Considering laser surgery to improve your eyesight? New
guidelines should help determine if you're a good candidate or might
be prone to vision-harming side effects.
One key: The guidelines explain what tests are needed before
getting zapped, so if your doctor skips these steps, consider
picking another surgeon.
``There is a major need for credible, reliable information,''
says Dr. Roger Steinert of Harvard Medical School, who co-wrote the
guidelines for the American Society of Cataract and Refractive
Surgery.
``You need to be aware of the complications and the risks,'' adds
John Jeter of Reston, Va., who may have narrowly escaped injury. He
was scheduled for surgery by one LASIK center but — nervous because
workers repeated his eye test six times before okaying him — got a
second opinion from another doctor who said Jeter's cornea was too
thin to be zapped safely.
Americans will undergo more than a million LASIK procedures this
year to correct blurry eyesight. It's quick and painless: Doctors
cut a flap in the cornea, aim a laser underneath it, and with a zap,
reshape the cornea for sharper sight.
While the vast majority of patients get better vision, it's not
for everybody — a message often lost in the hoopla of ads promising
that people can ``throw away your glasses'' or offering
bargain-basement prices for surgery that usually costs more than
$1,000 an eye.
Side effects include double vision, glare, halos or starbursts of
light. Occasionally, patients actually lose vision, unable to see as
well even with glasses or contact lenses after LASIK as they could
before. Others are left with painfully dry eyes, despite eye drops.
The Food and Drug Administration, which approved laser surgery,
cannot tell consumers just how big those risks are. It's not
tracking them. Recent studies estimate 1 percent to 5 percent of
patients suffer various side effects, although Steinert says
experienced surgeons can have lower rates.
That's a small risk, yet with millions undergoing LASIK, it means
thousands may suffer some problem.
The FDA has long offered general LASIK warnings, such as to know
the risks and consider treating one eye at a time. The American
Academy of Ophthalmology recently concluded LASIK is best for
moderate, not severe, vision problems. SurgicalEyes, a group of
injured patients, created a Web site that illustrates what it's like
to see through various LASIK-caused side effects.
The new guidelines, to be unveiled Tuesday by the surgeons' new
Eye Surgery Education Council, offer consumers a different approach
— steps to determine if they're good candidates.
A key is knowing what eye tests to get. Among the most important:
Finding out if the cornea is too thin or the pupil is too big. Most
patients need half their original cornea thickness — at least 250
microns — remaining after surgery, Steinert explains. Avoiding glare
and other vision distortions partly depends on the laser-treated
area not overlapping a dilated pupil, so doctors must measure pupils
in low light.
Side effects aside, you may need multiple LASIK treatments over
months, and not everybody gets perfect vision. You're not an
appropriate candidate for LASIK if you need a new prescription for
glasses every year, or have certain medical conditions that affect
vision or surgical healing.
Basic LASIK won't eliminate that middle-age need for reading
glasses. Some doctors offer a variation called monovision, where one
eye is focused for near vision and the other for far vision. Test
this by wearing different-strength contact lenses first, stresses
Steinert. While monovision works well for many people, including
him, others never get used to it.
One patient offers additional advice: Visit LASIK centers to
watch the procedure, get second opinions, and call former patients.
``I was willing to invest a little money to hopefully ensure I
got a good result,'' said Rick Robertson of Houston, who spent $250
on two eye exams before undergoing LASIK last year — and has almost
perfect vision.