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f you’re tired of

wearing glasses or

contact lenses, you may be

considering Lasik eye surgery — one of the newest

procedures to correct vision

problems. Before you sign up

for the surgery, get a clear

picture of what you can

expect.

Understanding

Your Eyes

To see clearly, the

cornea and the lens must

bend — or refract — light

rays so they focus on the

retina — a layer of lightsensing cells that line the

back of the eye. The retina

converts the light rays into

impulses that are sent to the

brain, where they are recognized as images. If the light

rays don’t focus on the

retina, the image you see is

blurry. This is called a refractive error. Glasses, contacts and refractive surgery

attempt to reduce these errors by making light rays focus on the retina.

Refractive errors are caused by an imperfectly shaped eyeball, cornea or lens,

and are of three basic types:

• myopia — nearsightedness; only nearby objects are clear.

• hyperopia — farsightedness; only objects far away are clear.

• astigmatism — images are blurred at a distance and near.

There’s also presbyopia — “aging eye.” The condition usually occurs between ages 40 and 50, and can be corrected with bifocals or reading glasses.

Basik Lasik: Basik Lasik: Basik Lasik:

Tips on Lasik Ey Tips on Lasik Eye

Surgery

The Facts

! Lasik is surgery to a very delicate part of

the eye.

! Hundreds of thousands of people have

had Lasik, most very successfully.

! As with any surgery, there are risks and

possible complications.

! Lasik may not give you perfect vision.

The American Academy of Ophthalmology (AAO) reports that seven out of 10

patients achieve 20/20 vision, but 20/20

does not always mean perfect vision.

! If you have Lasik to correct your distance vision, you’ll still need reading

glasses around age 45.

! Lasik surgery is too new to know if there

are any long-term ill effects beyond five

years after surgery.

! Lasik surgery cannot be reversed.

! Most insurance does not cover the

surgery.

! You may need additional surgery —

called “enhancements” — to get the best

possible vision after Lasik.

I
Facts for Consumers

Are You a Good Candidate for

Lasik?

Lasik is not for everyone.

• You should be at least 18 years old (21 for

some lasers), since the vision of people

younger than 18 usually continues to change.

• You should not be pregnant or nursing as

these conditions might change the measured

refraction of the eye.

• You should not be taking certain prescription

drugs, such as Accutane or oral prednisone.

• Your eyes must be healthy and your prescription stable. If you’re myopic, you should

postpone Lasik until your refraction has

stabilized, as myopia may continue to increase in some patients until their mid- to late

20s.

• You should be in good general health. Lasik

may not be recommended for patients with

diabetes, rheumatoid arthritis, lupus, glaucoma, herpes infections of the eye, or cataracts. You should discuss this with your

surgeon.

• Weigh the risks and rewards. If you’re happy

wearing contacts or glasses, you may want to

forego the surgery.

• Understand your expectations from the

surgery. Are they realistic?

• Ask your doctor if you’re a candidate for

monovision — correcting one eye for distance vision and the other eye for near vision.

Lasik cannot correct presbyopia so that one

eye can see at both distance and near. However, Lasik can be used to correct one eye for

distance and the other for near. If you can

adjust to this correction, it may eliminate or

reduce your need for reading glasses. In some

instances, surgery on only one eye is required. If your doctor thinks you’re a candidate, ask about the pros and cons.

Finding a Surgeon

Only ophthalmologists (Eye MDs) are

permitted to perform Lasik. Ask your Eye MD or

optometrist for a referral to an Eye MD who

performs Lasik. The American Academy of

Ophthalmology website (www.eyenet.org)

feature “Find an Eye MD” can provide you with

a list of their members who perform Lasik.

Ninety-five percent of all ophthalmologists (Eye

MDs) are Academy members. Also, the International Society of Refractive Surgery website

(www.LocateAnEyeDoc.com) will provide you

with names of refractive surgeons.

Ask your surgeon the following questions:

1. How long have you been doing Lasik surgery?

2. How much experience do you have with the

Lasik procedure?

3. How do you define success? What’s your

success rate? What is the chance for me (with

my correction) to achieve 20/20? How many

of your patients have achieved 20/20 or 20/40

vision? How many patients return for enhancements? In general 5-15% return.

4. What laser will you be using for my surgery?

Make sure your surgeon is using a laser

approved by the U.S. Food and Drug Administration (FDA). As of this publication’s

printing, the FDA has approved five lasers for

Lasik; they are manufactured by VISX,

Summit, Bausch and Lomb, Nidek and ATC.

Contact the FDA for updates.

5. What’s involved in after-surgery care?

6. Who will handle after-surgery care? Who will

be responsible?

7. What about risks and possible complications?

Risks and Possible Complications

Before the surgery, your surgeon should

explain to you the risks and possible complications, and potential side effects, including the

pros and cons of having one or both eyes done on

the same day. This is the “informed consent”

process. Some risks and possible complications

include:

• Over- or under-correction. These problems

can often be improved with glasses, contact

lenses and enhancements.

• Corneal scarring, irregular astigmatism

(permanent warping of the cornea), and an

inability to wear contact lenses.

• Corneal infection.
Facts for Consumers

• “Loss of best corrected visual acuity” — that

is, you would not be able to see as well after

surgery, even with glasses or contacts, as you

did with glasses or contacts before surgery.

• A decrease in contrast sensitivity, “crispness,” or sharpness. That means that even

though you may have 20/20 vision, objects

may appear fuzzy or grayish.

• Problems with night driving that may require

glasses.

• Flap problems, including: irregular flaps,

incomplete flaps, flaps cut off entirely, and

ingrowth of cells under the flap.

The following side effects are possible, but

usually disappear over time. In rare situations,

they may be permanent.

• Discomfort or pain

• Hazy or blurry vision

• Scratchiness

• Dryness

• Glare

• Haloes or starbursts around lights

• Light sensitivity

• Small pink or red patches on the white of the

eye

Surgery: What to Expect Before,

During and After

Before: You’ll need a complete eye examination by your refractive surgeon. A preliminary

eye exam may be performed by a referring doctor

(Eye MD or optometrist). Take your eye prescription records with you to the exams. Your doctor

should:

• Dilate your pupils to fine-tune your prescription.

• Examine your eyes to make sure they’re

healthy. This includes a glaucoma test and a

retina exam.

• Take the following measurements:

- The curvature of your cornea and your

pupils. You may be rejected if your pupils

are too large.

- The topography of your eyes to make sure

you don’t have an irregular astigmatism or

a cone-shaped cornea — a condition called

Keratoconus.

- The pachymetry — or thickness — of your

cornea. You need to have enough tissue left

after your corneas have been cut and reshaped.

• Ask you to sign an informed consent form

after a thorough discussion of the risks,

benefits, alternative options and possible

complications. Review the form carefully.

Don’t sign until you understand everything in

the form.

• If your doctor doesn’t think Lasik is right for

you, you might consider getting a second

opinion; however, if the opinion is the same,

believe it.

If you qualify for surgery, your doctor may

tell you to stop wearing your contact lenses for a

while before the surgery is scheduled because

contacts can temporarily change the shape of the

cornea. Your cornea should be in its natural shape

the day of surgery. Your doctor also may tell you

to stop wearing makeup, lotions or perfume for a

few days before surgery. These products can

interfere with the laser treatment or increase the

risk of infection after surgery.

During: Lasik is an outpatient surgical

procedure. The only anesthetic is an eye drop that

numbs the surface of the eye. The surgery takes

10 to15 minutes for each eye. Sometimes, both

eyes are done during the same procedure; but

sometimes, surgeons wait to see the result of the

first eye before doing the second eye.

The Surgical Procedure: A special device

cuts a hinged flap of thin corneal tissue off the

outer layer of the eyeball (cornea) and the flap is

lifted out of the way. The laser reshapes the

underlying corneal tissue, and the surgeon replaces the flap, which quickly adheres to the

eyeball. There are no stitches. A shield — either

clear plastic or perforated metal — is placed over

the eye to protect the flap.

After: Healing is relatively fast, but you

may want to take a few days off after the surgery.

Be aware that:

• You may experience a mild burning or

sensation for a few hours after surgery. Do

not rub your eye(s). Your doctor can pre-
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Facts for Consumers

scribe a painkiller, if necessary, to ease the

discomfort.

• Your vision probably will be blurry the day

of surgery, but it will improve considerably

by the next day when you return for a followup exam.

• If you experience aggravating or unusual side

effects, report them to your doctor immediately.

• Do not drive until your vision has improved

enough to safely do so.

• Avoid swimming, hot tubs and whirlpools for

two weeks after surgery.

Alternatives to Lasik

You may want to discuss some surgical

alternatives to Lasik with your eye doctor:

• Photorefractive keratectomy (PRK) is a laser

procedure used to reduce myopia, hyperopia

and astigmatism without creating a corneal

flap.

• Astigmatic keratotomy (AK) is an incisional

procedure to reduce astigmatism.

• Intrastromal corneal rings are clear, thin,

polymer inlays placed on the eye to correct

low myopia only.

For More Information

For more information about vision correction procedures, contact:

American Academy of Ophthalmology,

P.O. Box 7424, San Francisco, CA 94120-7424;

www.eyenet.org

The AAO works to advance the lifelong

learning and professional interests of ophthalmologists to ensure that the public can obtain the

best possible eye care.

American Society of Cataract and Refractive Surgery, 4000 Legato Road, Suite 850,

Fairfax, VA 22033; www.ascrs.org

The ASCRS works to raise the standards and

skills of anterior segment surgeons through

clinical and practice management education. The

Society also works with patients, government and

the medical community to promote delivery of

quality eye care.

International Society of Refractive Surgery, 1180 Springs Centre So. Blvd. #116,

Altamonte Springs, FL;

www.LocateAnEyeDoc.com

The ISRS provides scientific research,

knowledge and information to all individuals

who are interested in refractive surgery.

National Eye Institute, 31 Center Drive

MSC 2510, Bethesda, MD 20892-2510;

301-496-5248; www.nei.nih.gov

The NEI conducts and supports research on

eye diseases and vision disorders, and offers free

publications for the general public and patients.

Food and Drug Administration, 5600

Fishers Lane (HFE-88), Rockville, MD 20852;

1-888-463-6332; (301) 827-4420; www.fda.gov

The FDA oversees the safety of food,

cosmetics, medicines, medical devices, and

radiation-emitting products and provides information on contact lenses, intraocular lenses,

refractive surgery, and corneal implants for

myopia.

The FTC works for the consumer to prevent

fraudulent, deceptive and unfair business practices in the marketplace and to provide information to help consumers spot, stop and avoid them.

To file a complaint or to get free information on

consumer issues, visit www.ftc.gov or call tollfree, 1-877-FTC-HELP (1-877-382-4357); TTY:

1-866-653-4261. The FTC enters Internet,

telemarketing, identity theft and other fraudrelated complaints into Consumer Sentinel, a

secure, online database available to hundreds of

civil and criminal law enforcement agencies in

the U.S. and abroad.

Federal Trade Commission

Bureau of Consumer Protection

Office of Consumer and Business Education

Facts for Consumers produced in cooperation with

the American Academy of Ophthalmology (AAO)

August 2000