Lasik success rates are high, but be aware of risks
Not everyone is an ideal candidate for LASIK surgery. Make sure you discuss the side effects with your physician before submitting to a procedure.
Joe Tye got Lasik hoping to ditch his glasses but ended up needing four different pairs.
Along with glasses for reading, two pair for computer work and another for driving, the 58-year-old who heads a leadership training firm spends $1,000 a year on eye drops and uses them upwards of 50 times a day — regularly dousing his eyes in front of clients.
“Eye drops are to me what a drink is to an alcoholic, except there’s no recovery,” Tye says.
Along with double vision, laser eye surgery and a touch-up procedure in 2007 left him with the wrong prescription in his right cornea, blurred night vision and chronic eye stress.
"I paid a lot of money to have this damage done to my eyes and it's depressing," says Tye, an Angie's List member in Solon, Iowa.
About 700,000 Lasik procedures are performed annually in the U.S. at an average cost of $2,000 per eye. The elective surgery, not typically covered by insurance, is used to correct nearsightedness, farsightedness and astigmatism, a visual defect resulting in blurred vision.
The industry boasts a success rate in the high 90 percent range, but not everyone is happy with Lasik.
In October, the FDA announced a collaborative project to gauge the percentage of patients who suffer significant quality of life issues after surgery. The three-year study, expected to wrap in 2012, is focusing on factors that might contribute to problems like double vision, in hopes of improving outcomes.
"We need a better understanding of patient-reported outcomes after Lasik," says Dr. Malvina Eydelman, director of the division of ophthalmic, neurological and ear, nose and throat devices with the FDA. She says patient complaints prompted the agency to take a deeper look.
Dr. Stephen Slade, a highly-rated ophthalmologist in Houston who was involved in the first FDA trials of Lasik, before the laser technology was approved for use in the U.S., suggests people considering the surgery pick a doctor they trust, who's done thousands of cases, who is respected by peers, even someone who's taught other doctors.
Many surgeons fit that description, he says. He believes a doctor should also be equipped to provide alternatives.
Slade says an ophthalmologist's staff should be concerned about the patient, and the doctor should answer questions.
"I would not go to a place that pressures me," he says. "I also wouldn't want to go to a doctor who told me the surgery was perfect, I wouldn't have to wear glasses anymore, and [who] guaranteed I'd see great after surgery, because that's not true."
He adds that he doesn't know of a surgery with a higher success rate and lower complications. Almost three-quarters have 20/20 vision after Lasik, but, as with any surgery, there are risks. Dry eye, hazy or blurred vision and temporary sensitivity to light are a few.
Also, Lasik permanently changes cornea shape, making it harder to measure later. Before surgery, have your doctor fill out a card containing your eye measurements. To find this card, go to fda.gov and search for "Lasik card."
A small study published in the American Journal of Ophthalmology in 2008, found about one in five who had Lasik to correct nearsightedness underwent another procedure within 10 years because of undercorrection, overcorrection or regression.
John Ciccone, a spokesman for the American Society of Cataract and Refractive Surgery puts the overall number for touch-up surgeries at closer to 7 to 10 percent.
Unlike Tye, many take these follow-up procedures in stride, as evidenced in some reviews on the List. Others see nearly instant results.
Lori Stephens, a former TV news anchor and radio personality, is drawn to the mountains, water and wildlife near her home in Anchorage, Alaska. On frequent hikes, she sees it all with naked eyes - no glasses or contacts - after Lasik.
"For the first time since I was in grade school, I woke up in the morning, opened my eyes and I could actually see beyond my hand up against my nose," says Stephens, an Angie's List member who's in her 40s.
Ophthalmologists say lasers - the first approved for Lasik in 1998 - are safer and more precise than ever. And the sheer number of cases is making it easier for doctors to predict who will do well with the procedure. "The first thing people need to do is find out if they're a good candidate," Slade says.
The best candidates are adults with a stable prescription - their eyes aren't worsening. Many medical conditions, including cornea disease, unstable diabetes and various types of arthritis reduce the chances of a successful procedure.
Dr. David Whiting, a highly rated ophthalmologist in Minneapolis who did Stephens' procedure, says 85 to 90 percent of his patients wanting Lasik are good candidates. But Whiting, whose done more than 85,000 procedures, concedes there's a gray area.
Tye says his doctor told him he was a "perfect candidate" for surgery, and only later did he find out he had blepharitis, an eye condition which, if not properly treated, can cause complications with Lasik.
In an e-mail to Tye - which Tye provided to Angie's List - Dr. Todd Gothard of Wolfe Eye Clinic in Marshalltown, Iowa, says the condition and dry eyes were present pre-operatively. But Tye, who didn't use eye drops before Lasik, contends neither were discussed with him prior to surgery.
Tye says he was abandoned after problems. The clinic's chief executive, Kevin Swartz, declined to talk about Tye's case, citing confidentiality, but says they follow up closely with patients and have a high satisfaction rate.
In addition to chance complications, many require glasses or contacts right after Lasik. Ciccone says most who get Lasik do so to correct nearsightedness, and many have presbyopia, a common condition with age in which the eyes lose their ability to focus up close.
For those with presbyopia, the same Lasik procedure which grants distance vision also prompts the need for reading glasses. "They didn't realize they were presbyopic to begin with, they were using their nearsightedness to read," Ciccone says.
Some solve the problem by fixing one eye for distance and another for close-up, what's called monovision. About 25 percent of Lasik patients over 40 opt for this, Whiting says. Of those - maybe one in 10 - need Lasik on just one eye.
Ophthalmologist Dr. Alan Brown in Wilmington, N.C., wanted to preserve Johanna Arnold's ability to read, while giving her optimal distance vision with minimal surgery. He performed Lasik on her right eye in January 2009, and after several months her brain adjusted to monovision.
Arnold, 51, reads with the uncorrected left eye, and views distant objects, including birds, with her right. "Because I can see [the birds] so clearly, I can compare them with a book I have, and I can determine the species much better," Arnold says.
For most, Lasik has opened their eyes in a way glasses and contacts couldn't. And the millions of procedures done have only made it safer.
"It's not an iffy procedure," says Dr. Brown, who had it done on his eyes 10 years ago. But because Lasik was only approved in the U.S. 12 years ago and considered a relatively new surgery, the FDA says the long-term safety and effectiveness of the procedure is unknown.
"We're looking at every possible way to improve information for patients and physicians and ultimately to improve patient safety," Eydelman says.