Starry-Eyed Over Lasik?

As Rob Stein tells us today, officials at the U.S. Food and Drug Administration (FDA) are likely getting an earful -- or an eyeful -- at this morning's public hearing on Lasik surgery, the popular but pricey procedure in which a laser is used to slice open the eye, allowing the surgeon to reshape the cornea and thus improve the patient's vision, so that he or she can shed those onerous glasses or contacts.

Laser-assisted in situ keratomileusis (Lasik's full name) is generally safe and successful, as many who have undergone it will attest. Even NASA (whose early work with precision lasers paved the way for Lasik) considers astronaut candidates who have had such surgery.

Sometimes -- though it isn't clear how often -- things don't go well, leaving patients with persistent, often unfixable, visual impairments that range from annoying to debilitating. Some suffer intractable dry eye; others see halos, starbursts, or ghosting that can be maddening and can interfere with such activities as driving.

While there were some 700,000 Lasik surgeries performed last year (and more than 7 million since the procedure was approved by the FDA in 1995), there are signs that the procedure's popularity may be waning, perhaps because the weak economy leaves little wiggle room for elective surgeries that aren't typically covered by insurance. Bad news about botched surgeries aren't likely to boost Lasik's numbers.

The FDA hearings are aimed in part at improving the process by which doctors report post-operative problems. They're also meant to help bolster patient education through improving the FDA's Lasik Web site and other documents.

Norman Saffra, director of ophthalmology at Maimonides Medical Center in Brooklyn, has been concerned about Lasik's complications for years. He says Lasik technology has evolved and improved over the past decade, but still some patients don't get the best results. "If we can identify patients at risk for post-operative complications, that would be a good thing," he says.

People considering Lasik, Saffra suggests, should seek "a comprehensive exam by a competent eye-care provider, preferably a board-certified ophthalmologist. And they should think carefully about the risks and benefits of this elective cosmetic procedure."

Well, yeah. I'm fortunate to have pretty good vision, so I'm not likely looking at Lasik, anyway. But even if my vision weren't so hot, I'm not sure I'd be quick to sign up. (And not just because the very thought of it brings to mind that eyeball-slicing scene in Luis Bunuel's Un Chien Andalou.) I'm not too keen on the idea that, in the absence of understanding of Lasik's long-term consequences, everyone who has the surgery is basically a guinea pig.

Post Health reporter Sandra Boodman's been following Lasik and other corrective eye surgeries for years. She says today's hearings are "one of the first formal attempts to discuss the post-market experience with Lasik." Even as the surgery has grown in popularity, she says, "there have been persistent complaints by unhappy patients. Patients have not always been sufficiently warned about the bad things that can happen. Doctors are really interested in doing Lasik because it's fast, easy and lucrative and many patients tend to be thrilled with the results. But there is a learning curve in this surgery as in all surgery. And in some cases the doctors are not as forthcoming as they should be" about Lasik's risks, "and patients sometimes assume it's risk-free. They don't always really read the consent form."

"The Checkup" is not the FDA, but we'd love to hear your Lasik stories -- the good, the bad, and the ugly. We'll read them all -- if we can find our glasses.

By Jennifer Huget |  April 25, 2008; 7:00 AM ET  | Category:  Popular Procedures
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Comments

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I have sought LASIK for years, and repeatedly been told I'm not a great candidate, and to check back later as new techniques are developed. The last time I asked, I had my baby with me. The technician asked if I was done having children, which I thought was kind of bizarre conversation, and she quickly went on to explain that if a woman gets pregnant, sometimes the shape of her eye will change and she will need glasses again. I went online later, and saw what she was saying was true. I wonder how many women know about that before they get the surgery?

Posted by: RiverCityRoller | April 25, 2008 8:00 AM

My wife and I both had lasik about 8 years ago. Although my wife still has to wear reading glasses, I don't, and we both have excellent far vision. I continue to have some astigmatism, but not nearly as bad as before the surgery. I wouldn't hesitate to have the procedure--I would carefully research my physician's experience--the more the better.

Posted by: steve | April 25, 2008 8:03 AM

"Some suffer intractable dry eye; others see halos, starbursts, or ghosting that can be maddening and can interfere with such activities as driving."

I am not having Lasik for these exact reasons. My vision is 20/300 or something horrible like that. With contacts I can see 20/30. My doctor has said that with the shape of my eyes, I would almost definitely have that halo effect after the surgery - no thanks. I get that sometimes now and it is really annoying. Especially at night in the car. I am also concerned that sometimes, you are not corrected to 20/20. So if I end up more like 20/50, I would still need glasses or contacts - so what's the point? I've had terrible vision since I was born, and have worn glasses or contacts for 29 of my 32 years- what's another 40-50 years? Ha Ha!

Not to mention the fact that I would probabbly have a heart attack on the table as a laser enters my eye. . .

Posted by: LBH219 | April 25, 2008 9:52 AM

I had laser surgery over 7 years ago and am still extremely pleased with the results. It was a truly life changing experience after so many years of the glasses and contact lenses (and all the paraphenalia). However, I did not have it done on a whim. For over a year I researched the procedure and the local doctors carefully (in fact, using research already done by The Post) and asked a LOT of questions. I chose a doctor with an excellent track record and who was not in the business of just doing laser surgery, but who ran a full service eye care and surgery office and had been in practice for many years. I am of the age to need reading glasses, but that is no burden, especially since I can now go to the drug store and buy a $15 pair instead of a $300+ pair of bifocal prescription glasses. I urge complete research, references, and if you don't think the pre-surgery exam is thorough and careful, walk away. And, no doctor should pressure you to go through with such a procedure. I am thrilled with the results from my surgery and am grateful every day.

Posted by: InVirginia | April 25, 2008 9:53 AM

I had LASIK in January with a well respected and well qualified doctor, yet I still had complications. The corneal flap in my left eye developed a wrinkle and had to be "lifted and smoothed" but unfortunately it then wasn't aligned correctly and I had to go in for a 3rd adjustment of the flap. Fortunately for me it appears that the 3rd time was a charm and my vision is now 20/20 in both eyes. I will also add that the increased sensitivity to sunlight is kind of annoying and I hope that decreases with time.

Posted by: ShawnDC | April 25, 2008 10:50 AM

I had Lasik about a year and a half ago. My vision was horrible before then something beyond 20/400. My sister, wish similiar eyesight problems got hers done about a month before hand. We had considered getting it for years but because of age (too young) and money we really hadn't given it too much thought until my sister failed part of a job application process because of her terrible eyesight. She is now 20/15 as am I. If humanly possible I would've gotten it done sooner had I known how great it would be. Sometimes at night I see a small halo around lights but nothing that I find distracting. Usually just putting in some eye drops helps with that. Because of the success my sister and I had our father got his done (where our horrible eyesight originiated) He still requires reading glasses but is similarly thrilled with the results (he used a different doctor in a different state). Understanding the risks is important when thinking of elective procedures, especially one that involves your ablility to see but having it done at 23 I'm happier to spend the rest of my life glasses and contact free!

Posted by: ashley | April 25, 2008 10:53 AM

I'm getting ready to go in for my two year check up (I have the warranty on my eyes) and haven't had a problem. I went to the surgeon who had done my ophthalmologist and his wife's eyes so I figured she knew what she was doing. My eyes were 20/475 and 20/525 so going to 20/20 was HUGE. Every time I go camping and am able to look up at the stars with out fiddling for my glasses I remember how great it is.

If you're just afraid of the laser, they give you a valium. Worked pretty well for me.

Posted by: Em | April 25, 2008 11:04 AM

My husband had Lasik in January and I had lens-implants. Same as others have said, we did a lot of research and went to a couple of surgeons before making the decision. I was not a great candidate for Lasik because my vision was so bad and my pupils are really large. This meant that I'd probably have the halo thing going on at night and I wouldn't have many options down the road if needed/wanted. The lens implant procedure was easy and I have 20/15 vision now. I am definitely a satisfied customer. (Oh yeah, my husband seems pretty happy with the Lasik also, though he is pretty sure one eye is slightly better than the other.)

Posted by: Megan | April 25, 2008 12:13 PM

I had a great experience but as recommended, I had several evaluations at different clinics before I chose where to have my procedure. My eyes were really bad (like -13 diopter IIRC,it's been 5 years!) and the 1st clinic said I wasn't the ideal candidate due to thinness of cornea and degree of correction required. So I waited a few years. Next time, I went with a co-worker's recommendation since she had worse eyes than mine. I went with Dr who does stars in LA, so I figured if he hadn't been sued yet by these folks, and he had tons of experience, even running trials, I felt good about it. I've had some dry eye but not bad (use drops maybe 1-2x/day) and I can SEE my alarm clock, in the shower, when swimming/skiing/camping. Not worried about losing my glasses in an earthquake/fire and being useless...it's very freeing. But do your homework-I don't think I'd go to a $250/eye drive by clinic...

Posted by: dawn | April 25, 2008 12:24 PM

I had LASIK in 1999 at age 57 having worn glasses from the time I was in 5th grade. As a career military I could not have LASIK because it was not allowed by the Army during my active duty years. 9 years later it is still one of the best things I ever did. Shaving for the first time without glasses, incredible. Is is perfect? No, but 98% aint bad. Glasses to drive at night and some ghosting. Would do it again in a heartbeat.

Posted by: John Melia | April 25, 2008 12:37 PM

I used to wear -9.25 contacts and am very happy with the results of my Lasiks. I was evaluated by 2 reputable doctors (both evals were free). I already had minor halos driving at night, and they are the same now. Mr doctor also checked to see how well my eyes teared as part of my pre-op tests and the results were good. I have not experienced dry eyes or other side effects. I think the risks are real and doubt I would have had it for minor vision correction, but it was worth it to me.

Posted by: Flynn | April 25, 2008 1:15 PM

I nearly had lasik done about 7 years ago but chickened out and decided to wait until the technology improved. I had the procedure at the beginning of January 2008. I didn't have lasik; I had laser PRK, since I was not a good candidate for lasik due to thin corneas. For people who want lasik but are afraid of the corneal flap issues, PRK is an alternative they should consider. The PRK procedure is done with lasers, but there is no corneal flap cut and in that regard it is a safer procedure than lasik. There is more pain/discomfort with the procedure and a longer healing time, but in the big scheme of things it's not that much. Nearly 4 months after my surgery, my prescription changed from -7.5 in both eyes to 20/20. The only complication I have had is a bit of dry eye which is especially noticeable at night, which I treat with lubricating eye drops. I'm so glad I had the procedure done and would do it again without question.

Posted by: Auburn | April 25, 2008 1:52 PM

I had mine last August; It was one of the best things I have ever done for myself and I wish I could have done it before age 35.

I was nearsighted enough to not be able to get up in the middle of the night to use the bathroom in my own house without my glasses. I had worn glasses since the third grade, soft contacts since the fifth.

The last straw to consider the surgery was when my eyes had been hurting all day and I finally had to take a lens out and borrow a car to get home since riding on two wheels was out of the question (driving with one eye wasn't great, but it was the best of the options)

I opted for lasik after researching the procedure and possible complications and decided that, for me, it was a risk I was willing to take. My reasoning:

1. I don't see very well with contacts. Years ago I had great contacts that fit and corrected properly, but the company stopped making them since they were quite expensive and not disposable. Since then, all lenses float around in my eyes, didn't really correct the astigmatism as well, and I could never really achieve matching vision - one or the other was always over- or under-corrected.

2. My lifestyle makes glasses a huge hassle (daily exercise) and somewhat of a safety risk (motorcycle helmet). And my depth perception was always off in my glasses, not to mention the peripheral vision reduction which isn't a great thing on two or four wheels.

3. My eyes were already sensitive. I was well-accustomed to itching and burning during the various allergen seasons. I feel like the contacts made it all worse. I really hated sticking my fingers in my eyes when they already hurt. (during my preop, my doctor told me I had pretty dry eyes already, perhaps that's why I haven't felt more dry after surgery).

4. There are inherent risks associated with wearing contacts. It's not common, but there is a risk of infection, abraision, probably other stuff.

5. I was right smack on the middle of what can be corrected with today's technology. I didn't have to consider that I was possibly pushing the limits of the procedure in either direction.

6. I know I'm responsible enough to do all of my aftercare (the right drops at the right intervals). Sounds silly, but I know people who didn't manage to do this. I'm also pretty in touch, enough that I would recognize the first signs of infection and get attention for it.

6. I had full confidence in my surgeon. He is chief of eye surgery and has been teaching the procedure for years.

I couldn't be more thrilled with my results. I haven't seen this well since those great contacts years ago, so it's not just that I'm seeing more clearly, I'm seeing altogether better. Nothing floating around in my eyes. No problems with depth perception. I had no complications beyond a little sensitivity to sunlight, which I had with my contacts anyway so it didn't bother me too much. I'm eight months out and really thrilled.

Posted by: sb | April 25, 2008 1:56 PM

Thanks guys!

Posted by: aleks | April 27, 2008 8:59 AM

I had Lasik in 1995 in Bogota. My vision was something like 20/400 before and I've been 20/25 ever since. Never had any problems with halos, but still a little astigmatism, hardly noticeable. I'm 46 and have bought reading glasses for help with tiny font on some food packaging. I use eye drops if I get eye strain from staring at a computer screen all day.

This has been on of the best investments I've ever made.

Posted by: Myriamh | April 27, 2008 10:08 AM

My experience is that I lost the Lasik gamble. Given the starbursts and halos that I did not have before as well as the diminishment of my near vision for reading, I am not thrilled with my Lasik outcome. I picked a "top rated" surgeon and followed the post-operation recommendations.

The problem with these good story / bad story scenarios is that there is no way of knowing your own outcome before surgery. Its gambling and if things don't work out, you are likely to find that the Lasik surgeons are really mechanics of their machines who don't really know how to correct subsequent problems. When you listen to people who have had negative outcomes what stands out is the inability to reverse damage from Lasik.

Posted by: RS | April 27, 2008 12:07 PM

RiverCityRoller, I hope you're not going to different lasik providers and hoping one will "clear" you. That would be a very, ,very bad practice. If a doctor tells you you're not a good candidate, be glad that you met an honest and upfront practitioner. If you keep going to different ones, eventually you'll get someone willing to 'roll the dice', and you don't want that.

I had PRK done rather than Lasik due to fears about the corneal flap because of some contact-activities I do, but beforehand I did a lot of research into all the various procedures and the surgeons I was going to. I think if everyone did their homework instead of just hearing about the shiny new procedure on the 6:00 news, they might be better off. Someone above noted that the halo issue is what stops them from having it- in reality, studies have shown that the vast, vast majority of patients are happy with the outcome and very few have any permanent side-effects, but if you are happy with your contacts then of course there is absolutely no reason to risk it (even if it's a small risk).

If anyone's thinking about getting lasik, beware of both the websites trying to push you into getting it and those that have lots of hyped scary stories (these sites are usually started by people who, unfortunately, were the statistical minority and have problems; you shouldn't let yourself be too biased by jilted opinions, though). Instead, try and find more objective sources... the one I used was the forums at usaeyes.org, although I'm sure there are other ones as well.

Posted by: ep thorn | April 27, 2008 2:18 PM

I had Lasik at the top rated provider in 2006 and was told I was a good candidate and could count on having good vision when I got my surgery. However, there are many factors that the Dr. failed to consider that I believe have impacted my incredibly horrible results!

I was cross-eyed as a child and therefore had surgery to correct this condition. The cross-eyed surgery was only done on one eye and therefore I developed a sort of monovision with severe nearsightedness. The result was I was never able to wear contact lenses but had nearly perfect close up vision. My biggest reason for seeking Lasik was that I had really poor night vision and as I aged I figured it would only worsen and I had no choice in my long commute. I asked about what impact the surgery would have on this issue and was told I would be able to see well at night and that any halos that might occur would be better than my current night blindness.

So I went ahead with my surgery with the confidence that I was a good candidate. I had not read about any conditions like mine and the risks seemed to outweigh the negatives given that many friends and relatives had the same sort of glowing reviews as those above.

However, after my surgery I have a mixed bag of vision problems. Initially I saw distance fairly well but it decreased with time so that now I can see without glasses in the near distance but need correction to something like 40/80 so I still need correction for clear distances. The reason according to the Dr. is that I still have a type of monovision. A monovision correction was recommeded by the Lasik Dr., but the most reputable opthomalogist that I saw later has said I should have never been given the Lasik and that he does not recommend I try for a correction.

Additionally I have two new near vision issues. My reading needs correction (which is normal with age etc.) but I cannot do any close work i.e. thread a needle or craft of any sort without a major prescription.

So now, I have to use three pairs of glasses -- one for distance, one for reading and one for close up work. In addition, I need sunglasses!

Please consult a reputable opthamologist who does not run a Lasik practice if you have had surgeries or have unique vision problems from your childhood. Normal nearsightedness is correctable and works really well, but there are always the special cases like me and I have had a disastrous result!!!!!

There is no free lunch in life and once you have the surgery the options have to be weighed very differently. I am going to have to deal with the three pairs of glasses for now.

Posted by: MSL | April 27, 2008 8:44 PM

I had Lasik eye surgery about 15 years ago. The absolute best thing that has ever happened. I was told that I would need reading glasses probably very soon after surgery. I only just recently need them. My only complaint is that sweat stings the eyes more than it used to. It has eased a bit with time, but it still stings. Small price for clear vision.

Posted by: Murray McGrath | April 27, 2008 9:39 PM

I had Lasik done by Dr. Wexler in Columbia, MD and the entire experience was wonderful. I'm thankful to not have to wear contacts anymore, and my vision is now excellent. I was very afraid to have the surgery, but my Dr. and his staff took fantastic care of me. I chose him because a number of my coworkers had gone to him before me and were happy with the results, and after meeting with him and his staff, I felt confident that they would do an excellent job.

Posted by: Kristin | April 29, 2008 10:23 AM

Undergoing LASIK procedure was one of the most liberating experience of my life. I have had poor vision since I was a child, and this condition limited my activities.

Now, I engage in sports and other activities without the worries. I play better badminton. I can now clearly see people's faces when I go swimming.

Shedding the prescription glasses has also improved my overall image. I'm now more confident on how I look.

Who cares if I still need to wear reading glasses when I turn 40 or 50. 20 years of clear vision is already more than I bargained for.

But of course, I did my research before undergoing the procedure. I talked to those who've already done it. I also chose the most recommended surgeon.

I'm fortunate that my procedure was glitch-free. Aside from dry eyes, no other complication occurred.

Posted by: Rosie | April 29, 2008 10:13 PM

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