May 25, 2000 (Atlanta) -- People are trashing contact lenses and glasses forever, thanks to the "20-minute miracle" called laser-assisted in situ keratomileusis (LASIK) surgery. But not everybody who opts for LASIK is happy. While 99% of patients are satisfied, some of the others are grumbling openly on a burgeoning number of web sites devoted to telling their stories.
Here are just a few posted on one such site, called Surgical Eyes:
Roger: "Today, I can barely drive at night ... everything is smeared to the left in my left eye, and to the right in my right eye. Worse, my eyes are INCREDIBLY DRY. I can't sleep through the night ... When I read, my eyes don't seem to work together."
Howard: "My main trouble ... is from an annoying ghost image in my right eye ... very annoying, especially in bright lit places like food store or malls (Walgreen's is a nightmare of ghost images)."
The procedure is supposedly quick and painless: The doctor uses precise instruments to make a flap in the cornea, then the laser to remove some of the tissue underneath to reshape the cornea's curvature -- the key to good vision.
But is LASIK riskier than some surgeons might admit?
In Atlanta, George O. Waring III heads a refractive surgery center at Emory Vision Correction Center that does LASIK on 600 eyes per month. He tells WebMD that he's familiar with the Surgical Eyes web site, and is frankly glad that it's adding some realism to the LASIK picture.
"I honestly don't think it serves too bad a purpose, because, if anything, it increases the reality of people's expectations," says Waring, who is also a professor of ophthalmology at Emory University School of Medicine.
All the hype over LASIK has created a quick-fix mind-set, Waring tells WebMD. "People forget that LASIK is real eye surgery, and like surgery of any sort, something can go wrong. It's not something you drop in after work to have done, before you play tennis. It's a once-in-a-lifetime undertaking. You can always take a car back if it's a lemon, but this is different."
An estimated 1 million people are expected to have LASIK surgery this year alone, he says. Less than 1% will have complications, "but for that 1%, it's a very important occurrence."
LASIK has been around less than 10 years, but in that time, both the technology and doctors' skills have improved, Waring says. Today, both the microkeratome, the instrument that makes the flap, and the laser, which reshapes the cornea, are getting closer to foolproof, he tells WebMD. "That's why the complications are going down -- but not down to zero yet."
Still, people are taking the surgery too casually, Waring says. He encourages those considering LASIK to ask the surgeon questions about the procedure's outcomes and complications, and to shop around. "You need to be critical of discounts, claims of perfect vision," he says.
Kristin Pisacano, MD, medical director of refractive surgery at the New York Eye Surgery Center in the Bronx, also wants to help consumers understand what they're getting into.
"It's hard to tell what went wrong with Roger and Howard," who posted on the Surgical Eyes site, says Pisacano, author of the book LASIK Vision Correction. But they likely had complications which, if they were treated in a timely manner, could have been corrected.
The more serious complication, called "sands," creates a painful, dry-eye condition that is treatable -- but must be treated correctly and immediately, she tells WebMD. "Nobody knows exactly what causes it," she tells WebMD. It's treatable with drops, or sometimes the surgeon needs to perform a minor surgical procedure to lift the flap again and irrigate the area with solution. "But it is treatable," Pisacano says.
Wrinkles in the flap are rare, but can occur, she says, especially in people who rub or squeeze their eyelids -- sometimes in their sleep. "Those are more tricky to treat, but they are treatable if you're seeing someone who knows how." That condition must also be addressed right away to maintain optimal vision.
The longer such conditions are ignored, the less likely they can be corrected, Pisacano says.
Vision undercorrection and overcorrection are "pretty common," and correctable with a touch-up procedure performed two months after the original operation.
Most LASIK price packages include any follow-up procedures, Pisacano says, except those from many discount operations, which depend on getting patients in and out fast. "That's why I'm a little leery of those places," she tells WebMD.
Finding a good LASIK surgeon and having reasonable expectations are key to satisfaction, she adds. "Most patients are happy. They have realistic expectations when they go in. You need to find a doctor who will realistically explain things to you and not say you're going to see things 20/20 the next day, guaranteed."
Not everyone is a good candidate for LASIK surgery, she adds. "However, discount places aren't turning them away."
In fact, LASIK is one of the few surgical procedures that are marketed competitively, says William W. Culbertson, MD, director of refractive surgery at the Bascom Palmer Eye Institute of the University of Miami School of Medicine. "When the goal is to recruit people and sell them on the procedure, the potential risks are minimized, and patients who are not good candidates are encouraged to have it."
Further, patients often have unrealistic expectations about LASIK, Culbertson says. "I had a patient who had 20/20 in one eye and 20/25 in the other. She was extremely upset that both weren't 20/20. That's not always possible. But her perception was that she was going to have perfect vision.
"The pizzazz of lasers makes people think they can do anything," Culbertson tells WebMD. "Many patients have friends, family, co-workers who had perfect results. They go in thinking they will have a perfect result. It's a misconception that because it's a simple procedure, there may not be complications, there may not be side effects. ... There are people who have complications even in the best of hands, but the rate of complications is probably higher in certain patients and in less-experienced surgeons' hands."
The less-than-best candidate for LASIK has a large pupil in the dark and needs lots of vision correction, either for nearsightedness or farsightedness and particularly involving astigmatism and preexisting problems with dry eyes, Culbertson says. Side effects like halos at night, dry eyes, and glare may get somewhat better as time goes on, but in some, they persist, he says.
Age can also be a factor. Vision refraction, which determines how much correction a person's eyes need, may not yet be stabilized in patients younger than 25. The average age for LASIK treatment for nearsightedness is 39; for farsightedness, it's 49. "Medically speaking, you can have it done at any age, as long as there is stability in the refraction," he says.
So whom should you trust with your eyes?
When it comes to choosing a good LASIK surgeon, patients should have a "buyer beware" attitude, Waring tells WebMD. In the hype and price competition, there are "two-eyes-for-one" discount specials. You might "win a free LASIK" in a drawing. In one shopping mall, you can watch LASIK surgery though a storefront window.
"Patients need to have a shoppers' mentality, a critical mind-set, and probably need to interview more than one surgeon at more than one center," Waring advises. "Spend a good bit of time on the Internet, reading up on the subject and the different options.
"The basic warning should be, if it looks too good to be true, it probably is. You need to be critical of discount claims, claims of perfect vision, any claims that don't make sense," he adds.
Talk to your friends, he advises. "If someone you know and trust has been to a surgeon and has had a good result, or who says this doctor is pretty honest, he didn't do my neighbor because his eye wasn't the right shape -- that's the kind of reference that counts. But don't be naive, because you can also have a good result from a crummy doctor."
Also, check out more than one laser center, Waring says. "Sit down and evaluate everything, the center, staff, doctor. There are centers where the patient doesn't see the doctor until 10 minutes before the procedure. ... You need a doctor-patient relationship, in case anything happens."
You should also evaluate the surgeon, he says. Some questions to ask include: What is your training? What are your results? Have you published your results in a scientific paper? Can you show me your results? What is your frequency of complications?
"Most patients are embarrassed to ask these questions because they insult the integrity of the surgeon. But there is a retail side to this thing, even though it's real surgery. Those are the sort of questions you would ask about a house or a car," says Waring.
The answers you get are important, but so is the doctor's attitude, he says. "How does he answer the questions? Does he tend to minimize complications and say we almost never have a complication? Does he tend to exaggerate the good side? Does he seem more interested in selling the procedure than listening to your concerns?"
More information on LASIK surgery can be found at the web sites of the Council for Refractive Surgery Quality Assurance, the American Society of Cataract and Refractive Surgery, and the International Society of Refractive Surgery.
- LASIK is a type of eye surgery that attempts to reshape the cornea so patients don't have to keep wearing glasses or contact lenses to correct their vision.
- While most patients are satisfied with their LASIK results, an estimated 1% are not, and some are becoming vocal about it.
- Doctors who perform this surgery remind patients to be wary of promises and promotions. Patients should choose a doctor carefully, and understand there isn't a 100% success rate. Doctors also note that side effects often are correctable if addressed quickly.