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Some Patients Say Life After Lasik Not Perfect
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Some Patients Say Life After Lasik Not Perfect

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Some Patients Say Life After Lasik Not Perfect

Some Patients Say Life After Lasik Not Perfect
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Are you a good candidate for Lasik? How do you choose a surgeon? Physicians answer these questions and more.

  

Q&A: Doctors on Lasik Surgery

Eye surgery

Nearly a million Americans elect for laser eye surgery each year. Yian Huang/Star Ledger/Corbis hide caption

toggle caption Yian Huang/Star Ledger/Corbis

FDA Seeks Lasik Feedback

To report your Lasik complications to the FDA, click here.

Many people know someone who loves the result of their Lasik eye surgery.

The freedom from glasses or contacts can be liberating, and clear vision can feel nothing short of a miracle. The success stories help explain why nearly a million Americans are electing for laser eye surgery each year.

But about 5 percent of patients are not satisfied with their results. Some have minor, temporary complaints, while others report long-term complications.

"If I look to the extreme left, I can see ... double," says Joseph Schnell, 48, of Philadelphia. Schnell had Lasik surgery in April 2006. "It's hard for me to focus. It's even more pronounced when I'm tired."

Schnell also has trouble with night vision, which is among the more common complaints after Lasik recovery. Schnell says when he looks at street lights or headlights, the light explodes out as if he were staring at a sparkler. He used to be a very confident driver, he says, but now just the sight of oncoming headlights can disorient him.

"I just don't know if I'm really being safe," he says.

Asking More Questions, Demanding More Answers

Schnell says on the day of his Lasik surgery, he didn't meet his surgeon until a few minutes before the procedure. He says the technician and optometrist who did the pre-surgical exams didn't make much time for questions.

"I had to ... pull her teeth as far as getting information out of her," he says.

For one thing, with more time to ask questions, Schnell might have learned that Lasik surgery will not fix or prevent the age-related decline in close-up vision, a condition known as presbyopia, which necessitates reading glasses.

"No one ever told me that," Schnell says.

In retrospect, he says, he could have demanded more information. Lasik centers require patients to sign forms that disclose the risk of complications. But patients don't always read or understand the fine print.

"I share, definitely, part of the blame for going ahead with this surgery," Schnell says.

But when he spoke publicly at a Food and Drug Administration hearing about Lasik, he found himself in the company of many other patients who say they deserved more warnings and more discussion with doctors about the risks up-front.

Discussing Risks Before Surgery

The American Society of Cataract and Refractive Surgery says most patients do get proper counseling.

"I do think it's possible that patients may not always be getting all of their questions asked," says Kerry Solomon, co-chairman of the Joint Lasik Study Task Force and professor of ophthalmology at the Medical University of South Carolina.

Solomon stresses the strong success and satisfaction rates with corrective eye surgery. But if patients have unanswered questions before the surgery, he says, they should hold off.

"If a patient is in a position where [doctors or technicians] really haven't had a discussion with them about risks, and they're not comfortable with that, then I would get a second opinion," he says.

Reporting Lasik Problems to the FDA

The FDA says it's not certain how many Lasik patients have problems with their vision weeks or months after their surgeries. But the agency is planning a new study, scheduled to begin next year, to get a better handle on the prevalence.

Individual consumers can also report their Lasik complications directly to the FDA. (To report complications, click here or call 1-800-FDA-1088.)

"We encourage as much information as possible here, because FDA does look at every voluntary report that comes in," says Mary Weick-Brady of the FDA's Center for Devices and Radiological Health.

The agency uses patient reports to help determine if some new action is needed.

"If it's a decrease in vision, if it's a halo, if it's a starburst, if it's a problem with night vision, these types of things would be considered adverse events to FDA, and we would want those reported because it has affected your vision," says Weick-Brady.

Over the last decade, the FDA has received only about 140 adverse event reports related to Lasik. It's possible that the unfortunate stories such as Schnell's are few and far between. It's also possible that surgeons and patients have underreported complications.

Thorough Screening Before Surgery

Before opting to have the surgery, experts say you should make sure you get a thorough screening.

"It's not uncommon for us to bring the patient in two or three times," says Lasik surgeon Scott MacRae.

Ask lots of questions, and be certain that the optometrist and surgeon have agreed that you're a good candidate for the procedure, he says.

Q&A: Doctors on Lasik Surgery

The Food and Drug Administration says patients might not be getting all the information they need before undergoing Lasik eye surgery. NPR's Allison Aubrey talked to two experts to find out what patients should know before they have the procedure.

Kerry Solomon, M.D., co-chair of the Joint Lasik Study Task Force and professor of ophthalmology at the Medical University of South Carolina, Charleston:

What is Lasik?

Lasik stands for laser-assisted in situ keratomileusis. Basically what's happening is a small flap is cut on the cornea, the clear covering of the eye. A blade or a laser is used to make the cut. The flap is lifted and the cornea is reshaped, then the flap is put back into place. This corrects the vision.

Wavefront is often marketed as the latest innovation in laser eye surgery. What is it?

It's a type of Lasik that uses a more precise measurement of the eye. The patient looks into a device that takes thousands of measurements of the eye. The device then converts that into a digitized three-dimensional measurement that's really a fingerprint of the eye. That information is fed into the laser, and then the laser makes its cuts based on the measurement.

Why the difference in pricing for Lasik?

When you look at pricing, it's all about the same. Some people may advertise a very low price to get you in the door, and then increase the price to get you to have the procedure best suited for your eye. So, for example, it's not uncommon for some centers to charge a very low amount and if you have an astigmatism this ends up costing extra. A Wavefront procedure might cost extra, or using a laser rather than a blade to create the flap would cost extra, for example.

What's the alternative to Lasik surgery?

The other option outside of Lasik is photorefractive keratotomy (PRK). It's the same procedure for patients, but no flap is made. Patients who are nervous about having a flap made or who are not candidates for Lasik, may be PRK candidates. PRK has been around longer than Lasik. But Lasik is by far the most common laser vision-correcting procedure. The downside to PRK is that it's a little uncomfortable and it takes a while for vision to come back.

What are the top three indicators that someone isn't a good candidate for Lasik?

One is someone's corneas are too thin or corneal surface is irregular. Another common reason is someone who has dry eyes. Dry eyes are not always a contraindication for Lasik, but may make someone a bad candidate. And the third would be unrealistic expectations. If someone says, "I have to have perfect vision at all times of day and night," that is not realistic. I would tell that patient to stay with their glasses and contacts, because while this procedure is awesome, nothing is perfect.

Scott MacRae, M.D., professor of ophthalmology and visual science at the Center for Visual Science at the University of Rochester School of Medicine, Rochester, N.Y.:

How should someone looking to get Lasik choose a surgeon?

I recommend they go to someone who is a cornea specialist if there are problems with dry eye or irregular corneas. Also, choose a surgeon who has a high reputation and who contributes scientifically by doing research in refractive surgery. People who do research and publish are more invested in new technology, so they're more likely to have a better idea of how to treat complicated problems.

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