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Alejandro Lopez, 62, started wearing glasses when he was in his 20s in order to read the newspaper and see things in the distance, and never liked them. So in 2000, Lopez, who lives in Malverne, N.Y., opted for what was then a relatively new procedure: LASIK, laser surgery to correct vision problems. He distinctly remembers looking at the clock in the operating room before the surgery, and it was too blurry to read the numbers. When he opened his eyes afterward, the clock was suddenly crisp and clear. “It was amazing and so fast. In 10 minutes, my vision had completely changed,” he says. “I was driving and even went to work the next day.” His vision remains good nearly 20 years later.
That's the promise of LASIK: After a quick, relatively painless procedure in an eye surgeon's office, you can ditch your eyeglasses and contact lenses. Since 1995, when the FDA approved the first lasers to correct vision, about 9.5 million Americans have opted for the surgery.
Some people experience troubling side effects, however, including severe dry eye. Here are a few things to know about the procedure.
What is LASIK?
LASIK (laser-assisted in situ keratomileusis) is an FDA-approved procedure to treat all three conditions that normally require glasses: nearsightedness, farsightedness and astigmatism.
Using an ultraviolet laser, surgeons reshape the curvature of the cornea, the transparent dome-like front covering of the eye that refracts light and accounts for about two-thirds of the eye's optical power. With nearsightedness (myopia), the cornea curves too sharply, which focuses light in the front of the retina and blurs distances. Conversely, with farsightedness (hyperopia), when the cornea is too flat, light focuses behind the retina, blurring near vision. With astigmatism, the cornea can be too curved or too flat, which can cloud both close up and distant objects.
First, a surgeon will flatten the eye, then cut a flap in the cornea, peeling it back to reveal the section underneath, which is called the stroma. Pulses from the laser destroy part of the stroma, at which point the flap is replaced. The laser is used to reshape the patient's cornea for sharper sight, depending on what needs to be corrected. The procedure itself usually takes only 30 minutes or less, and while patients can't drive themselves home, they often can recover enough to drive within a day or two. It may take a few weeks or months before the eyes heal and vision clears, however. Because it is an elective procedure, it's not usually covered by insurance and costs average about $4,200.
What are the risks?
While a 2009 FDA study found that 95 percent of patients were happy with the surgery, a small number, less than 1 percent, had problematic symptoms. Those can include seeing starbursts, glare or permanent halos, and dry eyes, night blindness or worsened vision.
"The risks are low but they're not zero,” says Anat Galor, an ophthalmologist at the Bascom Palmer Eye Institute of the University of Miami Health System. “Anytime you do a surgery, you are damaging nerves. For whatever reason, some people have a propensity to develop chronic pain because their nerves become too sensitive."
One regretful LASIK patient is Paula Cofer, 60, a former banker in Tampa, Fla. She was becoming resistant to her contact lenses and after a long day at work, she found herself constantly putting drops in her eyes. Her sister experienced positive results with LASIK, so Cofer thought the surgery would help. Instead, her eyes became even drier, resulting in constant burning. She also had floaters that made it hard to see at all, especially at night, and her corneas became inflamed from scarring. “It's been a nightmare,” she says. “My vision has gotten worse and no part of my life has been unaffected by what the surgery did to me.” Cofer runs a website for people who have been harmed by LASIK that she says now includes 6,000 people who've had adverse outcomes.
But the technology used in the procedure has improved, says Eric Donnenfeld, a New York- and Connecticut-based eye surgeon who reports having performed thousands of LASIK procedures. “The LASIK of today is much safer and more accurate than LASIK of 20 or even 10 years ago."
Who's most at risk for complications
Some people are poor candidates for this surgery. They include those who suffer from diseases that affect wound healing, such as autoimmune disorders like diabetes, or those with a history of glaucoma, eye injuries or previous eye surgeries, along with thin corneas, large pupils (which make them more susceptible to glare, halos and starbursts and inhibits night vision) ordry eyes, which tend to be exacerbated by LASIK.
And people older than around 55 may not be great candidates for LASIK in general, some say, because aging eyes are changing — or “unstable” in eye doctor parlance: Their corneas become stiffer, and they may be developing cataracts and presbyopia (the nearsightedness that comes with age).
"You're doing surgery on a moving target. Two years from now, what we did today may be no longer be good for your eyes,” says Galor of the Bascom Palmer Eye Institute. “This diminishes the ability of LASIK to make you independent of glasses."
LASIK surgeons now do preoperative evaluations to identify who might have problems, including dry eyes. “We now have two good treatments for dry eyes, so we'll pretreat patients to prevent complications later on,” says eye surgeon Donnenfeld, who estimates that he excludes about one-third of patients because they're not good candidates for LASIK.