So you just saw an amazing commercial about how LASIK can change your life and free you from the shackles of eyeglasses and/or contact lenses. A simple solution to a simple problem, right?
Well, not so fast partner. I know, as Americans we expect a quick treatment and awesome results based on the wonders of modern medical technology. If you are willing, let me impart a small amount of wisdom to you. My wisdom is based on over two decades of experience in the medical field as an eye doctor. Twelve of those years were in the Air Force as an Active Duty Medical Officer where service members could obtain refractive surgery (LASIK, PRK, etc) free of charge. If you walked into my clinic and asked me about refractive surgery as a paying patient, this is what I would tell you, even if all signs point to you being a possible candidate.
Here’s the low-down.
There is no ‘perfect’ surgery. There are multiple refractive surgery procedures all utilizing the same excimer LASER (Light Amplification by Stimulated Emission of Radiation) technology which in turn ablates (or shapes) the cornea to a desired optical result. How the superficial layers of the cornea (clear part of your eye) are treated before application of the excimer LASER determines the name of the procedure, i.e. PRK, LASIK, LASEK etc. The end visual result is essentially the same if you are a statistician.
The surgery is only as good as the prescription dialed in, the stability of a person’s refractive error (how stable their prescription is over time) and how the patient’s eye heals post-op. For some odd reason, people seem to believe the magic of the LASER can somehow hold their eye’s prescription stationary in time. This is NOT true. No laser, pair of eyeglasses or contact lenses possess special powers to keep the optical status of your eyes stable with time. We all are essentially bags of water with protein and minerals dispersed throughout. Unless you are cryogenically-frozen, nothing will keep you the same with each passing day.
Speaking of statisticians, it is generally understood the more data or statistically significant information one can obtain the more reliable and conclusive results. This means that having at least five or six data points for an individual over time. Surprise! Many fancy civilian (read commercial) LASIK or PRK surgery clinics only look at your last prescription from one or three years ago and say “Congratulations, you are a perfect candidate for surgery!” Hmm…that’s not a statistically significant nor reasonable answer based on a single visit, is it? Oh, this is only your eyes and vision for the rest of your life we are talking about.
Pro’s and Con’s
- Significantly reduce or even eliminate (if you’re lucky, perhaps for more than a few years) your need for eyeglasses or contact lenses
- Enjoy activities which may be difficult to participate in with corrective eyewear or contact lenses
- Utilize non-prescription sunglasses, goggles, etc.
- Possibly enjoy a higher level of vision not attained with glasses or contacts due to limits in traditional optical corrections
- Potentially have to live with increased glare, halos and light streaking particularly in low-light situations
- Experience significant ocular dryness for months or even years after the surgery
- Suffer from increased photophobia (light sensitivity) post-operatively
- Require reading glasses for better near vision if you are over 40 years old post-op (especially frustrating if you were near-sighted before the surgery)
- Be subject to irregular astigmatism post-op which is very difficult to correct with traditional eyeglass and contact lenses – this means distorted vision at all distances
- Have thinning corneas and possibly a corneal flap from LASIK which never fully heals and can be a liability in an ocular injury or trauma (i.e. automotive air-bag or fist to the eye)
Are You Expecting too much?
Despite the advances in laser eye surgery techniques over the past decade, there are limits on what can be realistically achieved. I’d love to wave a magic wand and restore your vision back to a previous time in your life, perhaps when you could see clearly at all distances. Or perhaps I could simply lift off a black velvet cloth to reveal your naked eyes, free from glasses and contact lenses for ever more. Unfortunately, I am not a magician. I have to work with normal science and the tools of modern medicine.
The latest technology allows us to perform vision correction procedures with unprecedented accuracy and safety – often with few side effects and reduced downtime. Key point: let’s not forget what we are dealing with – the human eye and an organ of sight intimately linked to your brain where perception is flavored by your experiences, world-view and expectations. The same surgery procedure can leave one patient ecstatic and leave another feeling disappointed. There are very few surprises with the optical outcomes of laser eye surgery. If we aim to correct -3 dioptres of near-sightedness, the laser will do it without fail in the vast majority of patients. The problem is predicting the happiness of the patient with their outcome. This is more common in patients over the age of 40 who are developing presbyopia and looking for the first time in their lives at multi-focal lenses or two pairs of glasses.
A pivotal point in recommending vision correction to a patient is whether or not the patient is likely to be happy with their result. Eye doctors call it “20-happy vision”. Choosing the right procedure for the patient is essential. However, choosing the right patient for the procedure may be more important. Personality comes into play. Many patients are very pleased to eliminate the bulk of their prescription or refractive errors with surgery. However, some become obsessed with every small detail and overlook the big picture. We can fix their eyes but we can’t fix their paradigm. Some folks are happy with ’20-20-ish’ vision and others want to almost see through walls and have better than good vision. These may be the ‘type-A’ individuals. The engineers, the accountants, the artists and photographers of the world. I’d probably suggest they do NOT consider surgery and save everyone much frustration and unhappiness. Funny, with glasses or contacts they don’t expect to see the wings on a fly’s body 50 feet away, however after surgery many people somehow think they should have super-human vision. No way, Jose’.
Experience has shown me how to recognize these patients. Sometimes, with the right pre-operative counselling they can achieve a very satisfactory result. Some people just aren’t going to love their result. We believe that these people are better off sticking with glasses or contact lenses.
Ok…let’s take a step back. I am NOT against surgery to correct refractive error. I believe refractive surgery is a great for the RIGHT patient for the RIGHT reasons. However, it is NOT for every Johnny come lately who walks into the many over-advertised, over-search-engine optimized surgery centers. The KEY piece of advice is a properly vetted patient. This is where your medically-oriented optometrist is of utmost importance. He or she will hopefully provide you objective advice based on your exam findings, past history and expectations.
I’ve personally seen over 8,500 eyes pre- and post-operative from refractive surgery (LASIK, LASEK, PRK, etc). I earnestly want every patient I see to have a healthy and visually functional life. I’d like to think I treat every patient as my own mother. If you would like a fair evaluation and consult, please visit my at my Boulder, Colorado clinic and I’d be honored to help you.