LASIK eye surgery

Look before you leap

Consumer Reports on Health: August 2008

The Food and Drug Administration is taking a hard look at LASIK eye surgery, spurred by complaints of troubling side effects and a lack of reliable data about how often they occur. Millions of Americans have had LASIK to correct routine vision problems, most with good results. But some patients suffer side effects that impair the quality of their eyesight, even if visual acuity is improved.

In April an FDA panel called for stronger warnings in patient information materials, including photos of visual distortions that can occur. And patients can now file complaints through its LASIK Web page. The limited available research suggests that lingering problems from LASIK may be more common than many patients are led to believe. Evidence shows that six months after surgery some 10 to 25 percent of patients experience eye dryness, glare, or difficulty driving at night.

Those problems are more common when patients who aren't good candidates undergo LASIK anyway, perhaps because their doctor is too aggressive or doesn't have adequate experience. Here are questions to ask your surgeon to make sure your eyes are in good hands:

What's included in your presurgical evaluation? A thorough appraisal should take two to three hours, including time with your surgeon. Expect tests to measure the quality and quantity of your tears, the size of your pupils in dim and regular light, and the thickness, shape, and surface quality of your corneas. Abnormal results may reveal an unreasonable risk, as in the case of corneas that are too thin. Your medical history is also vital, since conditions and drugs that affect how wounds heal, such as diabetes and corticosteroids, can make LASIK a poor choice.

What's your rejection rate? Programs with high screening standards typically reject 10 percent or more of their prospective patients.

How do my results stack up? If you have borderline scores on some of those tests, ask how that might affect your outcome and the risk of side effects.

What results can I realistically expect? Your surgeon should prepare you for the likelihood of dry eye, nighttime glare, and vision fluctuations as you heal, and for a 2 to 10 percent chance that you'll need a second procedure. If your pre-LASIK vision is very poor, you may still require glasses or contacts for some activities, and you're more likely to experience halos and glare. Some people find that their vision isn't as crisp after surgery. And most people still need reading glasses after age 40 or so.

What's your training? Look for a board-certified ophthalmologist who does at least 250 procedures a year, including many that involve the same equipment and technique that will be used in yours. Other credentials to look for are a fellowship in corneal and refractive surgery, a related teaching position, and publications in professional journals.

Do my eye problems require the newer "all laser" LASIK technology? Using a special laser rather than the standard metal tool to create a hinged flap in the cornea is clearly a good option if your cornea is unusually flat, steep, or thin. And wavefront-guided LASIK, which uses a special mapping system, can tackle subtle optical defects. Those techniques may also help other people, although they cost about $200-$500 more per eye.

Is Lasik right for you? Before you spend thousands on laser-vision correction surgery, use our essential tool kit to make an informed decision.

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