A Close Look at Laser Eye Surgery

You'd love to wake up in the morning without fumbling for your glasses, but the choices for laser vision correction have been out of your price range until now. However, if you're enticed by low prices and money-back guarantees at some centers, you need to take a closer look.

The surgeon's experience with LASIK surgery may decrease complications. While complications generally occur in less than 1 percent of cases, complications may decrease after the surgeon has performed 1000 surgeries.

What is LASIK?

The cornea is the clear covering in front of the eye that bends light rays to help focus them precisely on the retina in the back of the eye. LASIK corrects blurry vision caused by an irregularly shaped cornea. During the procedure, the surgeon cuts and lifts a flap of thin tissue off the outside of the eyeball. The surgeon uses a laser to reshape the cornea and then replaces the flap. The surgery takes about 10 to 15 minutes for each eye.

Nearly 2 million Americans have LASIK surgery every year. Many people have it done simply because they're tired of wearing glasses and contact lenses.

LASIK is popular because it's quick, safe and painless, recovery time is short, and the results can be dramatic. Infection after LASIK is rare when proper sterile techniques are used.

Every medical procedure carries some risk, so beware of centers that offer a guarantee of "20/20 vision or your money back." Most patients have 20/20 vision after the first treatment. The remainder need a second treatment (called "enhancement") after three months.

LASIK is not a universal cure-all either; many people over the age of 45 need reading glasses because of hardening of the lens, a condition that's not affected by laser surgery. The results are generally not as good for patients whose glasses or contact lens prescriptions are very weak or very strong.

Eye surgery tips

It's "buyer beware" when choosing a center for laser surgery. The equipment used during the laser procedure must meet Food and Drug Administration (FDA) standards for safety and effectiveness, but the government doesn't regulate the surgeon's use of the equipment or other techniques that are part of the procedure. Here are some common questions and tips about LASIK:

• Find a doctor who will help you decide what's best for you. Only ophthalmologists (medical doctors) are allowed to perform LASIK. Meet with your ophthalmologist before the surgery to discuss your visual needs. You also should be evaluated thoroughly to ensure you are a good candidate. LASIK can correct farsightedness, nearsightedness and astigmatism, but about 5 percent to 10 percent of candidates are disqualified for health reasons (a previous eye injury, pregnancy, a serious health condition like herpes or diabetes or a recent change in an eye prescription, for example). Your ophthalmologist should also test you to see if your pupils are too large or your corneas are too thin.

• Learn the risks and limitations of the procedure. In some patients, LASIK causes a slight loss of vision that can't be corrected by glasses, contacts or surgery. Some studies suggest that after LASIK, you might not see as clearly at night or in fog as you did before the treatment. Blurred vision, corneal scarring, dryness and haloes or starbursts around lights are some potential complications. The LASIK treatment also is not reversible, and there are no conclusive data on how it will affect your sight in five years. But ophthalmologists are confident about the long-term safety because of the success of keratomileusis, a similar type of corneal surgery that has been performed since the 1960s.

• Should you have both eyes corrected at the same time? You can. Most LASIK surgeons believe doing both is safe. When both eyes are done together, there's no imbalance in sight and your recovery period is not doubled.

• Experience counts, so don't base your decision solely on cost. You should find a surgeon who has done the procedure at least 500 to 1,000 times. Most insurance companies will not pay for LASIK surgery, but you should still check about coverage with your insurer.

Sources:

The Food and Drug Administration

LASIK Eye Surgery, U.S. Food and Drug Administration Web site

Basik Lasik: Tips on Lasik Eye Surgery, Federal Trade Commission, in cooperation with the American Academy of Ophthalmology, August 2000

This article was reviewed and updated June 2007.