Reprinted with permission from Durham Magazine. Download the original article (PDF, 8.32 MB).

Five tips that could spare you money and complications when considering corrective eye surgery.

By Lisa Rossi
Durham Magazine, February/March 2010

More than 8 million people have undergone LASIK surgery, which uses precision lasers to reshape eye tissue and improve vision, usually making glasses or contacts unnecessary.

Despite its popularity, many people still have misconceptions about the surgical procedure that can cause them to either overestimate or underestimate the implications for their vision, comfort, and bank accounts. On average, it costs $2,035 per eye, according to Market Scope, a St. Louis company that tracks ophthalmology trends. It usually is not covered by insurance. In the Raleigh/Durham area, 303 out of every 100,000 people had LASIK in 2009, higher than the national average, Market Scope estimates.

The popularity of LASIK has waned with the recession, but Market Scope analysts predict a 15% growth in the number of LASIK patients in 2010 over the estimated 780,000 surgeries done in 2009.

That’s half the number of surgeries done in the peak year of 2007, when 1.4 million people opted for the procedure, Market Scope says.

Though serious complications are rare, there can be downsides to LASIK. If you are not the right candidate, your vision could be harmed. Patients have reported severe dryness, night vision difficulties and ghost or double images, among other difficulties. In response, the FDA is studying just who exactly experiences adverse affects from the procedure. Phase 3 of the study, a clinical trial on the quality of life following LASIK, is expected to end in 2012.

Here are tips from top area ophthalmologists on how to get the safest and most effective LASIK surgery.

1. Know the procedure. Alan Carlson, chief of cornea and refractive surgery at Duke Eye Center, is quick to point out that LASIK is, in fact, surgery. “I think we are seeing too many patients after the fact saying, ‘I wish I’d done my research. The fact the surgery was offered in a strip mall led me to believe it was something other than eye surgery,” Carlson says. To understand LASIK, you have to understand how vision errors occur, and it starts with the cornea. That’s the part of the eye that helps focus light to create an image on the retina. Usually the cornea is not shaped perfectly, which can make images on the retina blurred or out-of-focus. The LASIK surgery reshapes and sculpts the surface of the cornea, changing its focusing power, according to the FDA.
2. Ask how experienced your surgeon is, and make sure you meet him or her before the procedure. Christine Lee, a comprehensive ophthalmologist at the Eye Institute of North Carolina, says a surgeon has plenty of experience once he or she has completed between 500 to 1,000 surgeries - but different surgeons disagree on the level of experience and training that is best. Following your gut is much easier if you meet the surgeon who will be operating on you. “The surgeon is ultimately the person who is responsible for the outcome,” Lee says.
3. Make sure your surgeon is available for follow-up care. Dwight Perry, an ophthalmologist at N.C. Eye, Ear, Nose, and Throat, says that some practices leave this job to ancillary personnel, which is not as good as the insight from the surgeon him or herself.
4. Make sure you are a good candidate for LASIK, and be aware of the risks. Physicians should be evaluating how dry your eyes are, make sure you are older than 18, determine how thick your cornea is and measure your amount of nearsightedness, astigmatism or far-sightedness. They should get to know you on a deeper level as well, noting that pregnant women shouldn’t have LASIK, and that people with diabetes are not good candidates. It’s OK to ask your doctor about personal track records, and what sort of complications he or she has seen from a LASIK procedure, Lee says.
5. Make sure the laser equipment is the most up to date, and that it is well cared for. Good physicians make sure to control the temperature and humidity in the room that contains the laser, precautions that regulate the amount of water molecules the laser beam hits on the way to the eye, a measure that ensures precision, says Carlson. Ask questions about how much maintenance is done on the laser, and make sure it’s on the list of FDA-approved lasers in the United States, Lee says. (For more information, visit www.fda.gov and search for LASIK.)

Better Than a Stick in the Eye

LASIK has come a long way

Then: Before LASIK, the eye surgery to correct nearsightedness was done with a blade in the procedure called radial keratotomy (RK). It was used throughout the 1980s and 90s. Alan Carlson, with the Duke Center for Vision Correction, said RK was a good procedure, but was effective on a much smaller number of patients.

Now: “We’re moving into a realm of precision that is simply unmatched by the best of hands, the best of surgeons,” Carlson says. He says that each pulse of the laser removes less than 1/100,000^th of an inch of tissue, done in a fraction of a millionth of a second.