Seeing is Believing
Is laser eye surgery the right choice for you?
Twenty years ago, if you hated wearing glasses or contacts, there wasn’t a lot you could do about it — you were resigned to fumbling for your glasses on the nightstand each morning, or you spent a chunk of your bedtime routine with a contact lens case and a bottle of solution, your lower eyelid pulled down to your knees. Then along came a new procedure, laser eye surgery, and slowly but surely, the way a lot of people saw the world began to change.
In 2006, approximately 1.4 million laser eye surgeries were performed in the United States, according to Market Scope. Roughly 53 percent of the U.S. population wears glasses or contact lenses, and about 28 percent are nearsighted (myopic), which is the most common vision problem treated with laser surgery.
How does it work?
Laser eye surgery is typically used to treat refractive errors, such as nearsightedness, farsightedness, and astigmatism. (Refraction is the variance in light rays as they pass through a lens, and refractive errors prevent light from falling properly on the retina, resulting in blurred vision.)
Surgeries to correct those errors using lasers fall into two basic categories. The most common is Lasik, a name you’ve likely seen plastered across newspaper and phone book advertisements; more than 80 percent of laser eye surgeries performed in 2006 were Lasik surgeries. During this procedure, the doctor cuts a flap in the cornea, folds it back, and uses the laser to reshape the cornea. The other refractive surgery is PRK, which stands for photorefractive keratectomy. In PRK, the laser reshapes the cornea in the same way, but instead of creating a flap, the doctor rubs aside surface cells to get at the cornea.
Though both procedures might sound painful, proponents say there is little discomfort. Most patients are in and out of the office in an hour and a half, recovery time is brief, and the results are more than satisfactory for the vast majority of those who undergo the surgery, according to Dr. Elizabeth Serrage, an ophthalmologist who performs laser eye surgery with the Eyecare Medical Group in Portland, Maine.
Am I eligible?
“The best candidate for this surgery is somebody who hates wearing glasses and who understands that the goal of refractive surgery is not perfection, but to be able to go comfortably without wearing glasses or contacts,” Serrage says.
If you’re considering the surgery, here’s what you can expect. First comes an initial preoperative examination, during which the doctor will determine if you’re a candidate for the procedure. In the surgery’s nascent years, only nearsighted people were candidates, but now a much greater variety of refractive errors can be treated. “It’s very rare to find someone who’s outside the range,” says Dr. Marguerite McDonald, a refractive surgeon with Lynbrook, N.Y.–based Ophthalmic Consultants of Long Island who performed the world’s first laser vision correction surgery in 1987. Occasionally the doctor will discover a condition that requires treatment before the surgery: extreme dry eyes, which may require prescription medication or ointment, and blepharitis, a low-grade inflammation of the eyelid that may require a short course of antibiotics, are among these. Patients with certain corneal dystrophies or whose corneas are too thin are not good candidates for the surgery. Those are rare, says McDonald, but it’s important for doctors to identify those patients in the first examination and steer them toward other treatments.
Before surgery
Before your pre-op examination, you’ll receive instructions to stop wearing your contact lenses for a certain length of time — anywhere between one and four weeks, depending on the type of lenses you wear. The reason: contact lenses may change the shape of the cornea, and the cornea must be in its natural shape for the surgery to be as successful as possible.
On the day of the surgery, you will likely get a sedative to help you relax. Next the doctor maps the optics of each eye and programs the computer that drives the laser. (This optic mapping is called wave front analysis; it’s a technology that has helped make laser eye surgery more precise.) Topical anesthesia numbs the eyes.
From there, the whole procedure takes only a few minutes for each eye. You’ll receive antibiotic eyedrops and instructions to go home and sleep for several hours. By the next day, you’ll likely be seeing clearly enough to drive yourself back to the office for your follow-up visit. (With PRK the recovery time may be longer.) Depending on the doctor, you’ll return for follow-up visits at one-, three-, and six-month intervals.
Is this a risky business?
Laser vision correction has come a long way in 20 years, and the risks have diminished even as the range of eligible patients has grown, Serrage says. “The greatest risk is failure to meet expectations. There are people for whom only perfect vision is a success; if they don’t get that it’s a failure.”
When refractive surgery first came on the scene in the U.S., some patients experienced problems with night vision, but technological advances have made the chances of that “vanishingly rare,” according to McDonald. Infection, which occurs in about one in 5,000 cases, can be treated with antibiotics, and complications resulting from the flap incision may require additional surgical treatment. “The vast majority of these very rare complications can be treated nonsurgically or require one quick trip back to the operating room,” says McDonald. In about 10 percent of cases, says Serrage, undercorrection or overcorrection occurs; those cases can be retreated a few months after the original surgery. “The human body isn’t as accurate as any laser, and no matter how accurately you do it, some are going to [need adjustment] because that’s the way their tissue reacted to the laser,” Serrage adds.
The costs
Costs can vary tremendously from surgeon to surgeon. “Anybody who has an office in downtown Manhattan charges more than someone in Fargo, North Dakota,” says McDonald. The general range falls somewhere between $1,600 and $2,900 per eye. And just as costs can vary, so too can the patient experience. To make sure yours is optimal, seek out a surgeon who comes recommended by a friend or a colleague, or do some legwork yourself. How many surgeries has the doctor performed? Is he or she board certified? Do the people in the office answer all your questions? Is the practice itself established?
When it comes to your eyes, no question is too minor. And if perfect vision is your goal, it’s important to know all you can before making a decision.
— Meg Mitchell Moore
