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Is Lasik Eye Surgery For Me? By Wenda Reed

“One valium pill? Not going to do it. Give me another one.”

Kristina Shaffer of Woodinville is telling me about her LASIK eye surgery in 2004. “I was really nervous. They gave me a teddy bear to hold, and I almost tore its head off.” As the eye surgeon pulled back a flap on her cornea to begin to reshape it, everything went black. Ten minutes later, the surgery was finished, and Shaffer was asked to look at a large dot printed on the wall, which had looked blurry before the procedure started.
“Oh, my gosh, it was miraculous! It was crystal clear.”

Shaffer, suffering from nearsightedness (good close-up vision; bad distance vision) and astigmatism, had needed glasses or contact lenses since she’d started college, and her eyes got progressively worse through her 20s. Though she was tired of the daily hassle and cost of contacts, Shaffer had to wait until she was 32 for her eyesight to stop changing before she could have the surgery in both eyes. For LASIK to work, she was told, her eyesight had to stabilize, meaning that her corrective prescription had to have changed very little from year to year.

“About three weeks after surgery, I woke up and my eyes were on fire; it was agonizing,” she remembers. She was on a cruise, and had to use eyedrops and stay out of the glare of the sun. Later, she found out that the nerves were reconnecting. “The recovery was not fun; it felt like there was an eyelash in my eye all the time; I could feel the flap.” All of that cleared up in a few months.

Her eyesight was 20/15 right after the surgery, and has stabilized to 20/20. “I’m really happy; it changed my life,” she says.

HOW DOES IT WORK?

The first patent for “modifying corneal curvature” with a laser beam was granted in the United States in 1989, with the first surgeries performed in 1991. LASIK (Laser-Assisted In Situ Keratomileusis) uses an excimer laser, which mixes argon and fluoride gases to produce a cold ultraviolet beam of light. It was first approved by the Food and Drug Administration in 1998. Before that, many patients had the operation “off-label” (without FDA approval for the procedure) or went to Canada, where it had already been approved.

LASIK permanently changes the shape of the cornea, the clear covering of the front of the eye, so that light is focused better. After the eye is numbed and the eyelid is held open with an instrument, the ophthalmologist uses a blade or a laser device to cut a tiny flap in the cornea. He folds it back to reveal the stroma, the middle section of the cornea, and uses pulses from a computer-controlled laser to vaporize a portion of the stroma. If the person is nearsighted, the surgeon flattens a cornea that was too steep. If she is farsighted, he makes the cornea steeper. If she has astigmatism, he reshapes the irregularly shaped cornea into a more normal shape.
The surgery takes less than 30 minutes and costs between $1,500 and $2,000 per eye. It is generally not covered by insurance.

It takes three to six months for the vision to stabilize, and it may fluctuate during that time. Patients may initially suffer from dry eyes and experience halos, starbursts, glare or difficulty driving at night.

WHAT ARE THE LONG-TERM EFFECTS?

In 2000, when LASIK had been FDA-approved for two years, there were news stories on CBS and elsewhere questioning whether patients, five to 15 years after surgery, would be asking their doctors, “Why didn’t you warn me of the dangers?” Now, 13 years after approval, most of the reports have been positive.

Numerous university studies by LASIK surgeons report patient satisfaction rates of 92 to 98 percent. As 700,000 people a year receive LASIK in the United States, the American Academy of Ophthalmology and the American Society of Cataract and Refractive Surgery average the satisfaction rates at 95 percent. More than 90 percent of patients achieve between 20/20 and 20/40 vision without glasses or contacts, according to the AAO. In its 2006 annual meeting, the group reported that, on average, patients who’d had the procedure 10 years ago had maintained 20/25 vision.

On the other hand, according to the AAO, 10.5 percent of LASIK patients required re-treatment to achieve the desired results — mainly those who have major refractive problems and require strong prescriptions. The AAO estimated overall complication rates, usually from infection or inflammation, at .2 to 2 percent. About 2 percent of patients had adverse effects that permanently impact their vision and quality of life.

When I asked acquaintances and friends of friends about the procedure, I got answers like “Love it!” and “I’m so glad I did it.”

“Just heaven!” enthuses Mary Monfort of Edmonds, who had the surgery in 2000 when she was in her mid-40s.
Severely nearsighted, Monfort began wearing glasses when she was 7 and couldn’t walk around without stumbling unless she wore corrective lenses. She waited for two years after LASIK was FDA-approved so that she could find a reputable surgeon who had done thousands of the procedures. “I was a little fearful, seeing the instrument going towards my eye and not flinching,” she remembers.

She could see better within a day. “I couldn’t believe the difference,” she says. “I’m a hiker and a camper, and now I can see the stars at night. I can get up in the middle of the night and not have to hunt for my glasses. I have peripheral vision.” She still has some problems driving at night, but it’s much better than it used to be. She had a little initial pain, but no vision fluctuations, glares, halos or starbursts during the first few months. However, a small dry-eye problem she had before surgery intensified so that she must use eyedrops and put tiny plugs in her tear ducts to retain moisture.

She went back a year after the first surgery to have an adjustment, partly because she has thin corneas. “My eyes were nowhere near as bad as they had been before the first surgery, but the tune-up helped even more,” she says. Three or four years ago, she started wearing contacts again because of aging problems in the eye — nothing to do with failure of the initial surgery. As she’s now in her mid-50s, she will probably need reading glasses soon. “I was disappointed, but it’s not unexpected. I just remember how bad it used to be when I feel like complaining.”

Della Boelke of Edmonds, also nearsighted since childhood, had the procedure done in 1996, before FDA approval, when she was 47. She had one eye done at a time. She saw an improvement right away. Initial irritations, like halos, went away after a while, as she’d been told they would. She doesn’t recall suffering from dry eyes.

Still, she had to go back for an enhancement. After having the second surgery in one eye, she decided not to have it in the other. She ended up with really good distance vision in one eye and good close-up vision in the other, and found that worked for her. “I can read the gate numbers at the airport,” she says. “I can read the racing program and see the horses at the same time.”

She calls herself a LASIK “success story” even though her vision has deteriorated as she’s reached age 62, and she must use glasses to drive and to read. She recommends LASIK to friends, especially younger ones. “My vision is still a lot better than it was before; I’m still reaping the benefits,” she says.

SHOULD I GET LASIK?

I talked with Dr. Mark Walker, owner of Restore Vision Centers in Seattle and the Northwest, about who benefits most from LASIK and whether or not I personally should get the procedure. The Kirkland resident has been doing LASIK surgeries since 1999 and had the procedure himself seven years ago.

Apart from the fact that I’m so paranoid about anything touching my eyes that I’d probably need four valiums and two teddy bears to dismember, I found out that I’m not the best candidate because of my refractive issues and my age.

I’m nearsighted with perfect close-up vision and passable middle vision. I do need glasses, however, for driving, watching TV and movies and seeing distant objects clearly. If I had LASIK in both eyes, as is usually done, Walker told me I’d improve my distance vision considerably, but lose the benefit of my excellent close vision. A possible solution would be monovision — improving the distance vision in one eye and leaving the other eye alone.

He warns that only a few people can stand monovision because of the loss of depth perception when eyes don’t work together properly. Anyone considering having one eye improved should try wearing a corrective lens in just that one eye to see if they can tolerate the asymmetry.

Then there’s my age — 56. The average age of patients at Restore Vision Centers is 40. Older patients are going to run into the problem of presbyopia, a condition in which the lens behind the cornea becomes less elastic and loses some of its ability to focus. Presbyopia is the reason people in their mid-40s start having to hold reading materials farther away and most people eventually have to wear reading glasses or bifocals.

Distance vision corrected with LASIK will remain perfect, Walker explains. “But you’re still going to lose that close vision because of presbyopia, even though the cornea stays good.”

“There’s no maximum age for LASIK, but unless the lens is as clear as a bell, anyone over 60 should think about waiting until they need cataract surgery,” he adds.

Cataracts are a clouding of the lens that comes with age, and they affect most people eventually. LASIK can be done when the clouded lens is removed and a new plastic lens is inserted. However, long-term success of LASIK on older people has not been well measured, partly because they may have multiple vision problems.

My mother-in-law, Jean Reed, had LASIK in one eye, along with cataract surgery a year ago, when she was 81. “I can see better far away, but not as much as I anticipated,” she says. “Close-up vision was real good at first, but it hasn’t held up.” She soon went back to reading glasses.

On the other end of the age spectrum, the FDA does not recommend LASIK for adults in their early 20s or younger and has not approved it for patients younger than 18. This is because vision tends to change until age 20 and can take even longer to stabilize.

Women cannot have the surgery while they are pregnant or until six weeks after they have finished breast-feeding because hormones temporarily change the functioning of the eyes.

In general, the outcomes for women are the same as those for men, Walker says, although postmenopausal women may suffer from drier eyes, especially in the first six months after surgery.

In addition to younger people and pregnant or breast-feeding women, the FDA says LASIK is probably not a good choice for those who are not risk-takers or who are in the military or in other jobs that may prohibit the procedure; those who have diabetes or other diseases that cause hormones to fluctuate; those taking medications that may cause fluctuations in vision; or those with HIV or autoimmune diseases that may affect healing.

Other conditions the FDA lists as ruling out LASIK include Herpes simplex or Herpes zoster (shingles) involving the eye area; glaucoma; inflammatory eye diseases such as uveitis or iritis; eye injuries or previous eye surgeries; blepharitis (inflammation of the eyelids with crusting of the eyelashes); large pupils; thin corneas; or dry eyes.

The FDA and Walker also advise against LASIK for people involved in contact sports such as boxing, wrestling or martial arts because the flap on the cornea could come loose with a blow to the face or poke in the eye.

A better choice for people involved in these sports might be PRK (photorefractive keratectomy), a procedure that has been around longer and uses a laser to reshape the cornea directly without creating a flap. The end results are identical, Walker says, but PRK takes longer to heal and to stabilize vision. Walker performs PRK on about 20 percent of his patients, either because their corneas are too thin for LASIK or because they don’t want to have a corneal flap.

Finally, the FDA points out that while most people are pleased with the results of their LASIK surgeries, there are risks involved. Some patients may lose lines of vision on the vision chart that cannot be corrected with glasses, contact lenses or more surgery. Some develop debilitating visual symptoms, such as glare, halos or double vision that can seriously affect vision at night or in the fog. Others may develop serious dry-eye symptoms that cause burning and discomfort and also reduce vision with intermittent blurring.

LASIK is a relatively new technology, and as the FDA notes on its website, it has only been 13 years since approval for use in the United States and the long-term safety and effectiveness of the surgery are not yet known.

Wenda Reed is a frequent contributor to Seattle Woman who wanted to find out more about LASIK surgery for herself and others.

FOR MORE INFORMATION

“Is LASIK for me? A Patient’s Guide to Refractive Surgery,” published by the American Academy of Ophthalmology.

Federal Food and Drug Administration’s LASIK guidelines for patients

To report effects of LASIK, particularly problems, to the FDA, call 1-800-332-1088 or go to www.accessdata.fda.gov/scripts/medwatch.

©Copyright 2011, Caliope Publishing Company