What's the latest on Lasik?

Factual Questions
1

The last time I really did any research on Lasik was a few years back, and no one was really sure what the long term consequences might be.

In any case, what’s the state of Lasik surgery? Is it pretty routine and safe now? I’d read that there were a decent few cases of people being blinded and otherwise negatively affected by the surgery.

Are there any long term negative effects? Have people spontaneously started having eye explosions? :slight_smile: Are the people who got Lasik years ago still doing well?

How much has the cost gone down? Are insurers starting to help cover it?

Oh and one general question: What happens if your vision changes naturally over time, as you age, as it tends to happen? Do you have to be “re-burned”? Is that even possible?

2

I think they’re being more honest about bad outcomes now. I don’t think there have been any dramatic improvements in safety, although more is known about who who should not have this surgery done. So, if you see a good and ethical surgeon who performs a thorough pre-operative exam to check you for various risk factors it’s probably a little safer than it was a few years ago. But, since it is surgery, the risk will never be zero.

Actually, with the new “wavefront” technology the price just went up again. But since wavefront is supposed to give better results with less risk of refractive problems it might be worth it.

Let me emphasize that eye surgery is not something to do on the cheap. If you can’t afford it up front, there are financial institutions that are willing to loan people money for cosmetic procedures (which is what this is)

The only time my employer (a family of health insurance companies) is willing to pay for LASIK type surgery is when the alternative is blindness, not glasses. So, if your eye was injured in an accident in such a way that LASIK would restore useful vision they’d pay for it, but they won’t pay for it just so you can ditch your glasses or contacts.

“Presbyopia” is the term for the type of farsightedness that occurs with age. The eye gradually loses it’s ability to focus at different distances, leading to reading glasses and bifocals. This has to do with the muscles of the eye, not the cornea - the clear tissue in the front of the eye you see through and that LASIK reshapes. LASIK does not interrupt this process. As you age, you will still experience the presbyopia you would have had without surgery.

Now, the only surgical-type thing for presbyopia is to “burn” one eye for distance vision, one for near. So you use one eye for distance and one for reading. This can actually work surprisingly well, after a brief adjustment period. Even better, through the use of contact lenses you can try this out before you have surgery that permanently alters your vision (very important to do this - not all people can adjust to monovision, and men have a harder time doing so than women)

You can, at least in some cases, “re-burn” eyes. Sometimes this is done as an “enhancement” to attempt to further refine a previous LASIK alteration. But it depends in part on how thick your corneas are - below a certain thickness you start running into trouble - and that thickness varies considerably from person to person. Some people have corneas too thin for safe LASIK even before their first operation. Also, I think the odds of complications go up with each succeeding procedure.

3

Hmm, still no long term info, other than the countries where refractive surgery first started now ban in completely. (Russia, Japan) They had enough bad problems from RK and the earliest LASIK that they really want to take NO chances.

And refractive surgery is only good for the amount of time it takes your eyes to change again. Once presbyopia sets in (age 40 or so), you’ll have to have reading correction, or else get ANOTHER surgery (which most reputable eye surgeons will NOT do, except in extreme cases) to set up monovision. (Like monovision in contact lenses, one eye for distance, one eye for near vision. Still not perfect, still a problem after a few years.)

Pretty much, if you can be corrected by contacts and/or glasses, you’d be better off without it. When it works, it’s wonderful. When it doesn’t, you’re pretty much screwed. For about 3 years, I worked in the optical industry. (The signifigant other still does, but I escaped.) We would, on a regular basis, have people come in who had gotten refractive surgery. They could never get glasses or contacts immediately, because there was always a problem. If they didn’t warn the doctor that they’d had the surgery, they had to be re-refracted because MOST people that have had Lasik, RK or PRK refract differently in a dark room that they do in the presence of light. (Why? Don’t know, but it happens.) So, if you fill their prescriptions, you have to re-do it when they can’t see (and the optician eats that, not the doctor, although it’s not the optician’s fault the doctor made an error).

Many people who have refractive surgery can no longer wear contacts (surface of the eye is uneven, or it’s just painful) and those poor sad few who have infections…I can’t stand to think about that. Seriously. Cannot. Stand. It.

Now, to the questions…

Why do you want the surgery?
What is your current eyewear prescription?
Are you correctable with glasses and/or contacts?

And do NOT discount the use of contacts AND glasses. We had a -15.50 patient who was, at that point, out of the range of standard disposable contacts. We put her in -10.00 contacts and made her glasses with a high index lens, because they were still a -5.50, which is kinda thick in CR-39 plastic. When her prescription changed, we changed the contacts and left the glasses alone. (We’d built in some play in the contact range to do exactly that.) She LOOKS ‘normal’, without the very thick lenses that most high-minus prescriptions demand, and with the advent of the 1.71 high index lens (hers are a 1.6 index, and there’s 1.66 available in between) we can keep her in glasses and contacts with no problem for a number of years. Her assorted sisters have had refractive surgery, and 2 of the 4 have had severe problems, so she’s as happy as can be to NOT have someone cutting on her eyes.

OH, the reason that Russia and Japan banned refractive surgery? Twenty years down the road…too many blind people.

4

Not the muscles, the lens of the eye. The lens becomes rigid and cannot compensate for the differences in distance at which you wish to focus.

http://www.aoa.org/conditions/presbyopia.asp

Otherwise, you were right on…

Still going for my ABO certification, so it’s all in my head somewhere.

5

I had RK in 1991 (with an augmented procedure in both eyes). Had about -7 or -8 in each, and now am plano in left (but with astimatism of -3) and about -2 in the right (with astimatism of -1). After the operation, my vision changed dramatically at night. Early after the opn, at one point for a fleeting moment (and scary moment) my vision was back at pre-op levels. (I wear glasses now, still.) My opthalmologist said it was because my cornea was still healing and therefore more improvement would be noticed. My vision did improve slightly since then, but has been stable for about 5 or 6 years. However, my vision noticeably deteriorates at night, but not as dramatic as previously.

I don’t see the ophthalmologist anymore, but see an optometrist. I told him at every one of my annual appointments for years that my vision changes at night, but it passed through deaf ears. Finally, at one exam, my vision was not up to par, and he prescribed glasses two diopters more than I was wearing. After I got those glasses, the next morning, I went to his office and asked him to check the eyes again. This time he found the vision where it was previously. So he compromised and prescribed a pair one diopter greater.

Now I have three pairs of glasses. The one diopter greater I use at night, and sometimes I could use the two diopters greater. My vision has been stable for years, so healing is not the answer. I just knew that my vision deteriorated at night, and still does. So my cornea does refract differently depending upon the light. However, I thought this was due to dilation of the pupil in dimmer light. I notice that the “sunburst effect” of headlights is apparent at night if I don’t have the highest prescription, but that’s not a problem of I wear the highest correction. I first attributed that to the dilation of the pupil which then would encroach upon the slits, but now I attribute it mainly to the lower vision. Obviously, with PRK you don’t have slits, so that could not be the reason.

6

Indications are that some people are pleased with their results, some are moderatley disappointed, some have serious complications and a few face disasters so severe that corneal transplants are required. Long-term complications are still being discovered and studied. Wavefront technology may cause its own set of problems.

Do you feel lucky?

http://www.surgicaleyes.com
http://www.lasikdisaster.com
http://www.lasereyedoctor.co.uk/index.htm

7

moderately. (sorry).