Laser Surgery?

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Are you ready to learn the truth about blurry vision?
Would you rather avoid the risks of laser surgery?
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Check out the classes offered here!

Possible side effects of laser surgery
Some patients lose vision. Some patients lose lines of vision on the vision chart that cannot be corrected with glasses, contact lenses, or surgery as a result of treatment.

Some patients develop debilitating visual symptoms. Some patients develop glare, halos, and/or double vision that can seriously affect nighttime vision. Even with good vision on the vision chart, some patients do not see as well in situations of low contrast, such as at night or in fog, after treatment as compared to before treatment.

You may be under treated or over treated. Only a certain percent of patients achieve 20/20 vision without glasses or contacts. You may require additional treatment, but additional treatment may not be possible. You may still need glasses or contact lenses after surgery. This may be true even if you only required a very weak prescription before surgery. If you used reading glasses before surgery, you may still need reading glasses after surgery.

Some patients may develop severe dry eye syndrome. As a result of surgery, your eye may not be able to produce enough tears to keep the eye moist and comfortable. Dry eye not only causes discomfort, but can reduce visual quality due to intermittent blurring and other visual symptoms. This condition may be permanent. Intensive drop therapy and use of plugs or other procedures may be required.

Results are generally not as good in patients with very large refractive errors of any type. You should discuss your expectations with your doctor and realize that you may still require glasses or contacts after the surgery.

For some farsighted patients, results may diminish with age. If you are farsighted, the level of improved vision you experience after surgery may decrease with age. This can occur if your manifest refraction (a vision exam with lenses before dilating drops) is very different from your cycloplegic refraction (a vision exam with lenses after dilating drops).

Long-term data is not available. LASIK is a relatively new technology. The first laser was approved for LASIK eye surgery in 1998. Therefore, the long-term safety and effectiveness of LASIK surgery is not known.
Additional Risks if you are Considering the Following:

Monovision
Monovision is one clinical technique used to deal with the correction of presbyopia, the gradual loss of the ability of the eye to change focus for close-up tasks that progresses with age. The intent of monovision is for the presbyopic patient to use one eye for distance viewing and one eye for near viewing. This practice was first applied to fit contact lens wearers and more recently to LASIK and other refractive surgeries. With contact lenses, a presbyopic patient has one eye fit with a contact lens to correct distance vision, and the other eye fit with a contact lens to correct near vision. In the same way, with LASIK, a presbyopic patient has one eye operated on to correct the distance vision, and the other operated on to correct the near vision. In other words, the goal of the surgery is for one eye to have vision worse than 20/20, the commonly referred to goal for LASIK surgical correction of distance vision. Since one eye is corrected for distance viewing and the other eye is corrected for near viewing, the two eyes no longer work together. This results in poorer quality vision and a decrease in depth perception. These effects of monovision are most noticeable in low lighting conditions and when performing tasks requiring very sharp vision. Therefore, you may need to wear glasses or contact lenses to fully correct both eyes for distance or near when performing visually demanding tasks, such as driving at night, operating dangerous equipment, or performing occupational tasks requiring very sharp close vision (e.g., reading small print for long periods of time).

Many patients cannot get used to having one eye blurred at all times. Therefore, if you are considering monovision with LASIK, make sure you go through a trial period with contact lenses to see if you can tolerate monovision, before having the surgery performed on your eyes. Find out if you pass your state's driver's license requirements with monovision.

In addition, you should consider how much your presbyopia is expected to increase in the future. Ask your doctor when you should expect the results of your monovision surgery to no longer be enough for you to see nearby objects clearly without the aid of glasses or contacts, or when a second surgery might be required to further correct your near vision.

Bilateral Simultaneous Treatment
You may choose to have LASIK surgery on both eyes at the same time or to have surgery on one eye at a time. Although the convenience of having surgery on both eyes on the same day is attractive, this practice is riskier than having two separate surgeries.

If you decide to have one eye done at a time, you and your doctor will decide how long to wait before having surgery on the other eye. If both eyes are treated at the same time or before one eye has a chance to fully heal, you and your doctor do not have the advantage of being able to see how the first eye responds to surgery before the second eye is treated.

Another disadvantage to having surgery on both eyes at the same time is that the vision in both eyes may be blurred after surgery until the initial healing process is over, rather than being able to rely on clear vision in at least one eye at all times.

Finding the Right Doctor
If you are considering refractive surgery, make sure you:

Compare. The levels of risk and benefit vary slightly not only from procedure to procedure, but from device to device depending on the manufacturer, and from surgeon to surgeon depending on their level of experience with a particular procedure.
Don't base your decision simply on cost and don't settle for the first eye center, doctor, or procedure you investigate. Remember that the decisions you make about your eyes and refractive surgery will affect you for the rest of your life.
Be wary of eye centers that advertise, "20/20 vision or your money back" or "package deals." There are never any guarantees in medicine.
Read. It is important for you to read the patient handbook provided to your doctor by the manufacturer of the device used to perform the refractive procedure. Your doctor should provide you with this handbook and be willing to discuss his/her outcomes (successes as well as complications) compared to the results of studies outlined in the handbook.
Even the best screened patients under the care of most skilled surgeons can experience serious complications.

During surgery. Malfunction of a device or other error, such as cutting a flap of cornea through and through instead of making a hinge during LASIK surgery, may lead to discontinuation of the procedure or irreversible damage to the eye.
After surgery. Some complications, such as migration of the flap, inflammation or infection, may require another procedure and/or intensive treatment with drops. Even with aggressive therapy, such complications may lead to temporary loss of vision or even irreversible blindness.
Under the care of an experienced doctor, carefully screened candidates with reasonable expectations and a clear understanding of the risks and alternatives are likely to be happy with the results of their refractive procedure.

Advertising
Be cautious about "slick" advertising and/or deals that sound "too good to be true." Remember, they usually are. There is a lot of competition resulting in a great deal of advertising and bidding for your business. Do your homework.

Lasik's problems coming to light
Monday October 15, 2007 by Sabine Vollmer, OC Register

Evidence mounts that the laser eye surgery's complications, from chronic pain to blindness, are on the rise.

Millions of Americans have undergone laser eye surgery to correct bad vision, and along with the procedure's popularity, something else is coming into focus: its hazards.

Advertising stresses the surgery's safety, and most procedures are successful. Tiger Woods, who relies on keen eyesight as the world's best golfer, pitches it as a quick and painless way to restore sharp vision. Even the U.S. Air Force, long skeptical of the surgery, changed its policy in May to let people who had LASIK apply for pilot training.

But every year thousands of Americans who undergo LASIK are left with chronic pain, dryness of the eyes, distorted night vision and even blindness, according to Food and Drug Administration statistics.

LASIK - which stands for laser-assisted in situ keratomileusis - uses lasers to cut and reshape the cornea. It can improve eyesight without complications, but equipment flaws, a surgeon's error or a failure to screen out patients whose eyes are ill-suited for the treatment can cause the operation to go awry.

The American Society of Cataract and Refractive Surgery, which represents about 9,000 ophthalmologists specializing in laser eye surgery, estimates that only 2 percent to 3 percent of the more than 1 million LASIK surgeries each year are unsuccessful. But FDA records of clinical studies show that six months after the surgery, up to 28 percent of patients complained of eye dryness, up to 16 percent had blurry vision and up to 18 percent had difficulty driving at night.

LASIK surgeons at Duke University Eye Center in Durham, N.C., are among the best-trained and best-equipped in the field. But even surgery at Duke's level has damaged a few patients' eyes beyond repair.

Matthew Kotsovolos, 38, of Raleigh, N.C., had more reason than most patients to feel confident about undergoing LASIK. He was the Duke Eye Center's head of finances. As an employee, he said, he was promised "red carpet treatment" and the procedure would be free.

The surgery June 8, 2006, gave him 20-20 vision, but it left him with intensely dry eyes and excruciating facial pain. He wakes up with sore eyes every morning, puts on special goggles to preserve eye moisture and wonders when the pain in his face will start to kick in.

"I traded in my glasses for permanent head pain, eye pain and these things," Kotsovolos said, pointing to the goggles.

How many LASIK patients develop postsurgery complications is obscured by a lack of regulation and reporting. Because health insurers don't pay for LASIK, they generally don't track complications. The Food and Drug Administration doesn't require reports from doctors, and regulatory enforcement has been largely limited to recalling malfunctioning lasers.

Evidence of problems is accumulating. Some of the strongest is the growing market for contact lenses designed for people who have undergone LASIK and still have vision problems, some seeing worse than before the surgery. One of the leading post-LASIK lens makers is MedLens Innovations, a Front Royal, Va., company founded in 2000.

Robert Breece, an optometrist and MedLens' president, said his company provides hard contacts to more than 2,500 post-LASIK patients annually, and that business is increasing about 10 percent every year. Breece said his company serves more than 200 people per year who have been seriously disabled by the surgery.

"I don't get to talk to happy LASIK patients," he said.

By the end of the year, SynergEyes of Carlsbad plans to bring to market the first line of contact lenses designed specially for laser eye surgery patients with complications who cannot tolerate hard lenses.

Patients with complications are starting to fight back on the Internet and through support groups. Medical research in the past three years has come up with insights about LASIK worrisome enough that some eye surgeons have begun to ease away from the procedure.

"We've learned the limitations of LASIK," said Dr. Stephen Pflugfelder, professor of ophthalmology at Baylor College of Medicine in Houston.

An expert in laser eye surgery for more than 15 years, Pflugfelder is increasingly falling back on an older, less invasive procedure known as photorefractive keratectomy, or PRK, which involves only the surface of the eye.

In the past three years, the number of LASIK procedures at Baylor has dropped from about 70 percent to about 50 percent of all laser eye surgeries.

At Duke, LASIK makes up about 80 percent of laser eye surgeries. Dr. Alan Carlson, head of the Duke Eye Center, is comfortable with that.

"Dry eye hasn't been a big problem," Carlson said.

The university buys the most sophisticated lasers on the market, he said. Patients are screened for risk factors and informed of what they can and cannot expect from LASIK. A surgeon might even do LASIK on one eye at a time.

Federal privacy laws prohibit Carlson from speaking about individual patients' cases. But the head of the Duke Eye Center acknowledged that LASIK can cause serious complications.

"It's imperfect surgery in an imperfect world," he said.

Concern has been raised about the long-term effects of laser eye surgery after a new study has shown that tens of thousands of Kiwis are likely to suffer defective vision from the surgery in their later years.
Studies from Otago and Oxford Universities have shown that laser surgery for short-sightedness could cause haze, glare and blurred vision as people reach their 60s and 70s.
Given that around 25,000 New Zealanders have had the surgery, Otago University head of ophthalmology Anthony Molteno said there could be significant legal class actions in the future, an issue that is causing major concern among eye surgeons. "When we presented this work at the local conference, there was a stunned silence and some anxious questions," said Molteno.
In the procedure the central cornea is flattened. That provides better eyesight, but research shows that it seriously affects the movement of corneal cells, which affect sight. In a normal eye, the cells start at each end of the eye and migrate towards the centre. The top cells move quicker and meet the lower cells below the pupil. Where they meet, called the Hudson-Stahli Line, they create pigment, scattering light and causing glare, haze and blur.
As people age, that area increases and moderately affects eyesight but isn't a real problem, as the line is below the pupil.
"But after the surgery, the top cells move slowly down the flattened cornea, meeting the lower cells in front of the pupil. That causes haziness immediately, and most people who have the surgery see as though they're "looking through hazy spectacles", according to Molteno.

The new findings show the new location of the Hudson-Stahli Line will cause haze and glare in front of the pupil as people age. "The question is, is this permanent, and is it going to increase in the normal manner with age? If so, a lot are going to have a hazy, soft, fuzzy view of society as they get older. This is a long-term effect, and we are following these people. If this turns out to be a major effect, I presume it will one day see a major class action suit."
Molteno said the problems could be serious, with people unlikely to be able to drive. "Anybody who's had their cornea planed would be eaten by a lion at the water hole... If there was serious break-down of law and order, they would probably get shot before the others because they couldn't see so well."
At present, the process cannot be fixed. "The issue is really this: if you pay the private sector to do this, they do it at a profit and pay taxes. The question is how much of those taxes come to the public sector, and how much is it going to cost to clean up the mess? We don't know."
Molteno said the surgery was still full of unknowns, and it should be given serious consideration. There have been 11 claims lodged with ACC over complications since 2000.

"It's not risk-free, make no mistake about that. I wouldn't have them done myself or let my family. But it depends on what it's worth to you."

The research was first raised by a caller to Kerre Woodham on her talkback show for NewstalkZB.
But Malcolm McKellar, an eye surgeon in Canterbury, said that while the technique had risks, these outweighed bad eyesight. "Overall, the risk is very low, but it's not zero. However you do it, it's a surgical procedure. The technology in New Zealand is all cutting edge. Across the board every single centre has got a very new laser. It's one of the most precise surgeries on the planet."
Even though the technology was still evolving and new problems are uncovered, McKellar said, the technique was safe. "There's been animal research and evolving technologies, and we've now got 15 years of the surgery. Given that everything so far has been very good, we're prepared to take the small risk in order to trade poor vision now for good vision."

Worth the risk?
Laser eye surgery may have its risks but for most people it brings huge relief.
Katie Stow, a public relations consultant, had laser surgery eight months ago and she's delighted with the results. From being nearly blind, she now has almost perfect eyesight.
"It was really good and my eyesight is pretty much perfect." The only problem she has had is to do with night vision.
"My night vision looking at lights, there's a bit of a halo around it. But it's definitely deal-with-able."
Stow said her surgeons were helpful and she had confidence in them. "They went though all the risks involved. They were pretty cautious about the whole thing. I was thinking, 'just do it'."
And when she was told of the new research saying she may have problems in the future she wasn't unduly worried.
"Anything is better than what I had before. I might be concerned about that if my eyesight was bad.
"But having the next 30 years of proper eyesight is fine for me."

Research has shown that LASIK surgeries done in July, August and September, the most humid months, required more future corrective surgeries compared to those performed in other months. A study analyzed the temperature and humidity throughout the two weeks prior to about 200 surgeries. Another component to the study included the humidity level inside the operating room during the surgeries.

Participants of the study included 368 consecutive eyes of 191 myopic patients, who all had LASIK eye surgery in 2000 with the same surgeon. The participants were carefully observed for one year after the study.

Results from the study showed that LASIK surgeries performed during months where humidity was low required fewer enhancement procedures, however there were high incidents of overcorrection. On the other hand, those surgeries done during more humid months were more likely to result in under correction, requiring later enhancement procedures.

Before the LASIK procedure, surgeons set lasers to produce cuts in the cornea’s tissue according to the patient exams and to what extent of correction was required.

Researchers claimed that humidity required further cutting and changes might cause swelling on the cornea to the laser setting.

Based on these findings, researchers recommended surgeons to take environmental factors like humidity into consideration when scheduling procedures.

Journal of Cataract and Refractive Surgery April 2004;30(4):798-803

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Dr. Mercola's Comment:

The hotter and more humid it is when patients get laser surgery to correct poor vision, the more likely they are to need fine-tuning.

According to researchers, September was the worst month to get the laser surgery, with 50 percent of eyes needing a follow-up procedure compared to none in drier winter months. The extra moisture in the air may reduce the laser energy absorbed by the cornea.

Along with its vulnerability to climate, there are a number of other reasons why I believe that it is wise to hold off on this procedure until the technology is more mature.

These include:

It has a 10 percent failure rate
It is not recommended for people with dry eyes
Side effects of LASIK include seeing "starbursts" and "halos" and having trouble driving at night
I posted a great article in a past newsletter on the best ways to protect your eyes as you age that is useful for anyone, whether considering this procedure or not.

Most people need glasses or contacts for far-sightedness (myopia). I attribute this to an overabundance of grains, sugars and juices as a child.

Cultures that do not have these foods have a very low incidence of myopia so the key to prevention is developing a nutritious eating program and eliminating dangerous grains and sugars from your diet.

The technique uses radiofrequency energy to shrink small areas of the cornea, the transparent coat on the surface of the eyeball. Unlike laser in situ keratomileusis (LASIK), in which the surface of the eye is reshaped using a laser, conductive keratoplasty does not require cutting or tissue removal.

The treatment may become the preferred method of correcting farsightedness in older patients.

The average age of patients who undergo LASIK is in the early 40s, while for conductive keratoplasty, the average age for patients has been 58. LASIK is approved for higher degrees of farsightedness and astigmatism, which is blurry vision usually caused by an uneven curvature of the cornea.

Conductive keratoplasty could also be safer for patients with glaucoma because keratoplasty does not require the temporary elevation of pressure within the eye that is induced during LASIK. Glaucoma is a disease characterized by vision loss due to abnormally high pressure within the eye.

Reuters New York, April 17, 2002

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Dr. Mercola's Comment:

Anytime one relies on a surgical solution there is potential for irreversible permanent harm and damage. Although the complication rate of this surgery is certainly low with skilled clinicians, it is still possible to lose your sight completely and require a corneal transplant.

Most of us will or have experienced the vision failure that seems to occur when one approaches 45 years old. This is called presbyopia or farsightedness.

I started to experience this a few years ago. My vision started to progressively decrease to the point where I needed to wear glasses to read the menu in a restaurant at night.

Fortunately I was able to find a solution that seems to have improved my vision to the point where I do not require the use of glasses.

Are you ready for better vision?
Would you rather avoid the risks of laser surgery?
Do you want to know how to improve eyesight naturally?
Check out the classes offered here!