I began wearing glasses when I was twelve years old. Although I could see very well with them, I never liked the way I looked in glasses. Growing up in Florida, I loved to swim, but I couldn’t see very well when I took my glasses off. Playing sports with glasses was often a problem, because my glasses would become foggy, sweaty, or would get knocked around.

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More than one million Americans have undergone vision-correction surgery as a hassle-free alternative to wearing glasses or contact lenses. About 95% see well enough after the surgery to pass a driver's license exam-and 75% achieve "perfect" 20/20 vision.

The most common form of vision-correcting surgery, Laser-Assisted In Situ Keratomileusis (Lasik), is safe and effective-but not for everyone. People with cataracts or certain other eye conditions are poor candidates for it. Insurance companies do not cover it. And despite the advertising hyperbole of some clinics, Lasik doesn't guarantee perfect vision-and isn't free from risks or side effects.

Though the vision-correcting effects of the procedure are permanent, Lasik doesn't stop the natural changing of the eye over time, which may necessitate additional surgery or corrective lenses in the future.

To learn more about the benefits and risks of Lasik, Bottom Line/Personal talked to Andrew Caster, MD, clinical professor of ophthalmology at University of California, Los Angeles…


What does Lasik do?
It is a precise way of changing the curvature of the cornea. To correct nearsightedness, the cornea is flattened. For farsightedness, the curvature is increased. To correct astigmatism, the curvature is equalized.

The 10-minute outpatient procedure uses pulses of ultraviolet laser to remove microscopic layers of cells from different parts of the cornea. A computer determines the number of light pulses needed to remove exactly the right amount of tissue. It also guides the laser during the operation.


What exactly happens during the surgery?
The patient sits in a reclining chair. A numbing drop is placed in the eye, the surrounding area is cleaned, and the eyelid is propped open with an instrument called a lid speculum. The patient is given a mild oral sedative, be he/she is awake throughout the procedure.

The doctor cuts a tiny flap in the cornea. This allows the laser to shape the cornea from inside.

The patient is instructed to stare at a fixed light during the procedure to steady the eye. There's a ticking sound when the laser fires but no discomfort. Light from the laser is "cold"-it vaporizes, it does not burn the tissue.

Most patients have both eyes treated at the same time, but a few opt to have one eye treated first and the other later, after they have evaluated the results.


I've heard it is dangerous to move during the procedure. Is this true?
This used to be a real problem. In fact, people who couldn't keep their eye focused on a light for 60 seconds were often rejected for surgery.

Today, tracking lasers lock onto and follow the eye as it moves. The equipment I use measures the position of the eye 4,000 times a second. A little bit of head or eye movement doesn't matter.

Older lasers that lack the tracking feature are still in use at some low-cost vision-correction centers. Ask the doctor if he/she uses a tracking laser. If not, find a doctor who does.


How will I feel after the procedure?
Most people are able to return to work and drive the following day. However, there are mild fluctuations in vision for up to three months after the procedure. Most people will also experience dry eyes…mild scratchiness…and glare or "halos" for a few weeks or months.


What are the main complications?
The most common problem is when vision after the procedure is not as improved as it should be. This can almost always be corrected with "touch-up" surgery-usually performed from three to 12 months later to adjust the cornea's curvature. Most doctors don't charge extra for this, but ask ahead.

Infections are occasionally a problem, although they're easily prevented by using antibiotic eyedrops for a week after the surgery. 

About 2% of patients who undergo the Lasik procedure have long-term visual aberrations, such as glare or ghost images. But the use of newer lasers has reduced this problem to less than 1% of all people who undergo Lasik.

In rare cases-less than one in 10,000-vision is severely impaired and the patient requires a corneal transplant.


Who are the best candidates?
People with modest levels of near- or farsightedness or astigmatism. The less tissue that has to be removed from the cornea, the more successful the surgery.

Lasik is not recommended for people age 18 or younger because the cornea is still changing shape. Nor is it a good idea for adults with refractive instability, a condition marked by frequent changes in distance vision. If you need a new prescription for corrective lenses every year or two, you probably should not have Lasik.

Others who shouldn't undergo Lasik include people with cataracts or certain other eye diseases…those with very thin corneas or extremely large pupils…and women who are pregnant or breast feeding. Hormonal fluctuations during pregnancy and lactation may change the shape of the cornea.


Can Lasik eliminate the need for reading glasses?
Usually not. At this point, Lasik is not a solution for presbyopia (Latin for "old eyes"). Lenses normally focus up close by changing shape. By age 45, the lenses have stiffened and the muscle that changes the shape doesn't work as well.

Lasik can be used to create monovision, a condition in which one eye is corrected for distance and the other eye for close-up. To see far, the distance eye does the work. To read, the other eye takes over. Because the eyes don't work together, however, it may be difficult to perform certain tasks that require particularly sharp vision, such as threading a needle.


A lot of clinics advertise Lasik surgery. How do I pick the best one?
Make sure the surgeon is board certified in ophthalmology. Ask how many procedures he has performed. You want someone who has done the surgery at least 200 times.

Most optometrists have financial arrangements with certain eye surgeons or centers and will get a financial benefit if you act on their referrals.

Be wary of discount eye-surgery centers-especially those that use high-pressure sales tactics, such as a discount if you bring a friend or demanding a deposit on your first visit.

The prices at discount centers are tempting. I have seen advertisements for as low as $399 per eye, compared with the average of $1800 per eye. But the only way to cut costs is to cut corners.

Examples: Some clinics may clinics may calibrate their lasers once a day in the morning-but equipment needs to be adjusted for each patient to compensate for changes in room temperature and humidity. Low-cost eye centers are also less likely to give thorough eye exams or take multiple measurements prior to the procedure.


Is there anything I should do before and after surgery?
Don't wear soft contact lenses for 10 days before the procedure. If you wear hard or gas-permeable lenses, leave them out for one month for every decade that you've worn them. If you have worn hard contacts for 30 years, for example, don't wear them for three months prior to the surgery. Contacts temporarily change the shape of the eye to regain its natural curvature.


Are there other kinds of laser eye surgery?
About 5% of patients can't have Lasik because of certain eye conditions…or won't because they are concerned about having a flap cut in the cornea. In these cases, two other variations of the procedure may be appropriate; both of which require more healing time than Lasik.

One is Photorefractive Keratectomy (PRK), which uses a laser to alter the cornea but does not involve cutting a flap. A newer variation of PRK, called Laser-Assisted Epithelial Keratomileusis (LASEK), has slightly faster recovery time than PRK.