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Making The LASIK Surgery Decision

July, 2010

Series 2

Thomas S. Michelson, M.D.

The benefits of laser vision correction, specifically the newest LASIK technique, are being well advertised. In many cases, LASIK seems like the miracle cure for those with anything less than 20/20 vision. Unfortunately, this is not the case. Just as LASIK surgery cannot be safely performed by just anyone in the eye care profession, LASIK surgery is not automatically the right choice for every patient.

Is LASIK Right For Me? 

As you might expect, the success of LASIK depends on whether or not your eyesight falls within the range of likely success factors. LASIK may be the answer for you if your vision is stable and you have nearsightedness or farsightedness with or without astigmatism, and no other eye problems.

You are not a good candidate for LASIK if you have an eye disease, are pregnant or under age 18 (because the eye is still growing), have an autoimmune disease or a history of ocular herpes.

In order to determine your suitability for LASIK, you will need to undergo an evaluation with a licensed and trained LASIK doctor. During the physical evaluation you can expect to have your eyes dilated and your refraction (the way light focuses in your eye) measured. The doctor will also examine your cornea, take computerized measurements of its shape and measure its thickness. All these measurements are used to evaluate your specific vision functions against known LASIK risk factors.

If you are a successful candidate, your doctor may recommend LASIK surgery for both eyes. However, sometimes it is better to have LASIK done on only one eye. These are the types of questions best discussed with your doctor.

Who Can I Trust? 

Anyone considering LASIK needs to be cautious about whom they entrust with their eyes because LASIK evaluations are all too often made by eye care professionals other than ophthalmologists. Many of these people have not been trained and certified in LASIK, nor do they have the expertise to safely evaluate a patient's risk factors. It is always preferable to have the surgeon who will be performing the procedure determine whether or not LASIK is right for you.

Qualified doctors will only use competent surgical facilities. One thing to note is that the FDA has only approved certain excimer lasers, the surgical tools used for LASIK. Each machine costs a half-million dollars and the manufacturers charge per-surgery royalty fees. This is important to know because some doctors, in order to avoid these expenses, have imported lasers from Europe or have bought devices from other manufacturers. While some of these may be FDA approved for experimental use, others are illegal to use for vision correction.

Questions To Ask 

Just as the surgeon will be interviewing you to determine your suitability for LASIK, you need to interview the surgeon to determine his or her qualifications. Here are some questions you should ask your doctor:

  • Is the surgeon certified by the American Board of Ophthalmology?
  • Has the doctor completed a residency program at an academic medical center?
  • Has the doctor had training from the excimer laser manufacturer?
  • How long has the doctor been performing this procedure?
  • How many procedures have been completed?
  • Which FDA-approved laser will be used?
  • How does this doctor define surgical success?
  • How many patients have returned for follow-up corrective surgery?
  • Will this doctor personally be performing your surgery?
  • What post-operative care does this doctor offer?
  • What side effects might be expected?

Despite what some high traffic LASIK practices would like you to think, not everyone can benefit from LASIK vision correction. And some of the two million LASIK procedures performed this year will be more successful than others. But if you and your doctor each do a thorough evaluation up front, the likelihood of your own success dramatically increases. Our next column will take you through the actual patient experience of a LASIK procedure.

About the Author

Thomas S. Michelson is a LASIK surgeon with the Wheaton Eye Clinic and Medical Director for the Corneal Refractive Surgical Service at The Center for Surgery in Naperville, IL. Learn more ...