Liberated by LASIK Surgery

The Limits of LASIK Surgery

For most patients, LASIK is a vast improvement over previously available corneal surgery techniques in terms of pain, recovery time, and results. Overall, LASIK also has impressive rates of safety and effectiveness. In a 1999 study of LASIK performed on 1,013 eyes, 92 percent of patients gained 20/40 vision or better, and 47 percent were corrected to 20/20 or better. However, there are risks, limits to what LASIK can accomplish, and some important drawbacks: As with any invasive procedure, there is always a possibility of infection. According to the American Academy of Ophthalmology, complication rates vary from 0 to 5 percent in clinical studies, and 5 to 15 percent of patients return to their surgeon for enhancements to improve results.

  • Short-term side effects following surgery can include pain, light sensitivity, and corneal swelling. In some patients these can last for several weeks. One of the most common complications of LASIK is wrinkling of the flap, causing distorted vision. It can usually be repositioned or treated with drugs, though in rare cases the flap may have to be re-cut.
  • The majority of LASIK patients also report seeing glare or halos at night. This usually occurs in low light because the pupils widen beyond the area of the cornea corrected by the surgery. Most, though not all, find the problem subsides within six months, but the British Aviation Authority has discouraged pilots from undergoing LASIK for fear of permanently damaging their night vision. The U.S. military is still reviewing the long-term effects of LASIK.
  • Those who require the greatest vision correction, measured in diopters, are most likely to have ongoing problems with glare and halos because of the steep drop-off between the altered and unaltered areas of the cornea. For that reason, people with myopia exceeding minus-12 diopters, or farsightedness of more than plus-6 diopters, are often discouraged from undergoing LASIK. Or, they can opt for having one or more LASIK treatments that will improve their prescription, but don't attempt to achieve 20/20 vision.
  • At present, surgeons' calculations of how much corneal material to remove are based on statistical averages of all patients with a given set of eye characteristics. They yield very good educated guesses, but can't take into account minor idiosyncrasies in individual eyes, and 5 to 10 percent of LASIK patients require a second procedure to refine their vision correction. However, a computer scanner that actually maps a patient's eyes to plan the corneal correction is in development, so a more precise, custom LASIK procedure could soon become the standard.
  • Finally, LASIK can't prevent the inevitable. As we age, the lenses in our eyes lose elasticity, just like our skin, and their ability to focus declines, a condition called presbyopia. So, most patients over 40 are still likely to need reading glasses after LASIK, and even if a younger person achieves perfect vision, it won't last forever.

Choosing LASIK

A good doctor will offer all the above caveats to a patient seeking LASIK. "When patients come for an examination in our office," Moadel explains, "they're basically given a very thorough examination, however, the most important thing we do for our patients is educate them. That's critical to a patient, to understand what this procedure can do for them, the limitations of the procedure, and we determine whether or not they should have it done. About 20 percent of people that come to our office are not good candidates for this procedure."

LASIK cannot correct vision problems caused by defects in parts of the eye other than the cornea. Among the other conditions that would preclude LASIK are pregnancy, nursing, pre-existing eye diseases such as herpes, as well as diabetes or immune disorders that would hamper the healing process. Just as a qualified ophthalmologist will screen patients, you should screen doctors carefully if you're considering LASIK.

Find out what kind of training the doctor has had — a year-long fellowship is preferable to a weekend seminar. Ask how many of the procedures the doctor has performed. One study showed considerable drop-offs in surgeon errors after 600 operations, so the more experience your doctor has the better. And don't be afraid to ask how many of that doctor's patients have worse vision following the operation — for the best LASIK surgeons, the figure is 5 in 1,000 or fewer.