U.S. News & World Report
August 11, 2009
It's been a little over a year since Joseph Schnell, an elevator construction worker from Philadelphia, had LASIK eye surgery to correct his nearsighted vision. Rather than becoming clearer and sharper, though, Schnell's vision soon was plagued by near-constant glare, halos, starbursts, and double images. The results, he says, have affected his mood--he became depressed shortly after--and he rarely sleeps through the night because of eye pain.
In response to a Food and Drug Administration public forum on LASIK last week, where Schnell and other people shared their experiences with life-altering complications following the procedure, an FDA advisory panel has recommended ways to make warnings of the risks more clear. The panel suggests that photos depicting what people with visual impairment actually see be made available to those considering the surgery, as well as information on conditions such as large pupils and severe nearsightedness, which would disqualify a person from the procedure, and statistics on side effects. The FDA and a number of organizations, including the National Eye Institute and the American Academy of Ophthalmology, have formed a task force to study quality of life post-LASIK and figure out how to minimize problems.
Experts emphasize that serious complication rates are quite rare. Patient satisfaction hovers around 95 percent, according to a worldwide analysis released in March by another task-force member, the American Society of Cataract and Refractive Surgery. Among those remaining, many are simply dissatisfied that LASIK didn't measure up to their expectations--their vision isn't quite 20/20, and they still need reading glasses, for example. According to the FDA, only about 1 percent of patients report worse vision and have permanent side effects like eye pain, dry eye, and poor night vision. (Lots of people experience temporary effects like dry eye, glare, and halos.)
Still, "we want people to understand that not everyone is a candidate for LASIK," says Kerry Solomon, cochair of the task force and a professor of ophthalmology at the Medical University of South Carolina. "The quality-of-life investigation will provide us with additional knowledge on how to select the best candidates."
Meantime, there are steps you can take to minimize the chances of being among the dissatisfied patients.
--If you're predisposed to dry-eye syndrome, LASIK can exacerbate the condition, says Marguerite McDonald, a spokesperson for the American Academy of Ophthalmology and a clinical professor of ophthalmology at New York University School of Medicine. Treatment of dry eye is essential before surgery and is usually successful with eyedrops, prescription medication, or tear duct plugs.
--Any pre-existing conditions like blepharitis (an inflammation of the eyelids), keratoconus (which causes a curvature of the cornea), or severe seasonal allergies can increase the risk of infection and may decrease the success of surgery. Make sure your doctor tests for these and treats them effectively before going ahead with the surgery.
--Contact lenses can distort the shape of the cornea, according to McDonald, making it harder for surgeons to take accurate measures of the eye's refractive power. The FDA recommends patients who wear soft contact lenses switch to glasses full time two weeks before the first preop evaluation. That would be three weeks for toric soft lenses for astigmatism and four weeks for hard lenses.
--Accidentally bumping or rubbing your eyes, even while asleep, can disturb the thin flap of cornea the doctor cuts in order to reshape the cornea beneath. If a flap has wrinkles, the patient may be more susceptible to visual impairment and will likely require corrective surgery, which is typically included in the cost of the original procedure.
--Halos, ghosting images, nighttime glare, and starbursts can interfere with vision after LASIK and may be caused by naturally larger pupils or under- or over-treatment with the laser. For the vast majority of patients, these side effects improve after a few months. If they remain, however, consult a doctor who may suggest eyedrops or retreatment.
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