Laser eye surgery has
become so routine that ophthalmologists advertise it on billboards
and perform the operation at shopping-mall clinics. But the seeming
simplicity of the 15-minute procedure to correct nearsightedness can
be misleading. In the surgery, called Laser-Assisted In Situ
Keratomileusis (LASIK), a laser vaporizes part of the cornea and
reshapes it to change the eye's focus. That's not quite as routine
as having your teeth cleaned.
Some 2.6 million people have had LASIK surgery since it
became available in the U.S. in 1995. Along with that growth has
come an increase in complications and botched operations. These can
range from minor irritations--dry eyes or poor night vision--to
life-impairing conditions, such as double or blurry vision, or worse
yet, blindness. Even satisfied customers may find that their vision
regresses in a few years, and they need further surgery.
It's
hard to pinpoint a precise complication rate. Studies by everyone
from LASIK equipment manufacturers to the American Academy of
Ophthalmology have shown that anywhere from 1% to 8% of LASIK
patients experience post-surgery problems, depending in part on how
"complication" is defined. Many studies focus on vision loss, for
example, but overlook complaints about dry eyes or double vision. "A
vast underclass of LASIK patients are deemed successful because they
have 20-20 vision even though their visual quality is poor," says
Ronald Link, founder of SurgicalEyes.com, a Web site devoted to
LASIK patients with complications. In comparison, face-lift patients
have a 2% to 3% complication rate, according Doctor's Co., the
largest U.S. malpractice insurer for plastic
surgeons.
Surgical error is responsible for some LASIK
problems. If, for instance, the surgeon cuts the cornea's exterior
membrane incorrectly, the eye could suffer vision loss or scarring.
To find a qualified practitioner, try the Web site of the American
Academy of Ophthalmology, http://www.aao.org/, and go to its "Find an EyeMD"
page. Then ask the surgeon if he or she has done the procedure at
least 200 times. After that level, the instance of intra-operative
complications drops from 4.5% to 0.9%, according to a study
published by the LASIK Institute, a division of the American Society
of Cataract & Refractive Surgery in Fairfax, Va.
Patients
most likely to suffer complications are those who have preexisting
conditions that should have precluded them from having LASIK
(table). Critics say doctors may not be as diligent as they should
be, since fees are high--$500 to $2,500 per eye--and patients sign
preoperative releases absolving their doctors from complication
liabilities. "Complications often stem from the qualifications of
the patient," says Everette Beers, chief of the Food & Drug
Administration's surgical-devices division. "Physicians need to do a
better job screening out poor candidates."
A thorough
preoperative screening takes about an hour and should cost $150 to
$200. "After testing, I reject a quarter to a third of the patients
who seek LASIK," says surgeon Douglas Koch, who chairs the
ophthalmology department at Baylor College of Medicine in Houston.
To avoid conflicts of interest, Koch recommends that patients get
screened by a doctor belonging to a different medical group than the
one slated to perform the surgery. (Since LASIK is classified as a
cosmetic procedure, health insurance generally doesn't cover either
the screening tests or the operation.)
The first thing the
screening doctor should do is check the thickness of your corneas,
using a device called a pachymeter. The FDA recommends that corneas
be at least 410 microns thick after LASIK surgery--250 microns of
that in the cornea's bed and 160 microns in its flap. So the
presurgery cornea should measure 450 to 650 microns. Patients with
thin corneas can suffer vision loss.
Operating on an
irregularly shaped cornea can also cause vision loss. So in
preoperative tests, a surgeon uses a corneal topographer to map the
cornea's contours. Conditions such as ectasia, a steepness in the
lower part of the cornea, and keratoconus, a bulging cornea, should
disqualify the patient from laser surgery. Patients with these
irregularities may see so poorly after LASIK that they need corneal
transplants.
Oversize pupils are also a problem. They can
lead to a group of complications known as GASH--ghosting, arching,
starbursts, and halos--in which objects seem fuzzy at the edges and
light sources seem to burst like the sun. "Every light is like the
Fourth of July for me, with fireworks shooting out of it," says
Frank Boydston, a San Diego financial analyst who had LASIK last
year. The problem arises because LASIK lasers are built to operate
on eyes with pupil diameters of 6 to 8 millimeters. Boydston
discovered after the fact that his pupils exceed that
limit.
Dry eyes, which sting from a lack of tears, are
tolerable for most patients. But for those who already have dry
eyes, the condition can become so debilitating after surgery that
they can no longer be in a dry environment--such as on an
airplane--without excruciating pain. The Schirmer tearing test
detects dry eyes by using paper filters to measure tear production.
A tear spot less than 8 millimeters in diameter is a sign that the
patient has dry eyes and may want to avoid LASIK.
Painful
abrasions on the eye can become a recurring problem for LASIK
patients who have epithelial basement membrane dystrophy (EBMD), a
disease of the cornea's membrane, which causes it to erode. "It's
one of the most painful things I've ever experienced," says Thomas
LaMark, a freelance musician in Andover, Mass., who has EBMD and had
LASIK. "The eye becomes extremely bloodshot, swells up, and almost
closes." To test for EBMD, the surgeon should stain the eye with a
chemical called fluorescein and examine it under a lamp. The stain
will have a different color in regions of the eye with abrasions, an
EBMD indicator.
A common condition known as presbyopia can
present another problem after LASIK surgery: difficulty in reading.
The eye's lens hardens with age, and adjustments in focus from near
to faraway points are difficult. LASIK simply reverses the problem,
so the person can see distances better but not up close. The test
for presbyopia is a basic visual-acuity exam to measure the level of
impairment. Presbyopic patients will need reading glasses after
LASIK, though they should be able to drive their cars without
glasses or contact lenses.
If you're considering LASIK
surgery, you'd be wise to understand its risks and trade-offs,
especially since it is possible that the positive effects of the
surgery may not last. Generally speaking, the worse your vision is
prior to LASIK, the more likely it is your eyesight will regress
afterward. Then you will need to have LASIK a second time--a
so-called "enhancement surgery." That's something not to lose sight
of before you go under the beam.
By Lewis
Braham
Click to buy an e-print or
reprint of a BusinessWeek or BusinessWeek Online story or
video.
Add news from BusinessWeek Online to your Web site
with our headline
feed.
To subscribe online to BusinessWeek
magazine, please click
here.
Home Loans, Refinance, Purchase, Cash Out Home
Loans All Types, Online Ez App.,Real Rate Quotes, No Point No Cost
Loans Available, National And Local Lenders Compete for Your
Loan.
Vonage DigitalVoice...The BROADBAND Phone
Company Vonage is a digital phone service that replaces your
current phone company, offering unlimited local and long distance
calling for $39.99 per month
Sundance Communications Supplier of Business
Telephone Equipment at discount prices. Free Bulletin board for
technical help, programming and a regional directory of telephone
installers and phone techs.
Copyright 2002 ,
by The McGraw-Hill Companies Inc. All rights reserved.
