Scrubbing In: Candidate screening paramount for LASIK
As an ophthalmologist-in-training, I often receive questions from family and friends about LASIK. Should I do it? Would you? At these times, I often think about an insight from one of my professors. "In my whole practice, my happiest patients are LASIK patients and my unhappiest patients are LASIK patients," he told us at a teaching conference.
As an ophthalmologist-in-training, I often receive questions from family and friends about LASIK. Should I do it? Would you?
At these times, I often think about an insight from one of my professors. "In my whole practice, my happiest patients are LASIK patients and my unhappiest patients are LASIK patients," he told us at a teaching conference.
On one side of the spectrum are patients like Brian Sitongia, 30, a Wills Eye records manager from South Philadelphia. He was frustrated with contact lenses. His eyes burned when he became tired. If he fell asleep, putting him at risk for infection, the lenses would stick to his eyes.
He got a special rate at Wills Eye Institute four years ago because he had a doctor-in-training (under direct supervision) do his LASIK. He was thrilled with the results.
"The next day I drove to the Shore without glasses. I was amazed and in awe," he says. "It's the best money I've ever spent." Sitongia has had no complications and continues to enjoy watching TV and driving without glasses.
There is something about LASIK that can make patients unearthly happy. Removing the burden of glasses and contacts, while seemingly mundane, can give patients deep satisfaction. Another professor says his LASIK patients even seem happier than his corneal transplant patients, who can go from being blind to seeing the world.
Each year about 700,000 Americans get LASIK and the vast majority do well. LASIK is a short outpatient procedure, in which a flap is cut into the cornea and lifted up so that tissue can be reshaped by a laser. This remodeling changes the refractive qualities of the eye and enables the patient to go without glasses or contact lenses.
Insurance almost never covers the procedure, which costs $1,500 to $3,000 per eye.
Only 140 people filed complaints with the Food and Drug Administration from 1998, when the laser device was approved, to 2006. Yet many more patients are unhappy. No one knows the number, but studies are under way to clarify this question.
The most important step in avoiding problems is avoiding LASIK if you are not a good candidate. It is the job of the thorough LASIK surgeon along with the patient to decide if it makes sense to go forward. The preoperative evaluation can be more important than the actual surgery.
The most significant side effects range from debilitating dry eye to bothersome visual effects, such as halos, glare, or starbursts. Patients can also get ghost images (double vision) or poor night vision and even poor daytime vision. Surgeons screen out patients, such as those with dry eyes, large pupils, or irregularly shaped corneas, to help prevent such complications.
Some patients may be better candidates for surface ablation, a procedure similar to LASIK but in which no flap is created. While the end results of surface ablation are the same as LASIK, there is more postoperative discomfort and vision takes longer to recover.
Another part of the screening focuses on personality. A patient needs to be a risk-taker, for one thing. But the most important personality screening may be for depression.
A study of 370 active-duty naval patients, who had been surveyed with a depression scale preoperatively, revealed that although 89 percent of eyes achieved 20/20, those patients with higher levels of depressive symptoms had three times higher odds of being less satisfied than those with low levels of symptoms.
Web sites such as "LifeAfterLasik.com" are outlets and support for unhappy patients. One patient wrote in about constant eye pain since his surgery eight weeks earlier. "I now realize it was the most reckless decision I've made in my life," the posting says. He says his pain interferes with his work, and even worse, disrupts his sleep.
The FDA has made it easier for patients and physicians to report LASIK-related problems and has updated Web resources for prospective patients.
Would I ever get LASIK? I was nearly convinced after talking with an attending. Contact lenses pose their own set of dangers, with the risk of infection, so LASIK might be trading one risk for another. But that reasoning lasted just a few minutes. First, I'm not a risk-taker and the risk at hand is too weighty: Being an ophthalmologist with blurry vision would handicap me. Finally, I do have dry eyes, which could get worse. I'll stick to my glasses and contacts for now.