Lasik Eye Treatment Post-Op Complications

Laser eye surgery is no quick fix and not suitable for all that want it.

The eyes are the most sensitive of all human organs. A mere speck can render insensate the strongest man. Why, then, would millions of North Americans choose to subject their eyes to costly and unnecessary surgery? Because the overwhelming majority of those that have their eyes reshaped by laser beams say it has left them healthier and happier.

Laser eye surgery is performed to flatten the cornea to correct myopia and astigmatism, or to increase visual ability beyond 20/20. The two most popular kinds are PRK (photorefractive keratectomy) and LASIK (LASer In situ Keratomileusis). In PRK the cornea is shaved, and in LASIK, which has largely supplanted it, a corneal flap is loosened, pulled across and reattached.

These procedures sound dire, but then so once did corrective contact lenses. Most laser surgery is performed on contact lens wearers grown tired of the inconvenience of fluids and containers, of stumbling around looking for their glasses after they have removed their contacts, who delight in the prospect of being able to see when they get up in the morning. Refractive surgery has also enjoyed a vogue among athletes and other sportsmen, after baseballer Wade Boggs and golfer Tiger Woods had it done.

The surgery, which is done under a mild anesthetic in less than 20 minutes, usually costs between $1,000 and $3,000. The price has fallen by half in the last five years, as it has become more popular. About 1.3 million Americans, and over 100,000 Canadians, had refractive surgery last year

A shock passed through the laser surgery business last month when ophthalmologist William Jory of the London Centre for Refractive Surgery released the results of a study of 38 people who had undergone either PRK or LASIK two to seven year ago. According to Dr. Jory, 21 of these had suffered such a loss of "contrast sensitivity" that they failed a night-vision test. Officials at Toronto-headquartered TLC, the world's largest laser surgery chain, responded that Dr. Jory's sample was small, and that contrast-sensitivity loss is only a significant problem among those that had PRK or whose surgery was botched.

Going under the laser: Bad assessments cause most post-op complications.

TLC's share price did not fall, but much media attention was given to the growing network of people that claim profound post-operative complications. Many of these sufferers declare, "It is critical that the symptoms of ghosting, haloes, starbursts, glare, haze, loss of contrast sensitivity and compromised depth perception are deemed every bit as significant as the ability to make out the letters of the alphabet using a method that was invented in 1862--the Snellen eye chart."

Dr. Roger Gafur, an optometrist at Vancouver's Gimbel Eye Centre, which performs over 1,000 refractive surgeries annually, reports that only 1.8% of his patients experience any significant loss of contrast sensitivity. He explains that most of the post-operative complications mentioned above are "interrelated and lead to problems with night vision." He adds that "about 10% of our patients will end up needing enhancement," i.e., a further procedure. "People do experience complications such as haloing and glare," he admits, "but these almost always disappear after six months."

In the U.S. and Canada any qualified ophthalmic surgeon may perform laser refraction after being certified by the companies that manufacture the laser machines. Dr. Gafur's complaint with the industry is that "pre-operative testing is not regulated at this time." People with large pupils, about 10% of the population, are not suitable candidates for surgery, he explains. He adds that he has examined patients certified for surgery by other practitioners, who, because of pupil size, he rejected.

Howard Howland, professor of neurobiology and behaviour at Cornell University, has studied the effects of refractive surgery. He concludes, "I would advise my friends not to have it done because of the risks involved. The major complications are loss of best-corrected visual acuity and night vision. They are not high risks, but I find any small risks [to my eyes] threatening." He says that refractive surgery is becoming safer and admits that already "the great majority are very happy with the surgery." He adds, however, "The minority that are unhappy are very unhappy."

Dr. Howland agrees with Dr. Gafur that "bad assessments" are the cause of most post-operative complications." The eye is definitely weakened by the surgery, he says, and he predicts of baseball players like Wade Boggs, "The first time they suffer a glancing blow to the eyes, we're going to hear about it." He does understand why people have the operation and has this valediction for properly screened candidates: "You can take the gamble, and you'll probably win."

Glenn Hagele, executive director of the Council for Refractive Surgery Quality Assurance in Sacramento, California, concludes, "It's not for everybody." CRSQA is a non-profit organization that certifies refractive surgeons based on patient outcomes and acts as an information clearing house. His Web site provides a list of attributes patients should seek in surgeons. Echoing Drs. Gafur and Howland, it states, "Patients being properly screened away from refractive surgery indicates a doctor who is conscientious about providing refractive surgery only when it would meet the patient's needs."

Mr. Howland declares that laser surgery "is as much an art as a science." He advises that patients should consider only surgeons that have performed at least 500 operations overall and 250 in the last year, and can boast a post-operative complication rate of 3% or less.

The most important thing for potential patients to understand, Mr. Howland declares, is that "refractive surgery is not a 20-minute miracle; it is a six-month process." Corwin, a 36-year-old Vancouver baker, says he wishes he had known this before he had LASIK surgery two years ago. "I endured a long, healing process," he reports. He suffered from dry, irritated eyes, persistent haze, haloing and mild starbursting. "It was about three months before most of these were gone," he says. At one point, he found himself thinking, "Oh my God, what have I done?" Even a year after the surgery, he was still unsatisfied. Soon after that, he came to a realization: "I felt happy because I realized it was a trade-off. I basically got what I wanted. I have a way better life now."

Last updated Jan 4/07