All Eyes on Lasik

All Eyes on Lasik

While the vision correction surgery is effective, it may not be right for everyone

A week after having Lasik vision correction surgery, Tom Hansen of Chicago is seeing more clearly than he has in years.

“It’s unbelievable how quickly my eyesight changed,” says Hansen, 24, who is nearsighted. Hansen turned to Lasik after suffering several eye infections he attributed to the contact lenses he had worn since middle school. He says his vision is now 20/20, and he’s still getting used to it.

“I’m just thinking that now that my vision is so clear, should I be seeing even more? I am just figuring out the range of the human eye,” he says. 

Past the peak of popularity

While Hansen is reveling in his improved vision, Lasik procedures have fallen by more than half in the past 10 years, partly due to the economy and partly due to fear of complications.

The Food and Drug Administration (FDA) approved the first lasers to correct vision in the 1990s. With the hope of being able to put aside their eyeglasses, it is estimated that 9.5 million Americans have had vision correction surgery. 

Lasik surgery infographic Lasik, the most popular type of vision correction surgery, is a two-step surgical procedure that uses laser technologyto reshape the cornea. A thin, circular flap is made in the cornea, the tissue underneath the flap is reshaped to correct vision and the flap is put back in place. 

The procedure’s peak popularity was between 2000 and 2007. The number of laser vision correction surgeries was 1.5 million in 2007. It decreased to 604,000 in 2015, according to Market Scope, which analyzes eye care data. Since 2015, Lasik has been on a slight upward trend, according to the American Refractive Surgery Council.

“As we move further and further away from the recession, it seems like people are finding it a bit more comfortable to do an elective surgery,” says Michelle Andreoli, MD, an ophthalmologist with the Wheaton Eye Clinic and a spokesperson for the American Academy of Ophthalmology. 

Side effects and selecting patients

Side effects from the procedure can include severe dry eye, light sensitivity, blurred vision and perceived halos, starbursts or double images. The procedure enables 20/20 vision in more than 90 percent of patients and 20/40 vision in 99 percent of patients, according to the American Refractive Surgery Council. But it’s not ideal for everyone, including those whose prescriptions change often or those with higher corrective prescriptions for glasses or contacts.

And even after Lasik surgery, patients might need glasses for reading or for driving at night, and their vision can still worsen with age.

Modern-day Lasik is so different than it was 18 years ago. It’s a smart phone compared to a flip phone

Evaluating whether a patient is an appropriate candidate for the surgery is one key to success.

“Advanced diagnostics today are way more sensitive in detecting if patients are ideal candidates for the procedure,” says ophthalmologist Mitchell Jackson, MD, a member of the refractive cataract subcommittee of the American Society of Cataract and Refractive Surgery.

New technologies are making the procedure more effective, he adds.

“Modern-day Lasik is so different than it was 18 years ago,” says Jackson, who performed Hansen’s surgery. “It’s a smart phone compared to a flip phone.”

Thomas Michelson, MD, an ophthalmologist at the Wheaton Eye Clinic, agrees that today’s advanced laser systems “make the flap so it is more precise.” Screening patients is key, he adds. “The most important thing is to see a Lasik surgeon and have them do a complete evaluation,” including a complete medical history, a thorough eye exam and specific scans of the cornea to determine thickness and curvature of the cornea, he says.

Before Hansen’s surgery, he went for two appointments to have his eyes evaluated. His analysis involved measuring the shape and thickness of the cornea, measuring pupil size, testing for dry eye syndrome and testing for other conditions such as uncontrolled diabetes and autoimmune diseases that would disqualify a patient as a good candidate for the procedure. It even required DNA testing. 

Patients with larger pupil sizes may be at risk for glare and halos after Lasik surgery. Patients with abnormally thin corneas may be prone to developing corneal ectasia, a group of conditions that can cause the cornea to bulge leading to a worsening of a patient’s vision.

Jackson, who’s been in practice for 26 years at Jacksoneye in Lake Villa and who has undergone Lasik himself, says he turns down about 22 percent of those who seek the surgery. 

“If they’re not a perfect candidate, we’re not doing the surgery,” he says.

Post-surgery recovery

Early in his recovery, Hansen is following a strict regimen of taking antibiotic eye drops, an anti-inflammatory medicine and artificial tears to ward off any of the potential post-surgery problems that others have cited.

As happy as Hansen is with his surgery results, there is plenty of evidence to suggest that some side effects are common, although most resolve within a few months. In 2008, patients testified at an FDA hearing that they had experienced chronic eye pain and blurred or double vision after undergoing Lasik. In some cases, these conditions were so painful that patients had been driven to suicide. 

Opponents of Lasik argue that the surgery itself is the problem because it damages the cornea, which has no blood supply and can only heal by producing scar tissue. A 2016 FDA study concluded that there is a need for adequate counseling about the possibility of developing new symptoms following Lasik.

Despite these concerns, Jackson insists new technology has reduced side effects and is safe. For ultimate success, he says, patients need to adhere to the post-surgery regimen of antibiotic eye drops and other medications that Hansen is currently following. “Pre- and post-op protocols are part of the necessary adherence process to obtain the best possible outcomes,” Jackson says. “Patients who decide to deviate on their own may not have an ideal outcome, despite perfect surgery.”

Jackson estimates that the average cost of Lasik across the nation is about $2,000 per eye. He cautions anyone considering the procedure to be wary of providers who promise that they turn no patients away. 

Andreoli agrees that patients need to do their homework and be realistic. 

“Lasik doesn’t guarantee perfect success,” she says. “The eye can continue to change. A certain percent of patients will need eyeglasses, and some will come back for enhancement.” 

Practitioners are having more conversations with patients, opening their eyes as to whether the vision correction surgery would be right for them.

Originally published in the Spring/Summer 2019 print issue