By Drs. Barry Drucker and Elizabeth Kim
Yes, its great. Many refractive surgeons are advertising on radio, newspaper or TV, espousing the virtues of LASIK. See without glasses or contact lenses. Sounds too good to be true. Maybe it is too good to be always true.
Having performed refractive surgery since the 1980s, weve seen wonderful results. On the other hand, there is also another side of the coin. Before scheduling any patient for LASIK, potential side affects, limitations and common problems are both pointed out and driven home. Any responsible eye surgeon (or physician for that matter) wants his prospective patient to know what can go wrong. Below are listed the most common problems and how they can be dealt with.
Over and under corrections
As many as 20 percent of refractive patients may need subsequent enhancement surgery to correct this. Actually this generally accepted 20 percent is somewhat misleading, since it lumps all degrees of pre existing refractive errors together. We have only had to enhance about 7-8 percent, probably because in our practice, it is not recommended that the procedure be done on extremely high-, near- or far-sighted patients.
However, should an enhancement be necessary, within two or three months, the LASIK flap is easily lifted and 10 or 20 seconds of laser is applied for either over or under corrections. This is painless with some discomfort for the first night only.
It can be a problem for those patients with large pupils. It can also be a lingering problem for PRK patients. For this reason we have been using a new larger ablation zone on the Visx Star3 laser and the Autonomous Ladarvision, that has helped reduce the problem.
Glare is more common with PRK and less so with LASIK. That is one of the reasons that we usually recommend LASIK over PRK, so that there will be less chance of corneal haze and consequently less chance of glare.
Truthfully, this can still be a problem, but it usually subsides with time. If glare persists due to an irregularity of the flap, the flap can be refloated in the office and replaced more smoothly, usually with excellent results. Most LASIK surgeons have the necessary equipment in the office to refloat flaps. We have an operating microscope specifically for that possibility. With Ladarvision, and its Flying Spot technology, we feel the chance of glare is reduced, due to the smoother ablation and its tracker that greatly reduces the chance of off centered treatments.
Loss of vision
Between 1 and 2 percent of patients can have a loss of best corrected visual acuity. However, when the patient whose vision (corrected with glasses) is reduced from 20/15 to 20/20, they often dont take notice. The patient is usually so happy to see well without spectacles that euphoria reigns supreme. The problem can usually be avoided with meticulous repositioning of the flap during LASIK. Fortunately we have seen few of these cases.
Need for glasses at a later time
Every middle-aged patient is apprised of the need for eventual reading glasses. They are told that LASIK will improve their distance vision but when they are in their 40s, reading glasses almost certainly will be worn. The possibility of glasses for night driving is discussed. We have 100 percent of our refractive surgery patients driving without glasses. One or two do use spectacles for extended driving during dark or foggy conditions.
With PRK, this is present for three or four days and can be severe. With LASIK, very little pain can be expected and visual rehabilitation is rapid another reason why we rarely do PRK anymore. It is unusual for our LASIK patients to even need analgesics the night following the procedure.
An unhappy patient after the procedure
If all of the above is not discussed and understood, unhappiness with the result can and will occur. An experienced surgeon can prevent or at least mitigate most potential problems. With realistic expectations, the vast majority of patients are thrilled with their results. For this reason we have found our refractive patients to be the happiest ones.
If your surgeon doesnt go over all of these potential problems, he or she is either hiding the facts or is ignorant of them. The above paragraphs may sound negative, but that is not the reality of present day refractive surgery. This is one of the greatest medical breakthroughs of our time. The above information is not meant to discourage you, it is meant to enlighten you.
Dr. Barry L. Drucker is a board certified ophthalmologist and a Fellow of the American College of Surgeons He has been practicing ophthalmology and oculoplastic surgery in Bayside for more than 20 years. Dr. Kim has completed a corneal fellowship at Mt. Sinai Hospital and a glaucoma fellowship at Cornell University. They can be reached at 718-224-5500 or at their Web site, www.laserl
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