Are You a Good Candidate for LASIK?

By Rachel K. Sobel, MD

As an ophthalmologist-in-training, I often receive questions from family and friends about LASIK. Should I have LASIK surgery? Would you? At these times, I often think about an insight from one of my professors. “In my whole practice,” he told us at a conference, “my happiest patients are LASIK patients, and my unhappiest patients are LASIK patients.”

On the happy side of the spectrum are patients like Brian Sitongia, 30, a Wills Eye records manager from South Philadelphia who was frustrated with contact lenses. His eyes burned when he became tired. If he fell asleep, the lenses stuck to his eyes, putting him at risk for infection. He had LASIK four years ago, and he is thrilled with the results. “The next day, I drove to the Shore without glasses. I was amazed and in awe,” Sitongia says. “It’s the best money I’ve ever spent.” He has had no complications and continues to enjoy watching TV and driving without glasses.

LASIK is a short outpatient procedure in which a flap is cut into the cornea and lifted up, allowing tissue to be reshaped by a laser. This remodeling, which changes the refractive qualities of the eye, frees the patient of the need to wear glasses or contact lenses. Insurance rarely covers the procedure, which costs $1,500 to $3,000 per eye.

About 700,000 Americans get LASIK every year, and the vast majority do well. There is something about LASIK that can make patients remarkably happy. Being relieved of the burden of glasses and contacts, although seemingly mundane, can be deeply satisfying. Another professor says that his LASIK patients even seem happier than his corneal transplant patients, who can go from being blind to seeing the world.

Still, some patients are not satisfied. Although only 140 people filed complaints with the Food and Drug Administration between 2006 and 1998, when the laser device was approved, many more patients are unhappy with their results. The precise number is not yet known, but studies are under way to find out.

So how do you avoid becoming one of the many who regret their decision to have LASIK? The best way to avert problems is to ascertain whether you are a good candidate before deciding to undergo the surgery. A preoperative evaluation that assesses both physical and personality factors may be more important than the actual surgery. It is the job of the LASIK surgeon, along with the patient, to decide if it makes sense to go forward.

The most significant side effects range from debilitating dry eye to bothersome visual effects such as halos, glare, or starbursts. Patients may also get ghost images (double vision), poor night vision, and even poor daytime vision. To help prevent such complications, surgeons screen out patients with dry eyes, large pupils, or irregularly shaped corneas. Some of these patients may be better candidates for surface ablation, a procedure similar to LASIK, but one in which no flap is created. Although the end result of surface ablation is the same as LASIK, there is more postoperative discomfort and vision takes longer to recover.

Another part of the preoperative screening focuses on personality. A successful patient needs to be a risk-taker, for one thing. But the most important personality screening may be for depression. A study of 370 active-duty naval patients who completed a preoperative depression scale revealed that although 89 percent of them achieved 20/20 vision following LASIK, those with higher levels of depressive symptoms were three times as likely to be less satisfied than those with low levels of depressive symptoms.

The FDA has made it easier for patients and physicians to report LASIK-related problems and has updated Web resources for prospective patients. In addition, websites such as “LifeAfterLasik.com” can provide a supportive outlet for unhappy patients. One patient who posted on the site reported that since his surgery eight weeks ago, he has experienced constant eye pain that interferes with his work and, even worse, disrupts his sleep. “I now realize it was the most reckless decision I’ve made in my life,” he wrote.

So, would I ever get LASIK? After discussing the pros and cons with an attending physician, I was nearly persuaded to go through with it. After all, contact lenses pose their own set of dangers, along with the risk of infection. Undergoing LASIK might simply be trading one risk for another. But for me, that reasoning was ultimately unconvincing. As an ophthalmologist, blurry vision would handicap me. Furthermore, I do have dry eyes, which could get worse. The risk is too weighty for me, and I’m not a risk-taker. I think I’ll stick to my glasses and contacts for now.

About the Author

Dr. Rachel K. Sobel is a second-year resident of the Wills Eye Residency Program at Thomas Jefferson University.

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