Question of the Week

January 5, 2009


In their modern form, LASIK procedures began in the 1990s. Today, even those who may not understand the specifics of the procedure have likely heard of it--or even heard about someone who has had it done. Over the years, LASIK surgery has become more common, appealing to individuals with a variety of vision problems.

"LASIK stands for Laser Assisted In-Situ Keratomileusis. It is refractive surgery that reshapes the cornea. ... The process begins when the surgeon cuts a flap in the stromal layer. This flap may be created using a microkeratome blade or a laser. The surgeon then moves the flap, either by using alcohol to float it out of the way or by lifting it with the microkeratome. The surgeon removes the tissue underneath the cornea using an excimer laser. This removal or 'ablation' reshapes the cornea, allowing for vision that is more accurate. Once this procedure is complete, the surgeon folds the flap back down for healing. ... LASIK is useful for many vision problems that require corrective lenses. LASIK is an option for both nearsighted and farsighted individuals, and can help those with astigmatism as well."

While the LASIK procedure is of interest to many, there have been some who have questioned whether or not it should be considered illegal performance enhancement surgery for athletes.

"Players [for the San Diego Chargers] typically want to see better or more clearly. Whether that's through laser eye surgery or contacts, they want to improve their vision. The goal is to allow them to see as well as they possibly can. ... [W]hen the ball is in the air and they try to pick it up, the contact rotates. That split second could be the difference between making a good or great play, a reception, broken up pass or interception. The LASIK procedure allows them to play without contacts and play with an advantage over players who wear them."

As more high-profile athletes get the procedure, and more people hear about success stories from their friends and colleagues, the concept of laser eye surgery has become more accepted, and many no longer think of it as "risky." As with any medical procedure, there are benefits as well as risks.

"Before undergoing a refractive procedure, you should carefully weigh the risks and benefits based on your own personal value system, and try to avoid being influenced by friends that have had the procedure or doctors encouraging you to do so.

  • Some patients lose vision. Some patients lose lines of vision on the vision chart that cannot be corrected with glasses, contact lenses, or surgery as a result of treatment.
  • Some patients develop debilitating visual symptoms. Some patients develop glare, halos, and/or double vision that can seriously affect nighttime vision....
  • You may be under treated or over treated. Only a certain percent of patients achieve 20/20 vision without glasses or contacts....
  • Some patients may develop severe dry eye syndrome. As a result of surgery, your eye may not be able to produce enough tears to keep the eye moist and comfortable....
  • Results are generally not as good in patients with very large refractive errors of any type. You should discuss your expectations with your doctor and realize that you may still require glasses or contacts after the surgery....
  • For some farsighted patients, results may diminish with age....
  • Long-term data are not available. LASIK is a relatively new technology. The first laser was approved for LASIK eye surgery in 1998. Therefore, the long-term safety and effectiveness of LASIK surgery is not known."

Once the risks and benefits have been weighed, many decide that LASIK is the right decision for them, and many have been extremely pleased with the results. That said, LASIK is not for everyone.

"You are probably NOT a good candidate for refractive surgery if:

  • You are not a risk taker. Certain complications are unavoidable in a percentage of patients, and there are no long-term data available for current procedures.
  • It will jeopardize your career. Some jobs prohibit certain refractive procedures....
  • Cost is an issue. Most medical insurance will not pay for refractive surgery. Although the cost is coming down, it is still significant.
  • You required a change in your contact lens or glasses prescription in the past year. This is called refractive instability....
  • You have a disease or are on medications that may affect wound healing....
  • You actively participate in contact sports. You participate in boxing, wrestling, martial arts or other activities in which blows to the face and eyes are a normal occurrence.
  • You are not an adult. Currently, no lasers are approved for LASIK on persons under the age of 18."
  • Glasses and contact lenses are certainly alternatives to refractive surgery."

Additionally, for those seeking to improve their vision, LASIK is just one of many potentially beneficial options.

"It is important to understand that one technique isn't necessarily better than another, but each has certain characteristics that make it more or less effective in certain applications. ...

  • LASEK (Laser-assisted sub-epithelial keratomiluesis) is a more recent addition to the refractive repertoire. ... LASEK is essentially the same procedure as LASIK except that a thinner surface epithelial flap is created rather than a thicker corneal protective flap....
  • PRK, (photo refractive keratectomy) another alternative, is a predecessor of the popular LASIK procedure. ... The epithelial tissue is manually scraped away by the surgeon, or in some cases removed by the laser itself. This procedure, like LASEK, is generally performed on one eye at a time and has the longest recovery time of the refractive procedures. ...
  • INTRAOCULAR LENS IMPLANTS: This procedure is essentially the same as that of cataract extraction with placement of a clear intraocular lens implant. Upon surgical removal of the lens, a clear intraocular lens implant is placed to provide clearer vision. ...
  • CK (Conductive Keratoplasty) or CK is the application of radiofrequency energy in a circular pattern along the periphery of the cornea. The theory suggests the heat energy shrinks the corneal tissue, thereby steepening the cornea, and temporarily reducing farsightedness. ...
  • Glasses and contact lenses are certainly alternatives to refractive surgery."

Questions of the Week:
Who should consider LASIK? Who should not? What should you know about LASIK before you can determine whether or not you might be a potential candidate for the procedure? What should you discuss with your doctor if you are considering the procedure? What information about your medical history will you need to have with you when talking to a doctor about LASIK? Once you have determined that LASIK is an option for you, what factors should you take into consideration when determining whether or not it is something you want to do?

Please email me with any ideas or suggestions.
Note: Due to increasing amounts of SPAM sent to this account, please include "QOW" in the subject line when sending me email.

I look forward to reading what you have to say.

Health Community Coordinator
Access Excellence @ the National Health Museum

Request Question of the Week by email 
QoW Archives: 9/2002 - 8/2003 9/2003 - 8/2004 9/2004 - 8/2005 9/2005 - 8/2006 9/2006 - present

Custom Search on the AE Site