Dear Laura,
Ariel Berschadsky, who runs LASIK info center has done a very nice job and I respect him for many of the things he has done to bring out significant issues with laser eye surgery. Of course, these 10 reasons each have certain merits, but may not play a significant role in various situations
1. The True Degree of Risk is Unclear and is Being Downplayed.
answre: There is no question that LASIK is a real surgery. I tell my patients that just as with driving a car - problems can unexpectantly occur - so can problems occur following LASIK. A good example is that 1 in 10,000 to 20,000 patients are estimated to develop an eye infection - and some of these people can lose significant vision - and even go blind.
So any person contemplating LASIK (or for that matter any eye surgery) must understand that LASIK is a real surgery.
2. Lasik Technology is in its Infancy.
answer: the excimer laser was developed in the late 1980's and first applied on humans in 1991-92. There are now tens of thousands of patients who have had surgery 5 or more years previously. There have not been reports of late problems following laser eye surgery. By this - I mean there have not been reports that people who were doing well with LASIK after a few weeks to months later on (3-5 years later) developed a problem.
I would agree that the laser technology continues to improve. But that does not mean that people who have laser eye surgery will not get excellent results now. (please understand that I find that 40-50% of the people who come to my office for LASIK are not good candidates for surgery - and they are flat out turned down. As well -results with LASIK are strongly influenced by the degree of myopia and astigmatism, as well as numerous other factors. My point here is that a person with 2-3 diopters of myopia has a high likelihood of having an excllent result - although again every patient has a risk of a serious complication since LASIK is a real surgery.)
3. Lasik Induces Optical Aberrations that are Poorly Understood by Ophthalmologists.
answer: Wavefront tachnology is looking at these aberrations and trying to fgure out what they mean. For most patients who have a perfect surgery and are happy after surgery - the mild optical aberrations produced by the laser treatment do not affect vision in a noticeable manner to the patient.
But clearly early research is showing us that there are changes to the cornea from LASIK that can cause some optical aberrations on wavefront measuring.
4. Lasik Reduces Contrast Sensitivity.
I would agree
5. Lasik Reduces the Corneas Structural Stability.
I would agree
6. Lasik Can Cause Photophobia.
The only peopke who ever get photophobia are those who develop significant dry eye after LASIK. Dry eye after LASIK is a real concern - which I will address in section #9. But besides in dry eye - patients typically do not complain of "pain with light"
7. Myopia Will Eventually Be Your Friend.
The average age of the patients who have LASIK is by many studies ag4e 42-45. This is because only a small percentage of people over the age of 40 have the perfect level of myopia were "myopia is one's friend". Instead - most people over the age of 40 who elect to have laser eye surgery have significant myopia or astigmatism (or both). As well, people who are far-sighted also desire laser eye surgery to help both distance and near. I am happy to expand further - but clearly the people over the age of 40 who are having LASIK make this statement very innefective
One caveat is that when I have people over the age of 40 who are considering LASIK and who are helped with myopia for reading - I will point this out and either discourage LASIK or recommend laser eye surgery on just one eye.
8. Lasik Indirectly Increases the Risk of Cataracts.
This is just not the case. My high school friend who is 37 came in this past week with a catarct in one eye. He has no history of trauma and never had LASIK or any other eye surgery. The fact is that people under the age of 60 do get cataracts - and there have been no linkage between LASIK and cataracts.
In my practice - I have yet to have one of my own patients develop a cataract after LASIK. In fact - I do many cataract surgeries every week - and I have never operated on a patient who had previous LASIK. I would agree that there are some people who have had LASIK who later developed cataracts - but the key is to compare a similar group of people who have not had cataracts and look to see whether LASIK changes the frequency of cataracts.
9. Lasik Causes Drier Eyes.
i agree. This is why I carefully examine patients for dry eye prior to considering LASIK. As well, I am performing far more LASEK than LASIK due to (among other reasons) the fact that LASEK causes less dry eye.
10. Lasiks Long-Term Risks are Unknown.
You can say this about any surgery that has been developed in the mid 1990's. But I can say that I have not seen patients who were doing perfectly at their one year visit who returned at 2,3, or 4 years needing an enhancement (I am sure this will happen, but it has not happenned to me yet.
So I hope I helped answer these questions.
Best regards
Bill Trattler, MD
Miami, FL
