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THE LASIK "MIRACLE"

By Tate Gunnerson

salon.com | March 8, 2000

Kirk decided to have both eyes done at once. Like most LASIK patients, he wore his street clothes and a surgical cap for the procedure and sat back while the surgeon put drops in his eyes to numb any discomfort. He was told to look at the red light, but as the surgeon began, he wondered when they were going to discuss his questions and concerns in more detail. The surgery did not hurt, but afterward Kirk noticed that his vision was blurrier. It's a common side effect of LASIK, but one that clears up quickly for the majority of patients. Kirk also began to see fourpointed stars around bright objects at night, get headaches and sometimes feel nausea after trying to focus too hard. (A recent study found that only 3.5 percent of patients experienced severe halos and 1.7 percent severe glare.)

"People think 20/20 is a measure of vision but it's not," says Kirk. "It can only tell you if you can read something across the room on a highly contrasted chart." He believes that the use of this chart, which does not take factor in glare, starbursts and hazing, account for many of the favorable statistics about LASIK.  Two months after his initial procedure, Kirk had another, more painful surgery in an attempt to correct his problems. Between 5 and 10 percent of LASIK patients require another surgery or retreatment to touch up the first one due to over or undercorrection. In the vast majority of patients, the second surgery does the trick. But Kirk experienced more bad luck and that didn't work either. He is disputing the cost of the surgery with his doctor. No procedure exists to adequately fix Kirk's eyes.

"They're playing a game of high volume where the occasional casualty doesn't impress upon them all that heavily because they don't have to deal with it," says Ron Link, the executive director of Surgical Eyes, an organization dedicated to helping people who have suffered as a result of eye surgery. "If it works out, that's great. If it doesn't, it's hell." In Kirk's case, his doctor didn't take the shape of his cornea into consideration when he performed the surgery. Now, when his pupils enlarge at night, they expand beyond the part of his eye that was fixed by the surgery. Light comes in and is distorted by the portion of the eye that hasn't been treated. Now Kirk sees double images at night, and it's hard for him to focus. Although Kirk was given the impression that LASIK is a custom surgery, he has since learned that doctors use a "regression analysis technique" or a profile based on past patients to perform the surgery. "They take numbers based on the prescription, thickness of cornea and curvature and plug it into a formula."

Kirk's case is by no means unique. For many dissatisfied people, the main problem with LASIK is that nobody told them about all the potential side effects. This may have more to do with lack of training than any malicious intent. Assil, who has performed more than 4,000 procedures, suggests that many doctors do not have the knowledge to screen for potential problems and recommends that surgeons be trained in a full oneyear fellowship instead of relying on weekend certification courses given by the makers of the LASIK equipment.  LASIK is not right for everybody. People with diabetes and glaucoma may experience longer healing times, and people who are severely nearsighted or farsighted may find that the surgery will not result in the same miraculous results.

Kirk claims that his doctor never advised him that his surgery carried any great risk. Indeed, many people complain that they're not told about certain side effects or even misled outright. Although in the past it was difficult to check the claims of doctors, Assil says that may be changing. "The Internet is becoming a powerful policing tool," says Assil. "If they're noteworthy at all, their name will start popping up."  Patients should get all guarantees in writing, ask about their doctor's malpractice record and make sure that the laser the doctor will be using has been approved by the FDA, says Assil.

Dr. Barrie Soloway, the director of the Laser Vision Center of Excellence at the New York Eye & Ear Infirmary, suggests that people ask to see the doctor perform the procedure. If the doctor says that he operates every other Wednesday from 3 to 5 p.m., they should be avoided. "Do more research about it and about your doctor than you would about a television you're going to buy."

Phil and Polly Meagher researched LASIK and flew to Montreal for the procedure six months ago. They were pleased that in Canada, the procedure only cost $2,000 per eye, significantly less than was being advertised in their area. They felt comfortable with their surgeon, who had an excellent track record and was willing to guarantee his results. Although neither had any severe problems with LASIK, their differing expectations have affected their attitudes about it. Phil's vision is better than Polly's, but he isn't as happy with his results as she is. "I would not be a good poster boy for the procedure," says Phil. "I miss the nice crisp vision with glasses. I could spot a fly a block away." Although Phil appreciates the convenience of not having to deal with glasses, his vision fluctuates at different times of the day, although his ophthalmologist is surprised since his vision is 20/20 in one eye and 20/30 in the other. Polly, on the other hand, is elated with the results of the surgery. Before she had the procedure, Polly was legally blind without corrective lenses. "What other people could see at 800 feet, I had to be at 20 feet to see," says Polly. Polly's doctor advised her that because of her thin cornea, she was not the best candidate for LASIK surgery. He said he could only correct her from 20/800 to 20/60, but that was good enough for her. Although she still needs corrective lenses since her operation, she has been able to get rid of her Coke bottle glasses. Polly is representative of most LASIK patients. "The great majority of patents are satisfied," says Assil.

Future advancements may make the already safe procedure much safer. Newer lasers such as the LADARVision laser are making it possible to correct severely nearsighted and farsighted people who weren't eligible before, and efforts are being taken to customize the procedure for individual patients. In addition, a new phakic intraocular lens implanted in the eye eliminates the need to cut the cornea, and can be reversed by removing the lenses.  All the success stories in the world, however, don't change the fact that Kirk's life has been changed for the worse. Before the surgery, he and his wife enjoyed going to movies, but now in order to see the screen, he has to put strong eye drops in his eyes that cause him pain and dryness the next day. "The industry still doesn't have a Plan B," says Kirk. "They might say they can take care of it with drugs, but they're still in the development phases of techniques that might fix me." Kirk still has to wear glasses, and he never has scuba dived with his wife. 

When I searched the Web for information about the surgery, I came across hundreds of success stories and tons of hype, but I kept pausing to stare at the car crashes. I don't want to risk my eyesight, and I don't want to have to find a lawyer, no matter how small the risk. Although every doctor I talked with reminded me that it's possible to get an infection from contact lenses, the bottom line is that contact lenses aren't surgery. I can take my contacts out. For now, I'll buy an extra pair of glasses and give my eyes another chance to go into a total remission.

If you don't want to be dependent on glasses or contact lenses call Vista Alliance Eye Care Associates, The New York LASIK doctors toll free at 1-888-NYLASIK (1-888-695-2745) for more information on any of our Vision Correction procedures (LASIK, INtacs, ICL or SRP), to schedule a personal evaluation to help you determine the right prodecure for you, or to register for one of our classes or  seminars