Nearly 600,000 people in the United States will be getting Lasik (Laser-Assisted in Situ Keratomileusis) surgery this year to correct their vision as an alternative to wearing glasses or contact lenses. By the year 2020, that number is expected to rise to over 700,000. At an average of about $2,000 per eye (and don’t forget that every American has two), that’s an industry of $2.8 Billion per year – that’s right, B for billion. Lasik surgery is B for Big Business. And since Lasik is considered an elective, cosmetic surgery, private vision insurance and Medicaid and Medicare don’t cover it. Payment often comes from out of the patient’s own pocket.
During Lasik surgery, a computer guided laser cuts a thin flap to expose the patient’s cornea. A different laser then re-shapes the cornea by removing tissue. After the cornea is reshaped by the laser, the surgeon replaces the flap over the cornea in its original position. By reshaping the cornea, the laser “corrects” the manner in which light is focused onto the retina, creating better visual clarity.
For years LASIK was touted as the safe, cure all for everyone who didn’t want to wear glasses or who didn’t like putting lenses in their eyes. The success of Lasik surgery has typically been measured by a patient’s final vision – an improvement in seeing an eye chart. But not everyone is a good candidate for Lasik surgery and the potential complications of a bad outcome can affect you for the rest of your life.
Here are some things, other than diseases of the eye, which can increase the risk of a poor outcome with Lasik:
- Dry Eyes – One of the most common side effects of Lasik surgery is dry eyes. In fact, some researchers have found that nearly half of all procedures results in some level of dry eyes. So if you already have dry eyes, Lasik could make the condition worse.
- Deep set eyes – Before Lasik surgery, the doctor will fit a suction ring on the eye to provide a stable platform for the cutting laser and to raise the internal pressure of the eye, which stabilizes the cornea. If the suction ring does not fit well, which happens most often in far-sighted eyes, the laser won’t complete the flap dissection. Years ago, the doctor might try to complete the flap by hand, but that is no longer acceptable, today.
- Severe far-sightedness or near-sightedness – If the prescription on your glasses is +5 diopters or more, you have a severe case of far-sightedness and may be better served with an implant. A diopter is a measure of how powerful a lens is to properly focus light on a person’s retina. If you are severely near-sighted, meaning greater than -10 diopters, you are probably not a good candidate and the benefits of Lasik surgery may not justify the risks.
- Large pupils – also called scotopic pupils. While there is competing research about the effect of large pupils, there is still enough evidence that larger pupils may increase the risk of complications like glare and halo.
Even without these anatomical conditions, common complications from Lasik include dry eyes and difficulty seeing and driving at night, due to glare, halos, star bursts or ghost images. Sometimes you might get double vision. These complications are generally temporary and may last weeks or months, though there are no guarantees and many people experience these as long term and debilitating side effects.
As many as 1 in 10 patients require some form of revision surgery, which ophthalmologists refer to as an “enhancement.” An enhancement can more likely fix a first surgery under-correction, meaning not enough corneal tissue was removed. A more difficult problem is the over-correction, when too much of the patient’s cornea is taken. And while Lasik is meant to correct blurry vision from astigmatism, an unevenly curved or flattened eye, the Lasik procedure can also create an astigmatism by unevenly removing tissue.
Lasik procedures are overwhelmingly successful. But before making the decision, know the risks specific to you. At Atlee Hall, we help ophthalmology patients with significant vision loss in one or both eyes caused by negligence. Your vision is precious and the complications from a negligent eye surgery can be life-altering.
