Is Lasik Eye Surgery For You?
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If your eyesight is less than perfect, you may be wondering whether you should have vision-correcting eye
surgery.
Last year, 1.2 million Americans underwent the most popular form of the surgery, known as laser in situ
keratomileusis (LASIK). That number is expected to rise to 1.9 million in 2008.
A 15-minute outpatient procedure that costs about $2,500 per eye, LASIK has proven highly effective at
correcting nearsightedness (myopia) and certain other vision problems. But it's not without drawbacks.
Bottom Line/Health explored the pros and cons with LASIK pioneer Douglas D. Koch, MD...
How effective is LASIK? It's very effective for people with mild to moderate myopia, farsightedness (hyperopia)
or astigmatism. Among people with one of these problems, 90% of those who undergo LASIK wind up with
vision of 20/40 or better. Fifty percent to 60% achieve perfect 20/20 vision.
LASIK cannot correct cataracts, glaucoma or macular degeneration. Nor can it correct presbyopia, the
aging-related vision problem that necessitates the use of reading glasses.
How safe is it? As with any invasive procedure, there is a slight risk for infection. Ordinarily, infection caused
by LASIK can be eradicated with antibiotics. But in rare cases, the infection leaves the patient with mild vision
loss.
Overall, the risk of losing moderate to severe amounts of vision is less than 1%, but not zero.
Altogether, about 1% of people who undergo LASIK experience complications either during surgery or
afterward.
Who is a candidate for LASIK? Anyone with mild to moderate myopia, hyperopia or astigmatism who would
prefer not to wear contact lenses or eyeglasses.*
The main consideration is this--would it dramatically enhance your life to be able to see clearly without
corrective lenses? If not, it makes no sense to assume even the tiny risk that your eyesight could be harmed.
Who is not a candidate? Anyone with severe dry eyes, severe diabetes, an immune system disorder,
glaucoma or another ailment that might affect the healing process. LASIK is also off-limits to people who
have unusually thin corneas... or who have keratoconus. That's a condition in which the cornea develops a
conical shape.
Federal regulations require that LASIK patients be at least 18. There is no upper age limit.
Exactly what does LASIK involve? The patient, who might be given a mild sedative like diazepam (Valium),
reclines on a chair or gurney. The eyelashes are taped back, and a speculum is used to hold the eye open.
Using a special cutting device known as a microkeratome, the ophthalmologist slices a thin flap of cornea.
That's the transparent "window" at the front of the eye. This flap is folded, hinge-like, back from the eye.
Next, the ophthalmologist uses an excimer laser to vaporize portions of the cornea, reshaping it to alter its
refractive power. That's the extent to which it bends light rays that enter the eye.
The corneal flap is folded back into its original position and the eye is treated with antibiotic drops.
Some patients recover within 24 hours. Others take several weeks. Typically, an eye patch is worn for several
hours after surgery, and then at night for a few days.
Is LASIK performed on both eyes at once? Most patients like to take care of both eyes at once. But I
sometimes prefer to do one eye and then the other eye a week or so later--to make sure that the patient is
recovering well from the surgery.
What's the best way to pick a LASIK surgeon? Get a referral from your ophthalmologist or family doctor... or
from the head of the ophthalmology department at a local teaching hospital or medical school.
You'll want to select a board-certified ophthalmologist who has performed at least 100 LASIK procedures.
Afraid of the laser treatment? Or lasik is just not for you? Then you might want to consider some non-surgical
alternatives to lasik such as contact lenses, orthokeratology (ortho-k), or, keep it classic with good old
eyeglasses. Much cheaper than the surgery, these are less aggressive options to your eyesight problems.
Unlike the surgery, these less risky options give you the benefit of reversibility.
Setting LASIK aside, contact lenses have come a long way from what it used to be. There are now a huge
variety of contact lenses design wether it's for usual or special needs. They are now available in bifocal
prescriptions. And, sensitive eyes even have the option of extra thin lenses. There are soft, comfortable
lenses that you can discard after a day or a month, and rigid gas permeable lenses that can last years and
provide sharper, clearer vision than soft lenses. Soft lenses
Probably the most comfortable lens for the eye and also the easier to adapt to the soft lenses are also more
expansive than the rigid lenses over a long period of time. If you are using soft lenses, you can compare with
lasik how many soft lenses it would cost you to go for lasik. Rigid lenses
More durable than soft lenses but it takes more time to adapt to them. They are more resistant to buildup of
deposits. LASIK deals with astigmatism. With rigid contacts, you can differentiate between the left and right
eyes and select toric lenses for astigmatism. Seven-day continuous wear lenses and 30-day continuous
wear lenses have recently been approved by the FDA. Ortho-k
LASIK uses surgery to change the shape of the cornea. Ortho-K is just another type of operation to train the
shape of the cornea instead of reshaping it. It uses rigid gas permeable contact lenses. Basically this
improves the eyes's abilitity to refract light and focus. Although Ortho-K cannot be permanant, a person's
vision can can still improve drastically with continued use. It could go up to 20/40 or even 20/20 vision.
In the beginning of the Ortho-K therapy, the contact lenses are worn about eight hours each day. After LASIK,
vision improvement occurs in days. With Ortho-K, as the cornea changes shape over the weeks, improving
the vision, the lenses are worn less frequently. Wearing time shortens to a few hours at a stretch every few
days. Stopping the use of the Ortho-K lenses causes the corneas to revert to their original state. Occasionaly,
the effects of LASIK may fade, too.
Clarity of vision may fluctuate, and it may take several months to change the vision measurably. Accelerated
Ortho-K therapy may be used to get the desired effect more rapidly. If you are among those that have a low
level of nearsightedness and/or small astigmatism, then Ortho-K would fit you like a shoe.
Good Old Eyeglasses If LASIK or contact lenses are not for you, there is another alternative. Sticking with your
eyeglasses may be the choice you need to make. Eyeglass frames are more durable and flexible than ever.
Lenses are lighter, stronger, more scratch resistant. New options for glasses include tinting that changes
more rapidly, progressive bifocal lenses, anti-reflective coatings, UV protection and greater impact resistance.
Some advantages to this option are less expense than contact lenses or LASIK surgery, greater ease in
changing your mind, and fashion-forward styling. The greatest benefit may be the guarantee that the good
eyesight they have provided to you for years can continue indefinitely.
If you cannot have LASIK surgery now, or even if you never choose to have that procedure, these are viable,
safe, money-saving choices. Even if you decide to have LASIK surgery at some future date, choosing contact
lenses, Ortho-K therapy, or eyeglasses can keep you going until you make that decision.
