LASIK Eye Surgery

Improve your likelihood of a good outcome from LASIK – eye surgery that reshapes the central cornea, decreasing or eliminating nearsightedness, farsightedness and astigmatism – with careful evaluation of the surgeon and center in which you undergo surgery.

By Elizabeth Tracey, Senior Medical Writer

The American Academy of Ophthalmology recently released figures indicating that almost 2 million people underwent laser-assisted in situ keratomileusis in 2002 to correct their vision. That number continues to climb in 2003. Yet even as people flock to have the procedure, known best by its abbreviated name LASIK, significant risks remain. The Academy also estimates that 5 percent to 15 percent of those who have LASIK will return for some additional procedure to their eyes, and a smaller percentage will suffer permanent vision damage.

With something as precious as their sight in the balance, how can people who wish to trash their glasses and contact lenses improve their chances for the best possible outcome? Terrence P. O'Brien, M.D., professor of ophthalmology at Johns Hopkins, says the process begins at the moment someone first considers laser vision correction, including LASIK.

"Start with due diligence if you are considering LASIK," O'Brien recommends. "Seek out as much information as you can about the procedure itself and about the surgeons you are considering as well as the facility. What are the rates of complication and reoperation?  It is within your rights as a patient to ask these questions and receive accurate answers. Of primary concern is the facility that emphasizes speed and volume as well as precision and careful evaluation. You wouldn't consider budget brain surgery or discount open-heart
surgery, would you?  Don't cut corners when it comes to your eyes.”

Be wary of too much volume

Frequently, people recommend seeking a surgeon who has performed so many LASIK procedures that he or she may have stopped counting, but O'Brien says too much volume may indicate a lack of attention to the cornerstones of a LASIK procedure that provide the best chances for success.

According to O'Brien, those cornerstones include a very careful preoperative examination, including an assessment of medical conditions like diabetes or rheumatoid arthritis; going to an experienced surgeon and attention throughout the process to the potential for postoperative problems.

"The preoperative examination is, in my opinion, pivotal to the success of LASIK," O'Brien states. "We must identify those patients at risk of a poor outcome, including those with glaucoma, thin corneas, autoimmune diseases, herpes infections of the eye and other problems. The preoperative examination should be among the most thorough eye exams someone has ever had and must include general medical health as well."‘

LASIK can sometimes be modified

When problems are identified, it does not necessarily mean that someone cannot undergo LASIK, but that the procedure may need to be modified. O'Brien believes, however, that a very large percentage of the rare problems reported to have resulted from LASIK could have been avoided with careful preoperative screening.

Seeking an experienced surgeon means asking the staff at the clinic about infection rates and how often reoperation is required. "Be careful of centers boasting that thousands of procedures have been performed," says O'Brien. "What you don't want is a center or group who has sacrificed quantity for quality. We're not talking hamburgers here."

Watch for complications

Finally, the person who has had LASIK needs to be vigilant in the days after the procedure. If pain occurs, excessive redness develops, vision worsens or a discharge forms from the eye, seek help immediately. Prompt attention to problems will improve your chances for the best outcome.

"LASIK is truly a miraculous procedure, one of the greatest advances in medicine in the last century," O'Brien says. "We continue to improve upon the procedure with new techniques like wave front technology, which allows us to assess the entire eye as an optical system and customize improvements to it. I think we are continuing to strive for perfection in our vision recognizing the importance of quality and not equating quantity with proficiency. We are moving toward the day when glasses may not be necessary and contacts will be a thing of the past."

Last Updated: 5/22/2003
The Johns Hopkins University 1996-2003.  All rights reserved.  This information is not intended to provide advice on personal medical matters, nor is it intended to be a substitute for consultation.