What to look for in Lasik
By J. Scott Wilson, Staff writer
The ads are everywhere, on TV and radio and in the newspaper and your e-mail box: "Live Without Glasses or Contacts!" "Vision Restoration!"
All the noise is over LASIK surgery, but does it really work? The short answer, for the vast majority of clients, is yes.
Jennifer Haynes-Watkins, a Web journalist in Belmont, N.C., had LASIK five years ago.
"As cliché as it sounds, LASIK really did change my life. I’ll never forget my first trip to the beach after my surgery. I woke up in the middle of the night in the hotel and could actually see to get to the bathroom and didn’t have to pat down the entire nightstand to find my glasses. It was like a whole new world," she says.
Haynes-Watkins recounts her first trip to the beach after the surgery.
"Who knew you could actually just open your eyes and walk over? Then, to be able to go swimming without feeling like the children in the pool were planning an evil plot to splash you and ruin your contacts was great, too. I could go from lounge chair to pool and back without thinking twice about my vision."
LASIK, or laser-assisted in situ keratomileusis, is the surgical modification of the eye in order to restore proper function. Nearly 1.4 million procedures were done in the U.S. in 2006.
In the past, only certain types of patients were good candidates for the surgery. New technology makes it possible for almost every person -- nearsighted or farsighted, with or without astigmatism -- to have LASIK, according to Dr. Jonathan Christenbury, of Christenbury Eye Center in Charlotte, N.C.
How Surgery Works
The nuts and bolts of the surgery are simple.
It is essentially a two-step process, according to the Eye Surgery Education Council. In the first step, a flap is cut in the surface of the cornea, the "front window" of the eye that focuses light coming into the eye. A suction ring is placed on the eye to hold it stable and check the internal pressure while the flap is cut.
The cut goes through about 20 percent of the total thickness. This flap is then folded aside, and lasers are used to reshape the tissue of the internal cornea, or stroma, with a very high degree of precision. The corneal flap is then laid back into place. There are no stitches required, and the healing process is generally very quick, with most patients being able to return to work within a day or two and noticeable vision improvement immediately.
Vision improvement comes from changes in the cornea's ability to focus light into the eye. Think of a magnifying glass -- if the glass is distorted, the image seen through it will not be sharp. If the glass is repaired to proper shape, the image coming through will be seen properly.
Blades Not Always Used
In the most widely used LASIK procedure, the corneal flap is cut by a blade mechanism called a microkeratome. The cutting was the primary source of complications, such as infection and improper flap shape, although the incidence of such problems was less than one in 5,000 patients.
A new procedure, IntraLASIK, in use at the Christenbury Eye Center and several other clinics nationwide, replaces the microkeratome with a laser that pulses 15,000 times per second to create a flap that is accurate to the desired measurement within 10 microns.
"The majority of sight-threatening complications possible with traditional LASIK are totally avoided, and those non-sight-threatening side effects that are self-limited are markedly reduced," Christenbury says. He adds that it is probably 100 times safer than using a blade.
The recovery from the procedure is remarkably quick, but there are some very important restrictions to keep in mind. Chief among these is avoiding disturbance of the eye for a week to 10 days following the procedure.
Plastic shields are worn over the eyes at night, and care must be taken during waking hours to avoid rubbing or compressing the eye. It's also important to follow whatever eye drops or other regimen the surgeon sets, as the combination of antiseptic, lubricating and steroid drops will ensure proper healing and the best end results.
Finding The Right Surgeon
Your eyes are some of your most important and delicate assets, so finding the right surgeon and clinic to perform your LASIK procedure shouldn't be taken lightly. One of the primary things to look for is experience. How long has the clinic been in business? How satisfied are the patients?
The Internet can be an excellent resource here, with sites such as Epinions.com hosting discussion forums and opinion boards where you can get commentary straight from patients.
During your initial consultation, pay attention to how business is conducted at the clinic. Is the staff receptive to your questions? Do they seem knowledgeable about the procedure and potential complications? Are the pre-surgery disclosure and informed consent forms detailed and easy to understand? According to the FDA, while there is a very low risk of serious complications from the procedure, there are things that can go wrong, and they should be fully explained.
Something else to consider is what other services the clinic offers. Do the doctors also perform PRK, a less-common procedure used in some cases in which corneal thickness is not sufficient for LASIK, or other services? If a clinic offers only LASIK, there may be more of a push to treat patients who may not be ideal candidates.
On the flip side, make sure the clinic you choose specializes in refractive surgery. There is a lot of money to be made in LASIK and related surgery, and thus some clinics have begun offering it as a sideline to other medical services.
Don't be shy about asking about the background of the surgeons. Find out what training they have had and how long they have been practicing refractive surgery.
How Much Will It Cost?
Most insurance carriers do not yet cover LASIK or other vision correction procedures, classifying them as cosmetic surgery. However, you may be able to use funds in a flex-spending account for tax benefits, and most clinics offer payment plans.
While every major city has eye centers advertising LASIK procedures for a few hundred dollars per eye, according to AllAboutVision.com, less than 3 percent of LASIK procedures actually cost less than $1,000 per eye.
Basically, the worse your vision, the more you will pay. However, prices for the procedure have stabilized over the last two years, with the average per eye sitting at $1,900. That usually includes the diagnostic evaluation, the procedure itself, any post-surgical drops and several follow-up visits.
Other factors can increase the total fee for the procedure. The Intralase all-laser option will cost about $250 more. Also, "custom" LASIK using Wavefront technology to create a 3-D map of the eye's distortions will cost from $200 to $500 more per eye.
In the end, however, it is far more important to choose the right surgeon than it is to get a bargain. Getting two or three price quotes is a good idea, but the reputation and experience of the surgeon must be factored into the final decision.
What To Expect
Your eyes have always been delicate, but after LASIK, they are even more so. It is critical to avoid any impact or shock to the eyes for as long as your doctor specifies. If sports such as football, racquetball, basketball, martial arts or other pursuits are part of your weekly life, you'll need to take a break from them for a while.
For the majority of patients, the results are 20/20 vision or better, according to the LASIK Vision Institute. According to the FDA, there are some common things that may be experienced for varying periods of time after surgery, including:
Light sensitivity:: This may last one to two weeks after the procedure. If it persists, contact your doctor. It is important to wear sunglasses outdoors and to avoid squinting as much as possible.
Hazy or blurred vision: This may occur especially upon waking and after prolonged periods of reading or computer use for one to two weeks after the procedure. Do not rub your eyes! If your vision remains blurred for a prolonged period, contact your doctor.
Dry eyes: This is very common up to six weeks after surgery. Your doctor will likely send home samples of lubricating eye drops and recommend that you use them regularly while awake. It's important to note that artificial tears are not the same as lubricating drops.
Glare or halos when driving at night: For a month or so after surgery, this is not uncommon. The first time you drive at night after surgery, have another licensed driver available in case the glare is too distracting. The problem should diminish over time.
Fluctuations in vision: These can be the most disturbing problems, and they can last for up to six months. You may notice problems reading small print or other minor dysfunctions that come and go. If any of them persist, or start to occur more frequently, be sure to let your doctor know. Keep track of the disturbances by type and duration.
By your six-month follow-up visit, your eyes should have stabilized greatly. Your doctor should do a thorough evaluation and let you know what if any further treatment -- if any -- will be necessary.
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