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Lasik Surgery: When the Fine Print Applies to You

I WAS vain.

That’s the only way I can explain why I willingly let a doctor cut my corneas with a laser: vanity.

Little did I know when I chose Lasik surgery that I would not end up satisfied like the friends and acquaintances who raved about their post-glasses existence. Instead, my days are complicated, since I am dealing with side effects that are far more bothersome than being unfashionably four-eyed.

I had been wearing eyeglasses since I was 8, and I was tired of never seeing the stars without glare, of not being able to go rock-climbing unless I secured my glasses. Not to mention the horn-rimmed barrier between me and a date.

I had trouble figuring out which side of a contact lens to stick onto my eye, so I never really gave contacts a chance.

I had been considering Lasik — short for laser-assisted in situ keratomileusis, which entails cutting and reshaping the cornea — since the Food and Drug Administration approved it in the late ’90s. Because I was not too nearsighted and not too old, ophthalmologists told me I was an excellent candidate. But I wanted to wait until more people had gone under the laser.

Roughly 800,000 patients have had Lasik annually since 2000, spending about $2.5 billion on the procedure every year, said David Harmon, the president of Market Scope, a research company for the ophthalmic industry in Manchester, Mo.

The American Society of Cataract and Refractive Surgery reports a 95.4-percent patient satisfaction rate for Lasik, based on a recent analysis of research worldwide. The researchers found 19 studies specifically addressing patient satisfaction from the last decade, encompassing roughly 2,022 patients. (Some had been post-op for a month; others for a decade).

Most ophthalmologists are confident about the efficacy of Lasik, as well as another popular procedure — photorefractive keratectomy, or P.R.K. Both are designed to correct nearsightedness, farsightedness and astigmatism.

“It’s very few people who don’t have a superb outcome, especially with the new technology,” said Dr. Marguerite McDonald, the president of the International Society of Refractive Surgery of the American Academy of Ophthalmology.

About five of my friends had undergone the surgery. “Life-changing,” they cooed. “Miraculous!” Because my 40th birthday was looming, my parents offered me either a cello or Lasik. I chose Lasik. But first, I looked up studies online and consulted three doctors. Each did a spate of tests and pronounced me an excellent candidate.

I asked about the risks, and they explained that some people come away with dry eye, double vision, decreased contrast sensitivity and decreased night vision. Some see halos around lights. I was assured these side effects were rare, and usually fleeting.

Ultimately, I chose Dr. Sandra Belmont, the founding director of the Laser Vision Correction Center at NewYork-Presbyterian Hospital/Weill Cornell Medical Center. Dr. Belmont also runs a corneal fellowship program at Manhattan Eye, Ear and Throat Hospital.

A doctor who was a patient of hers recommended her. She charges between $4,500 and $5,500; I paid $4,500, nearly $1,000 less than other quotes I had received, a consideration since my insurance, like most, does not cover elective surgery.

I signed a consent form confirming that I understood the risks. I thought I did understand them. I did not know then that 5 to 10 percent of patients need to have their vision fine-tuned — or in industry parlance, “enhanced” — after surgery because of an under- or over-correction, according to John Ciccone, a spokesman for the American Society of Cataract and Refractive Surgery.

Nor had I spoken to any individuals who wished they had never had the procedure — of which, I have since learned, there are plenty.

On April 13, 2007, I had the surgery. Dr. Belmont’s colleague examined me the next day. My vision was a little blurry, but apparently that was normal. Dr. Belmont said that everything looked good on subsequent visits, too. But the blurriness never went away.

At night, I saw halos around streetlights; neon signs bled; the moon had two rings around it like Saturn. My eyes felt sore, a result of dry eye, which also causes sporadic blurriness.

Dr. Belmont told me that sometimes women of a certain age who are undergoing hormonal changes or who take certain medications get dry eye. It would have been nice if I’d known my advanced age (39) might be problematic before I sat in the chair.

I cut out all prescription and nonprescription pills. Didn’t help. The doctor told me to use Refresh Plus, over-the-counter drops that temporarily help dry eye. The drops cost around $12 a box; I go through two boxes a week. She also prescribed Restasis eye drops, which can help increase tear production. They didn’t for me.

True, I no longer wear glasses. But the 20/20 line on the eye chart is blurry. I can make it out only if I squint, and it takes about a minute to read. My doctor views this as proof of the surgery’s success.

“I do see it as a success,” Dr. Belmont told me in a recent interview. She also has said repeatedly that these troubles will pass. “In 18 years of practice, I’ve never had a patient whose symptoms don’t go away. Most patients take three to six months to heal.”

But I see my slow-squint reading as a sign of failure. I thought I’d be able to decipher words in the real world at a glance. My consent form said: “The patient understands that the benefit of the Lasik/P.R.K. procedure is to have an improved uncorrected visual acuity.” I took that to mean that my eyesight would be 20/20. Most doctors, on the other hand, focus on the words “improved uncorrected visual acuity.”

“Not every patient has the potential to see 20/20,” Dr. Belmont told me this month. So, if your eye can see 20/20 with glasses or contacts, the doctors try to replicate that, but there are no guarantees. Dr. Belmont said, “You do the best that you can.”

The F.D.A. cautions patients to “Be wary of eye centers that advertise ‘20/20 vision or your money back’ or ‘package deals.’ ” (Still, some refractive eye surgeons’ phone numbers end in 2020.)

Nearly a year later, my problems remain. Still, I’m not mad at my doctor. I’m mad at myself. No one forced me to do it. In our quick-fix culture, we forget that there are risks with any surgery, elective or not.

Between 1998 and 2006 the F.D.A. received 140 negative reports relating to Lasik, including double vision, dry eye and halos, said Mary Long, a spokeswoman. Granted, this is not that many, but Ms. Long said, “If this many people are responding to an adverse event, there are probably others who are not.”

After concluding that too few well-designed studies have examined quality of life after Lasik, the F.D.A. put together a task force in 2006 to design a clinical trial to explore the subject. A pilot study is now under way at the National Eye Institute in Bethesda, Md.

LOOKING back, I do not think my doctor and the other experts I consulted adequately represented the pitfalls. It’s one thing to say that dry eye is “annoying,” as Dr. Belmont did; it’s another to explain how feeling as if your eyes are coated in Vaseline may make every waking moment a chore.

Perhaps it depends on what your definition of success is. “People say, ‘Well, you don’t wear glasses anymore,’ ” said Barbara Berney, 53, of Rockford, Ill., who had the surgery in 2001 and now reports dry eye, night blindness, dimmed vision, halos and starbursts. “Unless you see what I see, you have no frame of reference.”

Unhappy Lasik patients, some with worse experiences than mine (one man I spoke to needed a corneal transplant), have created about a dozen Web sites. The 12 patients I talked with all reported feeling as I did, gaslighted. They said they kept telling their doctors that they couldn’t see, and that their doctors kept telling them that they could.

A few doctors have told me that they think they can help my dry eye, but I worry they will suggest more surgery, and I haven’t gone to see them. A few optometrists said they could fit me with special lenses to moisten my eyes, and I may have to go that route.

Meanwhile, I walk by eyeglass shops and wish I needed to go inside.

***

Note from Ben Kim:

This article was originally published on March 13, 2008 in The New York Times. Many thanks to Abby Ellin for graciously allowing us to share her article with our readers. To learn more about Abby's work, including her book on childhood obesity, please visit: TeenageWaistland.com.

For information on the potential long term dangers of Lasik surgery, please feel free to view:

Potential Long Term Dangers of LASIK Surgery

To discover simple eye exercises that you can begin using immediately to promote better vision naturally, please feel free to view the following articles:

How to Reduce Eyestrain and Promote Optimal Vision

Why Frequent Blinking is Essential for Healthy Eyes and Optimal Vision

More Information on Lasik Complications:

Lasik Complications

 
 

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Comments

Great article. Hard to stick to my guns about not tampering with surgery of any sort unless it's essential, when friends all around me are raving about their wonderful new surgically produced vision and I long to join them but for no other reason than the same that Abby gives - vanity.

Was she ever checked for Fuchs' Corneal Dystrophy? Most Ophthalmologists don't check and you find out after LASIK or cataract surgery that you cannot see. The only thing you can do then is have a cornea transplant or partial cornea transplant. Fuchs' affects the endothelium of the cornea. Trauma to the cornea causes the cells to die that pump fluid out of your eye. Your vision is reduced to looking through waxed paper or vaseline film. When a sufficient number of cells have died the only way to release the fluid is through a blister. Very painful!!

I'm a 49 year old male that had PRK about 5 weeks ago. My left eye still has some double vision, but I can see it improve very slowly, each week. The right eye is quite clear.

The Doc gave me "mono-vision". I'm not sure that I'll like it (right eye tuned to read close, left eye shaped for distance). However, as I get older, I see that it may be the only way to avoid reading glasses.

My advice? Get the very best Doctor in your area, that has done lots of procedures with the very best equipment.

You are definitely taking a permanent gamble with your vision (and daily quality of life). The first 2 weeks, I felt I was legally blind and could only read a newspaper comfortably after the 3rd week. If you have PRK, be prepared to be discouraged and handicapped by a lengthy and slow recovery of a number of weeks (quite different from lasik).

I had Lasik surgery end of 2004 and have never ever regretted it. I have 20/20 vision and no side effects. To me it was a miracle and I thank God every day for this. You will know what I mean if I tell you that I had to pick up my spectacles from the floor more than once during squash games. That is only one example of the discomfort of having to wear glasses. Getting up at night to go to the bathroom and having to find your glasses first, is no fun.

My experience is very similar to Marisa's. I am in awe to be glasses free after 6 years after lasik. If I had to pick one experience in my life that was the most positively life changing, next to the birth of my son, it would be this procedure. I went from extremely visually impaired to 20/20 vision almost overnight! AMAZING!

Do your research on LASIK risks before undergoing the procedure. Check out a resource like http://www.lasikproblems.org

The same thing happened to me when I received Lasik surgery. My eyes were very dry and I had double vision. I think if I remember correctly, my "perfect" vision only lasted for around 9 months, then it started to decline. I decided to just go back to wearing glasses, so went and had another exam done and the doctor told me that my vision was not 20/20, and, that my left eye had become weaker than my right eye.

I was quite furious about this but knew I could not do much about it. I got the glasses and since then my vision has been stable. I have not had any increase in my vision, but it has not decreased either. I can go for a few days without wearing glasses and even drive without them (unless it's at night), I can even go scuba diving. But after a few days my eyes start to hurt and get dry again.

In conclusion, I think LASIK is a fine prceedure, I just don't feel it's for everybody. Warning for anyone who is considering LASIK, "Know what what your getting into, before you get into it".

I also had LASIK after wearing contact lenses for over 20 years. I waited to have the procedure for several years after it hit the market hoping the "kinks" would have been worked out. I was very excited about having uncorrected vision since I really had no memory of what "perfect" vision was like.

Long story short, I chose a very reputable local eye surgery center and had LASIK on both eyes. I suffered from dry eye issues almost immediately. It continued to worsen and a few years later my vision began worsening so I went to see my opthamologist (not the one who performed my LASIK). He spent more than two hours trying to refract my eyes. My left eye wasn't difficult but he couldn't get my right eye no matter what he did. All of sudden, he stopped and said I needed to see a specialist. At the time I didn't think too much of it but off I went to see a specialist more than a 100 miles away. Within minutes she diagnosed me with corneal ectasia. This is just about the worst side effect you can experience from LASIK. There is no cure. Most patients eventually need cornea transplants. Luckily the specialist knew of a procedure (collagen cross-linking or CXL) being performed in Europe that halts the progression of corneal ectasia. Going to Europe, however, was not in our budget and my doctor told me of a cornea specialist (one of the top cornea transplant surgeons in the country) in the U.S. who was performing the procedure on an experimental basis. He had performed CXL on numerous patients and the results were very encouraging. I didn't have anything to lose so we traveled some 600 miles in order for me to have the procedure. We had to make the trip two more times for follow-up exams. I had the procedure almost four years ago and my eyes are stable. The corneal ectasia hasn't progressed further. I ended having to leave my career in IT as I could not be in front of a computer for so many hours day-in and day-out. Financially, I haven't been able to recover and there was no legal recourse for the damage to my eyes. I will always have difficulty focusing with my right eye and suffer severe, chronic dry eye (which Restasis does not help). I use very expensive eye drops(Oasis Plus) daily and night time is pretty icky. I wake up several times a night every night because my eyes are so dry they hurt. I keep eye drops on my bedside table...can't be without them. I tell people who are considering LASIK NOT TO DO IT. It is not worth the potential consequences even if the odds are slim. The odds don't matter one bit if YOU end up being the 1 in 10,000 who ends up with a life altering result. If I could have a "do over" I would have chosen to have PRK rather than LASIK.

I'm a healthy 38 year old woman who just underwent LASIK 2 months ago. My advice to EVERYONE is DO NOT have this surgury! They make healthy eyes sick! They cut corneal nerves - and they don't inform you of this. It wasn't in my consent form, wasn't in the presentation, and nobody explained the procedure to me in any real detail. The surgury was presented to me as relatively safe with good outcomes.

It never even crossed my mind that the eyes are connected to the sinusus and have mysteriously developed painfully dry sinus and allergies - not to mention the dry eye that causes light sensitivity and DAILY headaches - DAILY! Night "glare" or painful headlights now too. Wow! Noone will warn you. I've never had allergies in my LIFE before this! The eye doctor will only tell you that your eyes are seeing well - and won't acknowledge that any other discomfort or health problems that you have developed or are experiencing are a result of the surgury. You are on your own. The LASIK centre is set up so they wash their hands of you once the damage is done. Such a terrible way to treat people. Steal their money - damage their eyes and leave them to suffer. Don't forget about the depression and anxiety that will follow this traumatic surgury. It is TRAUMA to the eye and you will mourn the loss of your original and once healthy eyes. Appauling and disgraceful. It's sinister - don't let them trick you too. Be smarter. Save your natural WORKING and comfortable eyes. Please - share the TRUTH with as many people as you can. I would not wish this on anyone - not even the surgeon that caused me this suffering. :(

3 weeks in and full of regrets. Halos blurred vision. Driving with one eye shut. Sensitive to light. Pretty much a total nightmare.. Doctor says give it a couple more weeks.