The Real Truth About LASIK

Not the Practice of Medicine

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Hi,

I'm Dr. David Malitz, yes a real MD, an ophthalmologist, and a LASIK surgeon. There is a lot of information and misinformation on the net and in the media about LASIK. The truth is that LASIK is a modern medical miracle. The problems develop when complications of the procedure occur. In skilled hands these complications are few and far between, but with over 1 million successful procedures annually, even with a 1% complication rate, this will leave 10,000 eyes with complications. Now the good news is that most complications are avoidable and the better news in skilled hands, most complications can be corrected without a serious loss of vision.

LASIK is a procedure to reshape the cornea. The complications can occur with the laser, data gathering (garbage in, garbage out) data entry (wrong patient, wrong prescription); microkeratome (creates the flap that is lifted to allow the laser to reshape the inside of the cornea). The procedure is like opening a book, removing a few pages, and closing the book back up.

There can be overcorrections, undercorrections, halos, glare, infections, dry eyes, and scarring or ectasia (warpage of the cornea).

If you are post menopausal, live in the desert, and female you may be at higher risk for LASIK than an average candidate.

You can minimize your risk by participating in your care.

ASK what your pachymetry (corneal thickness) is. Ask how much tissue the laser will remove (certain lasers and certain treatment profiles remove more tissue "tissue hungry" - this is true, for example with the B-- and L--- laser.

I have used several lasers and prefer the VISX brand, but an excellent result can be obtained with an excellent surgeon even with a mediocre laser.

This brings us to pre screening. Many surgeons say they have done 10,000 microsurgical procedures. This is a spin doctor's approach to answering how many LASIK procedures have you done. You are looking for a sincere, honest physician, who will answer your question, not politicians that may skirt the question or answer it with double speak!

The sheer number of procedures is not nearly as important as the quality of the procedures that have been done, especially if the physician has done at least 1000 procedures. Thinks about this, who would you want on your team? A basketball player that has shot 10000 free throws and has made 10 of them or another player that has shot 1000 and made 995?

The next critical factor is the staff. Many errors are clerical. Ask at your exam for your prescription; insist on comparing your prescription on the laser treatment screen with the one that was given to you and confirming that it is your name on the screen. This may seem like overkill, but you only have two eyes and nearly all doctors will treat both eyes on the same day and if they have another patient's data in the system, you can count on a treatment error. This CAN generally be corrected but the best way to control medical errors is to avoid them in the first place.

If you have a steep cornea or a flat cornea you may be at increased risk for a button hole (hole in the center of the flap) or a free cap (no hinge). AGAIN, generally not a disaster but if the doctor does not recognize the complication and proceeds with treatment with a button hole, it can lead to distorted vision.

To avoid complications during the flap creation, try to relax and raise your eyebrows. It is hard to squeeze if you are consciously raising your brows.

The flap can be decentered. Make sure you are looking exactly where the doctor directs during this stage. If he locks on off center it is difficult to correct this and some of the treatment will be ineffective potentially leading to an asymmetric treatment and residual astigmatism.

The suction can be inadequate during the flap creation. Your vision should be dim or black before the flap is created. The pressure can be confirmed with a tonometer, but many surgeons skip this step and rely on your report of dim vision or their assessment of the suction on the eye.

You can get a corneal abrasion, especially if you have dry eyes or a corneal dystrophy called "map dot fingerprint".

Ask your doctor (which should be the surgeon) if your cornea is normal. Ask specifically about MDF, dry spots, abnormal vessels, scars, and tear film.

Ask about his retreatment rate. A low rate can be indicitive of a quality surgeon (getting it right the first time) or someone unwilling to correct a suboptimal outcome. Retreatment rates should be less than 10% (ours is less than 3%) Ask if there is a fee for retreatment. If your fee is over 2000/eye, generally a year of retreatment is included. A life time "guarantee" is frowned upon by organized medicine as it is impossible to guarantee medical procedures. Ask the surgeon about his success rate, and how he defines success. The vast majority of our patients see 20/20 after LASIK. If you have an extreme prescription you may not achieve 20/20.

Ask the surgeon about his/her complication rate All surgeons have complications and if they deny any complications, it will be difficult to trust anything else they say.

Share your expectations with the surgeon. Ask if LASIK is the best procedure for you or if there is a better procedure for your age, prescription and vision needs. LASIK centers, especially the corporate centers, or unskilled or untrained surgeons will not offer other options that may be more appropriate for you.

i.e. if you are over 60, farsighted, have an extrememe prescription, you still may be a candidate for LASIK but may be a better candidate for an off label procedure called C-Lex.

Naturally, you are not expected to take responsibility to drive your complication rate down, but you need to select an experienced, board certified eye surgeon and be prepared for potential complications if your only criterion for your surgeon is cost. A reasonable fee for LASIK is $1500/eye. Expect to pay $500 more per eye for "custom". This is a marginal improvement when the refraction is done correctly with "standard" LASIK. Studies suggest better night vision with custom vs. standard and if you can afford it, I would suggest going with custom if you are a candidate.

Regarding follow up. Often you are referred to a physician from an optometrist. The optometrist may select the surgeon based on a co-management relationship. This relationship involves a sharing of the total fee for the procedure and may not be based on the surgeon with the best outcomes.

If you have other questions, e-mail me and I will try to address your concerns. In skilled hands, LASIK is an excellent procedure that should allow you years or even a lifetime of freedom from glasses or contacts for the majority of your activities.

David Malitz, MD

southwesteyeinstitute.com

hubpages@sweyeinstitute.com