Fall 2001

A closer look at LASIK

For her twenty-sixth birthday, Karry Case decided to throw out her eyeglasses, even though she needed them to see everything from her alarm clock to road signs. Instead, she joined more than 3 million Americans who, in the past few years, have undergone LASIK.

LASIK, which stands for laser-assisted in situ keratomileusis, is a brief outpatient surgical procedure in which the cornea is reshaped so that images entering the eye strike the retina more precisely. Nationally, 96 percent of people who undergo LASIK surgery have an outcome of 20/40 vision or better.

A week after Karry's surgery, her eyesight was 20/15 - considered a "better-than-perfect" improvement from her uncorrected vision of 20/100. "I'm glad I did it," smiles Case. "After the surgery, I went home to rest. When I woke up, I could see the clock on the microwave across the room. I went out the next morning to walk the dog, and I saw the little bugs crawling on the grass."

How does LASIK work?
Ophthalmologists are the medical doctors licensed to perform LASIK surgery. Depending on where you go to have the surgery, you will meet with either the ophthalmologist who will perform the procedure or an optometrist who can only do the pre- and post-op exams.

Karry chose to go to ICON Laser Eye Center in Minneapolis. She initially met with an optometrist who performed a complete eye exam. This determined that she was an appropriate LASIK candidate, what kind of vision correction she would need and how much laser removal was necessary.

One week later, on the day of her surgery, she had another eye exam to ensure her vision was still the same. The laser was then calibrated and programmed with her prescription before she entered the laser room. (The laser room, by the way, offered visitors in the waiting area the opportunity to watch the procedure through a plate-glass window.)

Most procedures, depending on the amount of correction needed, take about 15 minutes under the laser. Karry's surgery was even shorter - from the time she laid down on the surgical table to the moment she stood up was less than five minutes.

The procedure, step by step
A liquid anesthetic is dropped into the patient's eye, numbing it for surgery. The physician then props the eyelids open with a metal clamp (to keep the patient from blinking) and marks the cornea with water-soluble ink to guide the laser repositioning of the flap.

A suction ring holds the eye steady while the platform for the microkeratome, a cutting instrument, is put in place. Pressure is applied to the eye so that it is firm enough to be cut cleanly. The patient's vision goes black.

After the cornea is moistened, the microkeratome glides across its surface, cutting through the outer layers. The instrument stops automatically, leaving an uncut section to act as a hinge.

After the suction is turned off and the cutting device removed, vision returns. The surgeon carefully lifts the still attached corneal flap out of the way, exposing the underlying layers that must be excised by the laser. Guided by a computer program, the excimer laser reshapes the cornea. To correct nearsightedness, the laser trims the cornea's center, making it flatter. For farsightedness, a doughnut-shaped ring of tissue is removed. The flap is then put back in place.

Following the surgery, the ophthalmologist examines the operated eye. Karry was then given medicated drops, eye shields (for light sensitivity) and artificial tears to use for one week. She was asked to return one day after her surgery for a follow-up visit, then one week, one month, three months, six months and one year. Typically, eyes require two to three months for the vision to stabilize.

Karry's results
Although the procedure is relatively painless, Karry says by the time she got home, the numbing drops had worn off and her eye was throbbing - similar to a headache in the eye. That was gone by the time she woke up from a long nap. Two days later, she was seeing halos around lights, but was positively gleeful about the results.

"It's so nice that I can just go outside without my glasses," she said. "The best part is to see those results right away."

Possible side effects
Not every LASIK story is a success. Remember, LASIK is a surgical procedure, which means there are inherent risks. The Food and Drug Administration (FDA) has released the following statistics about LASIK side effects:

  • 3.5 percent of patients see halos. Generally appearing around lights, halos can make night driving difficult.
  • 3 percent experience worse vision.
  • 2.6 percent report "severe visual fluctuations."
  • 1.7 percent suffer light sensitivity and visual glare.

    Duane Rouse, a Twin Cities corporate executive, had worn glasses and contacts for 25 years before he had LASIK in January 2000. He is one of many who have experienced some side effects.

    "I don't have any major problems, but my vision is not 20/20," he explained. "At night, it's harder to see; I see starbursts around lights."

    Despite this, he's glad he had the surgery. "I don't have to wear glasses or contacts anymore, that's the bottom line."

    Frequently asked questions about LASIK
    LASIK is quickly becoming the most popular elective surgery among baby boomers. To some, though, the biggest drawback is the price tag: Costs can range from $649 to $2,000 per eye. (Since it's considered a cosmetic procedure, health insurance doesn't cover LASIK.)

    Despite the cost, more than 750,000 Americans had the procedure last year. For answers to the most frequently asked questions, we sought the expertise of David Hardten, M.D., an ophthalmologist with Minnesota Eye Consultants who specializes in laser refractive surgery.

    Who has LASIK surgery?
    Typically, who are your patients and their reasons for wanting the procedure? The typical patient is someone who wants to decrease their dependence on glasses and contact lenses. The patients vary in age from teen-age years to patients in their 60s. The average age is about 40, but patients of all ages have surgery. Most are active and don't want the hassle of contact lenses or glasses. Most are well-educated about LASIK and have learned from friends who have undergone the procedure.

    What are the reasons a person may not be a good candidate for LASIK? Some patients have unrealistic expectations, and this is often the reason they should not have LASIK. All patients do not end up with perfect vision, and some have residual nearsightedness or farsightedness. All patients over 40 (whether or not they have LASIK) will need bifocals or reading glasses for near tasks if they have good vision, and LASIK cannot make their vision back to what it was like when they were 20 years old. Some patients have problems with their eyes that LASIK cannot fix, such as cataracts or macular degeneration.

    What are some common complications? The most common occurrences are "nuisance" problems. These are things like under- or over-corrections that may occur frequently, even up to 10-15% in some of the higher corrections. These patients may require a second surgery to fine-tune their vision, even though they had much improvement from the first procedure. Dry eyes, glare and halos are extremely common early on after the surgery, almost universal, but improve with time in most patients. More severe things like infections or scarring can occur, but typically don't interfere with vision, although they could.

    Realistically, what should people expect? Most patients can expect to have a great improvement in their uncorrected vision.

    How many procedures have you performed? I have been doing LASIK now for the last seven years, and have done more than 7,500 procedures. The typical surgeon should do about 20 or more procedures per month to stay current with techniques that are performed.

    Finding Dr. Right

  • To find a skillful surgeon and improve the chance of a successful result, do your research.
  • Following are some questions to ask when considering LASIK surgery:
  • How long have you been doing LASIK surgery?
  • How many LASIK surgeries have you
  • performed in the past three years?
  • How many surgeries do you usually perform in a month?
  • What laser machine will you use on me?
  • Do you track and analyze results? What results have you had after six months for someone with my correction?
  • Do you see any other ways I might be able to correct my vision problem?
  • What are the risks and possible complications in my situation?
  • What percentage of your patients experience complications?
  • Who will handle after-surgery care? At what intervals are my follow-up visits? Are extra visits within a year free, if
  • necessary?
  • What are my chances of getting 20/20 vision?
  • Have any of your LASIK patients initiated legal action?

    Read on!
    The August issue of MPLS.ST.PAUL magazine featured a pull-out section on sight and hearing issues. For the fourth year, the Sight & Hearing Association partnered with MPLS.ST.PAUL magazine to produce the section, which featured articles on LASIK, tips on dealing with a hearing loss, and the causes and signs of ear infections in children. Minnesota Eye Consultants provided financial support to sponsor the section. To request a copy of the special section, call our office at 651/645-2546, ext. 16.

  • SHA, MAO screen for glaucoma at Juneteenth
    The Sight & Hearing Association and the Minnesota Academy of Ophthalmology provided glaucoma screening at Juneteenth, the largest annual African-American celebration. Glaucoma, which affects African Americans five times more than Caucasians, is an eye disease that slowly diminishes a person's peripheral vision and can lead to blindness. Overall, 63 percent of participants screened at the event were referred for potential glaucoma or vision problems. SHA thanks the following ophthalmologists who volunteered their time and expertise: Andrew Harrison, M.D.; Eric Nelson, M.D.; Scott Schaefer, M.D.; and Janice Sinclair, M.D.

    Dine or Dash? A noise review of local (Minneapolis/St. Paul) restaurants

    How many times have you been out to eat and found yourself raising your voice to talk over the clatter and chatter? As a new, ongoing column, the Sight & Hearing Association will feature a restaurant review in each issue. However, our reviews will concentrate on whether the restaurant was conversation-friendly (one bell) or noisy (four bells). If you have a restaurant you would like us to check out, please call Julee Sylvester at 651/645-2546, ext. 12.

    Reader Rita Swanson of Edina suggested we check out Ciao Bella in Edina, where, she says, she "can't enjoy even simple conversation."

    Here is what we found.

    Location: Ciao Bella, Edina
    Type of food: Italian
    Time of day: Lunch (11:30 a.m.-1:00 p.m.)

    Atmosphere: Open dining room with arched ceilings

    Average noise level: 82 dB(A)
    Peak noise level: 92 dB(A)

    The main dish: At 11:30 a.m., diners were spread out around the restaurant and conversation was easy to follow. By 12:30 p.m., the restaurant was full and we had to raise our voices slightly.

    Is this restaurant conversation friendly? If you plan on meeting for lunch, get there early to avoid the chatter. Regarding dinnertime, our guess is that the restaurant becomes even louder. Not only is there a trendy bar at one end of the restaurant, but tables are fairly close together.

    Overall rating on a scale of one to four bells (one=quiet; four=noisy): 3 bells

    On the side: The food was delicious. I'd highly recommend the Chop Chop Salad and the Hazelnut Brownie Dessert.

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