For the right patient—in the hands of a skilled surgeon—the vision-correcting surgery known as LASIK can be "life-changing," says Kamran Riaz, director of refractive surgery at the University of Chicago. For instance, say you're a solider in combat. Not having to fiddle with glasses or contacts could literally play a key role in your survival.But if talking about "corneal flaps" and letting someone come straight at your eye with a bright, burning light freaks you out a little, well, good job being normal. LASIK is serious stuff, and it's not right for everyone. It makes sense to do a little bit of homework before you plunk down your hard-earned cash at a mall-adjacent surgical center.That's why Riaz offers a no-strings-attached preliminary visit to every patient, to make sure they understand the pros, cons, and risks. Here's what he tells them.LASIK is full-on surgery.
Sure, it only takes about 10 to 15 minutes per eye—meaning the whole thing might be over in less time than it takes you to stream an episode of The Walking Dead. But make no mistake, LASIK—or more formally, laser in situ keratomileusis—is a serious surgical procedure.Here's what actually happens: Your doctor will use lasers to cut a thin flap in your cornea, a layer of tissue at the front of your eye. Then, he or she precisely sculpts some of the tissue underneath to change the way rays travel to the light-sensitive retina at the back of your eye, refocusing your vision. Finally, the flap goes back over the area to protect it—no stitches required.While things usually go well, every operation comes with its risks, says Ravi Goel, a surgeon in Cherry Hill, New Jersey, and spokesperson for the American Academy of Ophthalmology. In the case of eye surgery like LASIK, rare but possible hazards include inflammation, infection, pain, and even—extremely rarely—loss of vision.Your vision might not end up perfect.
Patients who do best after LASIK come in with realistic expectations, Riaz says. Don't think you'll wind up with X-ray vision or even less blurriness than you currently experience with corrective lenses. "The goal is to try to get you to see as well as you can see with your glasses and contact lenses," he says. (And note that if you're not truly unhappy with using corrective lenses, it might not even be worth the hassle.)According to the American Academy of Ophthalmology, most people reach somewhere between 20/20 and 20/40 vision after LASIK. That's good enough to perform most everyday tasks unaided. And, it's good enough for most patients—only 1 to 4 percent were unsatisfied with their vision after the procedure, according to a recent study in JAMA Ophthalmology.But if your work is detail-oriented and you tend to notice small discrepancies—say, you're an engineer or an architect—you face a higher risk of being among the unsatisfied, Riaz says. Ophthalmologists even have a saying about this, according to Goel: "There's a difference between 20/20 and 20/happy."You can also experience other wonky changes in your sight, including glares or halos at night, double vision, and dry eye. According to the same JAMA Ophthalmology study, one or more of these symptoms develop in more than 40 percent of patients within three months. But they'll often go away—and your surgeon can help you take steps before surgery to minimize them, such as treating existing dry eye with rewetting drops.Eventually, you'll still need readers.
LASIK can correct nearsightedness and farsightedness, but not presbyopia, the loss of near vision that causes pretty much everyone to need reading glasses sometime after age 40.In fact, LASIK might actually hasten this process. Some slightly nearsighted people can get away with using their middle-distance vision to read a page or screen without glasses, even after age 40, Goel says. But if you have LASIK, you won't have that luxury.You might require a redo.
As your eye heals and time passes, subtle shifts can cause your vision to regress again over time. Eventually, you might need "refresher" surgery to see well without corrective lenses, Goel says. The risk is higher when you get surgery at a younger age, since your eye may still be growing.While surgeons can officially perform LASIK on anyone over 18, some surgeons recommend waiting longer, including Michael Sulewski, director of refractive surgery at Penn Medicine. He advises holding off until at least age 25, especially if you're in college, grad school, or a job that requires lots of intense close work or reading. Your refraction might not yet be "stable"—in other words, your prescription's still changing, meaning your odds of needing revision surgery later on increase.You'll have to give up your contacts awhile beforehand.
As part of the preoperative assessment and planning, your surgeon will create a detailed map of your cornea, then use that guide to program the lasers on precisely where to whittle. Contact lenses slightly warp the shape of your cornea, altering the calculations.So, you'll need to do without for at least a few weeks beforehand—longer if you wear rigid, gas-permeable lenses instead of soft ones. "Patients are not always happy about that, because no one ever told them," Sulewski says.There might be a better option.
Some people aren't good candidates for LASIK because their corneas are too thin, they're extremely near- or far-sighted, or they have dry eyes, large pupils, or other eye conditions. But, some of these people might benefit other so-called refractive surgeries to improve vision.This includes a procedure called photorefractive keratectomy or PRK, which uses similar techniques but without creating a flap in the cornea. Recovery tends to be more painful, but flap-less PRK may work better in the long term if you have a thin cornea or a job or hobby that involves potential trauma to the eye (say, boxing or mixed martial arts), Riaz says. And people with extremely poor vision might be able to get implantable lenses, which unlike LASIK or PRK have the added perk of being reversible if you're unhappy with the outcome.If you're considering LASIK, you might want to choose a facility or surgeon that offers all these procedures, rather than one that does LASIK only. That way, you can be sure they don't have a financial incentive to recommend one technique when another might be a better fit, Riaz says.You might never see your surgeon again.
There's another downside to some high-volume LASIK-only centers. Sure, their surgeons are very experienced—they might do 100 procedures a day—but that's not necessarily a good thing.For one thing, rushing patients through can lead to operations on people who aren't good candidates. In other cases, the surgeons are fatigued and have mid-surgical slip-ups, says Sulewski, who's both treated patients after botched operations and consulted on lawsuits involving other doctors.Besides, those surgeries are literally all these doctors do (in ophthalmologist slang, they're called "cutters"). Someone else will do your pre-operative consultation and post-op follow-up visits. "You might not meet your surgeon till 10 minutes before the surgery, and, at that point, you don't have the opportunity to get out of it if you don't feel comfortable with the way things are being done," Sulewski says. "You have no rapport with that surgeon."It's not cheap (nor should it be).
In fact, surgical trends are often tied to economic ones, Riaz says. He saw a drop in demand during the recession of 2008 and 2009, and always sees a surge in November and December, as people rush to drain their flexible spending accounts.Because LASIK is an entirely elective procedure, most insurers won't cover it. You can expect to fork over about $2,000 to $3,000, Riaz says. (He adds, though, that the investment can pay off in five to seven years, when you consider the cost of glasses, contacts, and solution.)If you see ads or group deals for discount offers, read the fine print (if you can, har)—often, the lowest price will cover only people with mild refractive error. And then think twice about whether you really want a cut-rate operation. "I tell people getting a discount massage or flowers, fine," Riaz says. "Not so much for eye surgery."
Advertisement
Sure, it only takes about 10 to 15 minutes per eye—meaning the whole thing might be over in less time than it takes you to stream an episode of The Walking Dead. But make no mistake, LASIK—or more formally, laser in situ keratomileusis—is a serious surgical procedure.Here's what actually happens: Your doctor will use lasers to cut a thin flap in your cornea, a layer of tissue at the front of your eye. Then, he or she precisely sculpts some of the tissue underneath to change the way rays travel to the light-sensitive retina at the back of your eye, refocusing your vision. Finally, the flap goes back over the area to protect it—no stitches required.While things usually go well, every operation comes with its risks, says Ravi Goel, a surgeon in Cherry Hill, New Jersey, and spokesperson for the American Academy of Ophthalmology. In the case of eye surgery like LASIK, rare but possible hazards include inflammation, infection, pain, and even—extremely rarely—loss of vision.Your vision might not end up perfect.
Patients who do best after LASIK come in with realistic expectations, Riaz says. Don't think you'll wind up with X-ray vision or even less blurriness than you currently experience with corrective lenses. "The goal is to try to get you to see as well as you can see with your glasses and contact lenses," he says. (And note that if you're not truly unhappy with using corrective lenses, it might not even be worth the hassle.)
Advertisement
LASIK can correct nearsightedness and farsightedness, but not presbyopia, the loss of near vision that causes pretty much everyone to need reading glasses sometime after age 40.In fact, LASIK might actually hasten this process. Some slightly nearsighted people can get away with using their middle-distance vision to read a page or screen without glasses, even after age 40, Goel says. But if you have LASIK, you won't have that luxury.
Advertisement
As your eye heals and time passes, subtle shifts can cause your vision to regress again over time. Eventually, you might need "refresher" surgery to see well without corrective lenses, Goel says. The risk is higher when you get surgery at a younger age, since your eye may still be growing.While surgeons can officially perform LASIK on anyone over 18, some surgeons recommend waiting longer, including Michael Sulewski, director of refractive surgery at Penn Medicine. He advises holding off until at least age 25, especially if you're in college, grad school, or a job that requires lots of intense close work or reading. Your refraction might not yet be "stable"—in other words, your prescription's still changing, meaning your odds of needing revision surgery later on increase.You'll have to give up your contacts awhile beforehand.
As part of the preoperative assessment and planning, your surgeon will create a detailed map of your cornea, then use that guide to program the lasers on precisely where to whittle. Contact lenses slightly warp the shape of your cornea, altering the calculations.So, you'll need to do without for at least a few weeks beforehand—longer if you wear rigid, gas-permeable lenses instead of soft ones. "Patients are not always happy about that, because no one ever told them," Sulewski says.There might be a better option.
Some people aren't good candidates for LASIK because their corneas are too thin, they're extremely near- or far-sighted, or they have dry eyes, large pupils, or other eye conditions. But, some of these people might benefit other so-called refractive surgeries to improve vision.
Advertisement
There's another downside to some high-volume LASIK-only centers. Sure, their surgeons are very experienced—they might do 100 procedures a day—but that's not necessarily a good thing.For one thing, rushing patients through can lead to operations on people who aren't good candidates. In other cases, the surgeons are fatigued and have mid-surgical slip-ups, says Sulewski, who's both treated patients after botched operations and consulted on lawsuits involving other doctors.Besides, those surgeries are literally all these doctors do (in ophthalmologist slang, they're called "cutters"). Someone else will do your pre-operative consultation and post-op follow-up visits. "You might not meet your surgeon till 10 minutes before the surgery, and, at that point, you don't have the opportunity to get out of it if you don't feel comfortable with the way things are being done," Sulewski says. "You have no rapport with that surgeon."It's not cheap (nor should it be).
In fact, surgical trends are often tied to economic ones, Riaz says. He saw a drop in demand during the recession of 2008 and 2009, and always sees a surge in November and December, as people rush to drain their flexible spending accounts.Because LASIK is an entirely elective procedure, most insurers won't cover it. You can expect to fork over about $2,000 to $3,000, Riaz says. (He adds, though, that the investment can pay off in five to seven years, when you consider the cost of glasses, contacts, and solution.)If you see ads or group deals for discount offers, read the fine print (if you can, har)—often, the lowest price will cover only people with mild refractive error. And then think twice about whether you really want a cut-rate operation. "I tell people getting a discount massage or flowers, fine," Riaz says. "Not so much for eye surgery."