To See or Not to See

Insurance won’t cover it, some healthcare providers say it’s unsafe, it’s costly, and results are not guaranteed. Still, this year 1.8 million people will spend an average of $2000 on this voluntary medical procedure scientifically known as Laser Assisted In Situ Keratomileusis—you and I know it simply as LASIK. In the two years since my surgery, many people have approached me and asked what LASIK is, whether it works, what happens, and how it feels. While each person’s experience may vary, there is some general information that applies. The simplified version of what happens is easy to tell: LASIK involves making a flap by cutting partially through the cornea, and using a computer controlled excimer laser to reshape the cornea.

What does it cost?

Cost is a consideration, since most insurance providers will not pay for LASIK surgery, because it is elective. LASIK, when it’s all said and done, will cost between $2000 and $3000. Some surgeons hide the total cost by charging separately for the evaluation, the surgery, and the follow-up visits. Find out, up front what is covered in the quoted or advertised price. You will likely find, after checking with several surgeons in your area, that prices are very similar. If someone quotes a price that is considerably cheaper than others, use caution and remember that if something sounds too good to be true, it probably is. In any case, the price should not be the primary consideration when choosing a surgeon.

If you cannot find a surgeon whom you trust and can afford, do not settle for cheaper surgeon if you question his or her experience and/or credentials. Although the TV and radio ads trivialize the LASIK and casually advertise prices and effectiveness, never forget that LASIK is a surgical procedure, and deserves some serious thought before settling on a doctor.

What You Should Know About LASIK

If you decide to pursue LASIK, the first and most important step is to find a LASIK specialist who has an established and respected practice. Nearly all of the high-profile “nightmare” stories related to LASIK come from people who cared more about finding a bargain price than they cared about finding a conscientious expert to entrust their vision to.

Independent studies indicate that LASIK surgeons have a “learning curve” and the odds of complications decrease significantly as a surgeon gains experience. The doctor I chose was one of the first to offer LASIK in my area (North Alabama) and he had been performing the surgery for over five years when I made my appointment to see him. In addition to LASIK, my surgeon had been performing glaucoma surgery and inserting corneal rings for almost ten years and had credentials from some very prestigious medical schools.

Don’t be afraid to ask a prospective surgeon how long and how many surgeries that he or she has performed, and how many he or she will be performs in a single day. Find out how many of his or her patients have had significant problems with the surgery and the nature of these problems. Reputable doctors will gladly answer your questions, understand your concerns, and provide information regarding their practice, experience, and education.

Who can have LASIK and Who Can’t?

LASIK candidates must be at least eighteen years old and generally should not be older than sixty. The candidate should have stable eyesight (no major changes in vision in the previous year or so), and have healthy eyes. A history of excessive scarring from previous injuries, pregnancy, diabetes, AIDS, glaucoma, and/or acute dry-eye are matters that may disqualify a potential patient. A new procedure, called LASEK, has made vision correction possible for candidates whose corneas are too thin for LASIK. In any case, however, only the physician can determine whether a person is a good candidate.

LASIK: The Truth

LASIK has received much media attention, and many surgeons are advertising their services. Still, the limited information provided by these ads often inspires questions but provides few answers. To answer the most common questions, the prospective patient should know that LASIK does not involve the use of scalpels, stitches, or general anesthesia. The surgery is not painful, and there is only very mild discomfort during the procedure.

No reputable surgeon will guarantee any patient that he or she will have 20/20 vision after the surgery, and no one can promise that the patient will never need corrective lenses again. The doctor and the laser can reshape the cornea, but over time, it can become misshapen and vision may deteriorate, once again. A reputable doctor will discuss the possible complications and answer questions about his or her experiences with complications.

What are the Odds?

After researching the FDA website and reading results of an extensive study conducted by Dr. Karl Stonecipher at the Southeastern Eye Center in Greensboro, North Carolina, the data are consistent: there is a miniscule chance of LASIK going very badly, but that chance still exists.

The excimer laser that reshapes the cornea is computer controlled, but the computer controls must be programmed in accordance with the patient’s needs. Therefore, the surgeon’s expertise in discovering and interpreting a patient’s needs and setting the controls accurately is crucial to a successful LASIK procedure.

According to a study done by the FDA, and Dr. Stonecipher’s findings, the chance of a patient suffering permanent blindness from LASIK is less than one tenth of one percent (.1%). Additionally, this low percentage is further reduced if the number of injuries caused by unscrupulous surgeons who use an “assembly line” approach to these surgeries as if they are processing beef. On the other hand, the chance of the patient’s vision being improved, after LASIK, to the point that he or she can drive a car without requiring corrective lenses is well over 90%.

As is true with any other type of surgery, there are certain risks associated with LASIK. A majority of the LASIK-related problems pertains to the flaps that are created during the procedure, and a vast majority of these can be easily corrected. Some patients experience a “halo effect” when driving at night, however, this is often temporary. There is a chance of infection, debris can sometimes get under the flap, or the flap can tear loose. For these reasons, it is important to find a reputable surgeon who treats his or her patients with the same care and concern as that which you would expect from any other medical professional.

What Happens During LASIK?

About five minutes before the surgery, numbing drops are applied to the eyes. This anesthetic completely desensitizes the eyes and prepares them for the surgery. The patient is placed on a reclining chair that is similar to a dental chair and a comfortable restraint is used to stabilize the patient’s head. The surgeon then tapes the eyelashes back to keep the patient from blinking and applies a suction ring (or speculum) to the eye to keep it stable and to provide a platform for the microketotome (sometimes called a flapmaker). This flap making business is the part that makes many people feel squeamish, but it is painless.

After the flap is made, the surgeon folds it back, rolls the excimer laser over the patient’s head, and instructs him/her to look at the orange circle. The patient’s eye is exposed to the laser for a predetermined amount of time that is usually no more than twenty-five or thirty seconds, and the process is repeated on the other eye. The elapsed time, from the time I walked into the operating room until the time that I walked out, was no more than ten minutes, and half of that was spent on preparations for the surgery.

Immediately after surgery, the surgeon or nurse will carefully examine the patient’s eyes to ensure that the flaps were repositioned correctly, and that no debris is trapped beneath them. My vision was blurry, at that point, and I had no indication as to the degree of success that I would experience.

My doctor taped plastic lenses over my eyes (to protect them), gave me a prescription for antiseptic eye drops and pain medication, instructed me to keep the lenses over my eyes for twenty-four hours, keep my eyes closed as much as possible, and made an appointment for me to return on the following morning for a check up.

After having my prescriptions filled and taking a Vicodin, I slept for about two hours, and opened my eyes to a new world. I entertained myself for hours, testing my vision by trying to read distant objects and relishing the fact that my vision was better than it had been since I was six years old.

While I could see a marked improvement in my vision after only several hours, a LASIK patent’s vision quality is not stable and consistent, for several weeks, although within twenty four hours, most patients find that their vision is more than adequate to enable them to function normally, go to work, drive, etc.

A Sensible Conclusion

Why did I have LASIK? I was attracted to LASIK because I’d grown tired to dealing with glasses and contacts. My research indicated that LASIK is very safe, when performed by a skilled and experienced surgeon. LASIK has been in use for nearly twenty years overall, and has been used in the US for about ten years. Time has shown that LASIK is a very good option for vision correction, and the surgery is less discomforting than having one’s teeth cleaned.

However, there’s no substitute for having confidence in the physician, understanding the surgery, and knowing the benefits and the risks. When you learn the facts, as I have, I feel confident that you will find that LASIK deserves consideration as a legitimate and viable option for better vision.

Steven Sharp is a 37-year-old freelance writer from Huntsville, Alabama. His first book, The Art of Managing Everyday Conflict: Understanding Emotions and Power Struggles has recently been released by Greenwood Publishing Group.

LASIK at a Glance

Supplemental Material:

What happens when LASIK is performed?

1. The eyes are desensitized with anesthetic drops.

2. The patient’s eye is steadied by the attaching of a suction ring.

3. A device called a micorkeratome is used to create a corneal flap.

4. The flap is lifted and moved aside to expose the area of the cornea that will be reshaped.

5. The surgeon tests the alignment of the laser for accuracy

6. The laser, preprogrammed to provide the proper level of correction to suit the patient’s need, is fired for a predetermined length of time.

7. The corneal flap is replaced and the process is repeated on the other eye.

(Transparencies to accompany these seven steps are available, if requested)