To LASIK or Not to LASIK

The popularity of LASIK (Laser-Assisted in situ Keratomilieusis) eye surgery has been increasing dramatically. I have a few friends who have already gotten the surgery with many others considering the option. Since so many people were looking into LASIK and with the bombardment of LASIK advertisements over all media, I naturally assume that it was a safe and even recommended procedure for those with poor eyesight but during a conversation with a good friend, who is a medical student specializing in ophthalmology, I was made aware that LASIK may not be such a great option.

First things first, what is LASIK? It is a special laser that PERMANENTLY RESHAPES THE CORNEA to change its focusing power to correct for refractive errors. The surgery is performed by first creating a flap on the corneal tissue then remodeling the cornea underneath the flap by removing layers of the cornea using the laser. The procedure ends with repositioning of the flap.

The basic gist of our conversation was that although LASIK can be effective, the risk-reward factor may not make it such an attractive option. LASIK corrects eyesight by removing parts of the cornea so naturally the procedure is irreversible. Once a piece of your cornea is gone, it is gone forever. Most people get LASIK because they do not want the hassle of wearing contacts or glasses, but what most people are not aware of is that as they age, their visions will naturally worsen (presbyopia) due to changes in the lens (not the cornea) of the eye. Therefore, even if you get LASIK, you may be needing glasses before you know it again (time also tends to move much faster as people get older). Some complications of LASIK eye surgery are dry eyes, halos or glare at night, double vision, infection under flap, induced astigmatism and uncorrectable vision loss. Also, since LASIK is a fairly new procedure (first LASIK laser approved by the FDA in 1998), it is not possible to know of the long term implications and effectiveness thus making the procedure even riskier (it is possible that in 50 years, all LASIK patients experience vision loss). With the many serious complications and risks of surgery paired with the fact that your glasses/contact free lifestyle may be short lived, one really needs to seriously consider whether or not to get LASIK.

Here is my take on LASIK surgery with a simple Pros vs. Cons comparison:

Pros - 1) Improved Eyesight - No More Glasses, Contacts, etc.

Cons - 1) Costs (It's expensive), 2) May Still Need to Wear Glasses/Contacts After Surgery, 3) Irreversible Procedure, 4) Long Term Effects and Complications are Unknown, 5) If Complications Occur, they are Usually Very Serious.

Personal Conclusion: I would not get LASIK. There are too many serious risks when compared with the reward of short term glasses/contact-free living. Without long term studies, you're essentially volunteering to be guinea pigs at the uncertain cost of your vision.

Like LeVar Burton from Reading Rainbow would say: "But you don't have to take my word for it" - Please understand that the information in this article is not complete and for something as serious as your vision, you should perform your own due diligence and get evaluated by a GOOD physician. Different people have different needs especially when it comes to vision.

For those seriously considering LASIK, my friend has been kind enough to create a checklist for you.

How Do You Know If You Are A Good Candidate For LASIK?

1. How important is it to you to be out of glasses? If it is very important, you may want to consider LASIK

2. Can you accept the risks of surgery including complications and possible need for additional surgeries and physician visits?

3. How old are you? As everyone reaches their forties, they will become presbyopic and will need to use reading glasses. Is this method acceptable to correct your distance vision now and need reading glasses in the future? Or would you rather keep your vision the way it is now and not need reading glasses in the future (this only applies to low myopes). Or do you want to be corrected for monovision (one eye corrected for distance vision, one eye corrected for near vision) by LASIK? If so, you should do a trial with contact lens first to see if you can tolerate monovision.

4. Do you play contact sports? If so, there is an increased risk.

5. Do you have visually demanding tasks? Will your occupation allow for LASIK (Ex. military, etc)?

6. Can you afford LASIK? Most insurance companies will not cover the procedure.

7. Do you have refractive instability?

8. Do you have dry eye (which can worsen with LASIK, usually temporary)?

9. Do you have any disease that affects wound healing, are you on steroids?

Ask Your Doctor If You Are A Good Candidate For LASIK And Find Out:

1. How large is your refractive error? If you have very large refractive error, the doctor may not be able to correct fully your prescription.

2. Do you have thin corneas?

3. Do you have history of or active corneal disease?

4. Do you have large pupils?

5. Ask your doctor to do a topography (to measure the corneal curvature)... and you should be out of your contact lens a certain amount of time and then have the test repeated.

Choosing The Right Doctor

1. Choose the doctor based on experience not on cost or advertising.

2. Choose a doctor who can do other types of refractive surgery such as PRK (photorefractive keratectomy), so they will be able to choose the best procedure for you, not just LASIK.

Final Advice:

1. Know if you are a good candidate for LASIK- both for yourself and from your doctor.

2. Know all the risks and benefits of the procedure. Read information on the web and read all the fine print in the consent form.

3. Go to a good ophthalmologist with lots of experience.

4. LASIK when done properly in good candidates is an excellent procedure and can improve uncorrected visual acuity.

Recommended Readings:

An informative websites concerning LASIK:
FDA Website on LASIK

For those with complications looking for support:
Complicated Eyes
Vision Surgery Rehab Network

For those who found this article informative and have friends/family considering LASIK, please feel free to send them the link for this specific article:
http://seeminglyuseless.blogspot.com/2008/03/to-lasik-or-not-to-lasik.html