reading glasses to see things up close. Presbyopia happens to all of us, regardless of whether we have Lasik or not. One advantage of remaining nearsighted is we can delay the need for reading glasses because that nearsightedness serves as a built-in pair of reading glasses, so myopic presbyopic patients can take off their glasses to read and may not need reading glasses until their 50s. Patients who undergo Lasik eye surgery in their 20 or 30s now become “normal,” so they will likely need reading glasses in their 40s, just as normal-sighted patients who didn’t wear glasses when younger will need reading glasses in their 40s.
Not everyone is a good candidate for refractive surgery. Wearing glasses isn’t the end of the world. Patients should seek proper evaluation and have a thorough discussion with their Lasik surgeon prior to moving forward. When Lasik is done on the right patient and by the right surgeon, it can be a positively life-changing experience for the patient.
Ophthalmologist and clinical spokesman for the American Academy of Ophthalmology, Laser Vision Medical Associates, Los Angeles
There were things we didn’t understand when Lasik eye surgery was first introduced, like how pupil size can affect the chances of getting glare or halos in the vision. But it’s just not the same surgery we were doing 15 years ago. The laser has gotten more exacting and can cut a flap in 15 seconds. The blade might have severed more corneal nerves and led to more cases of dry eyes. There isn’t zero risk, but most operative complications happen in the first few days. Outside of a week, you should be home free. I tell patients Lasik eye surgery will eventually go down as the safest and most predictable surgery we can perform on the body. If you are highly myopic, there might be a greater chance of complications. Less myopic, and you have a better chance of getting 20/20 vision.
I would be wary of any surgeon or center who makes a guarantee of 20/20 vision, since there are no guarantees, or ads for $200 procedures. You really can’t do the procedure for that amount of money.
Responses have been condensed and lightly edited.