Setting Your Sights on Laser Eye Surgery LASIK Procedure Relatively Safe but Knowing Risks Is Important by Gina Shaw For years, Iíd debated whether or not to get my near-sighted vision corrected through laser eye surgeryófirst, with the earlier version known as PRK (photorefractive keratectomy) and later with the LASIK (laser-assisted in situ keratomileusis) procedure. But what finally spurred me to walk into a laser eye center and make the appointment wasóa sale. Well, not a ìsaleî exactly, but a special price offered to promote the opening of a new location and the arrival of a new surgeon. But letís call it what it wasóa sale. Whereas LASIK can cost from under $1,000 per eye to more than $2,000 per eye, I had it done for the bargain price of $1,000 for both eyes. I did check out the new surgeon and found that sheíd done more than 5,000 laser eye surgeries with a low rate of complications and ìenhancementsî (having to repeat the surgery), and I learned that she had been on the ophthalmology faculty of a leading university. My surgery couldnít have gone more smoothlyóthe doctor and technicians were as skillful and careful with me as I had been promised, and my 20/60 vision was better than 20/20 by the first evening. I lucked into a good doctor and a great outcomeóbut I could have just as easily ìluckedî into a disaster for my vision. About a million laser eye surgeries are performed in the United States every year, with an estimated complication rate that ranges between 1 percent and 5 percent. Before you make the decision to have laser eye surgery, itís important to understand that you could, in an attempt to get rid of your glasses or contact lenses, damage your vision beyond repair. Itís not likely, but itís not impossible. Possible complications of laser eye surgery include loose visual acuity to the point of functional blindness; blinding halos or starbursts from light sources at night, which can make night driving impossible; vision thatís worse than it was before the surgery, perhaps uncorrectable even with glasses; continuous fluctuation of visual acuity; overcorrection; the inability to wear contacts; and infection and subsequent eye damage. OK, so youíve considered the possibilities and decided itís worth the small but very real risk of complications. The next thing youíll want to do is check out the centers in your area that offer laser eye surgery and find out which one is right for youóand whether youíre actually a candidate for surgery or not. Many people are not. If your myopia is worse than -12D (diopters), your astigmatism is worse than 6D, or your hyperopia is up to +6D, you shouldnít have laser eye surgery, according to the new Eye Surgery Education Council (ESEC) of the American Society of Cataract and Refractive Surgery. (These numbers may change as new laser technology is developed that can handle a wider range of correction.) Youíre also not a good candidate if you have a history of dry eye, have pupils that become extremely large in dim conditions, or have very thin corneas. And people with diseases such as cataracts, advanced glaucoma, corneal diseases, or other pre-existing eye conditions that threaten or affect vision are completely excluded from the surgery. As youíre selecting a laser eye surgeon, donít make price your priorityóIíll repeat, I was lucky, not smart. And make sure you ask a lot of questions. A year and a half after my LASIK, I almost canít remember what it was like to wake up and not be able to read the clock across the room, to scramble to find my glasses before driving to work, or to have to cut short a day at the beach because sand had irritated my contacts and left me with runny eyes. Iím thrilled with my ìnew eyesîóas are most people who have had the surgery. Tiger Woods is one of them, and within the last two years, the Army has gone from disqualifying soldiers who have had LASIK from active combat to enthusiastically promoting the procedure. If you meet the criteria, odds are good that after eye surgery you really will ìsee clearly now,î as all of the advertising promises, but you can certainly make those odds better by doing your homework first. Gina Shaw is the medical writer for The Washington Diplomat. Questions to Ask Your Eye Surgeon Here are a few suggested questions for your doctor when considering laser eye surgeryóoffered by the Council for Refractive Eye Surgery Quality Assuranceóand the answers that you want to hear: ï How long have you been performing refractive surgery procedures? (Not less than three years) ï How many total procedures have you doneóand how many in the last 12 months? (Not fewer than 500 and not fewer than 250 in the last year) ï How many procedures in patients with my particular refractive error or eyeglass prescription have you done? (Not fewer than 100) ï What percentage of your patients have achieved uncorrected visual acuity (UCVA) of 20/40 or better (ìdriving visionî)? (More than 90 percent of patients do develop UCVA, but if your surgeon claims a figure such as 98 percent to 100 percent, ask for documentation.) ï What percentage achieved 20/20 or better? (It should not be less than 50 percent, but if itís much higher, be suspicious of ìsuccess inflation.î) ï What percentage of your refractive surgery patients report complicationsósuch as starbursts, dry eye, or halos at nightósix months after surgery? (The norm is under 3 percent, but if your doctor claims none, be suspicious.) ï How many candidates have you ruled out for surgery? (Your doctor may not know the exact number, but ìnoneî should send you out the door. When a friendís husband called to lament that my surgeon had screened him out due to thin corneas, I was reassured.) Other good questions to ask and the essential components of a pre-surgery examination can be found on the Eye Surgery Education Council (ESEC) of the American Society of Cataract and Refractive Surgeryís Web site at www.eyesurgeryeducation.com. Itís fair to note that the ESEC does receive funding from companies with a financial interest in laser eye surgery, so you should also check out the FDAís information on the surgery at www.fda.gov/cdrh/lasik/default.htm. Here, you can read about specific FDA-approved lasers and their individual track records. óGina Shaw