Laser eye surgery - pros and cons

laser vision...

For those of us who have to fiddle with contact lenses or grope for glasses first thing every morning, the prospect of 20/20 vision is an unimaginable dream. The little inconveniences of suffering from imperfect sight mount up over time and many people have at some time wondered about the benefits of having surgery to correct their sight. Since the advent of laser surgery, it has been possible to resculpt the eye in order to change how it sees the world.

The original laser eye procedure, PRK (photorefractive keratectomy), involved the complete removal of the cornea's outer layer before sculpting and allowing it to grow back on its own after some days. However, the development of Lasik (laser in situ keratomileusis) surgery now means that in suitable cases ophthalmologists can carefully peel back the cornea surface to operate underneath and then return it to its original place.

Potential side effects

While the procedure remains expensive, and there can be serious complications, for some people the benefit of throwing away their spectacles and lenses is cheap at any price. However, there are risks to the procedure of which even many eye experts are unaware. A small minority of the people who have undergone Lasik surgery have found their vision not improved, but seriously damaged by the surgery.

A patient undergoes a Lasik operation.

Lasik surgery permanently changes the physiology and optics of the eye. When considering any form of non-urgent surgery, patients should always bear in mind the risk-benefit ratio. The benefits are obvious - no more glasses or contact lenses. However, the risk of permanent damage to vision can be greater than even many ophthamologists know.

According to the 'Review of Optometry' journal, up to one in six people who undergo laser surgery end up with complications that affect their eyesight. These include distortions of vision, such as irregular astigmatism, which cannot be corrected by glasses. Other patients simply experience a deterioration in their quality of vision or serious 'dry-eye' syndrome.

Multiple vision is something most of us associate with crossing our eyes, but a small minority of patients have found that one eye can see double and even triple vision as a result of Lasik surgery.

Mr William Power is an eye surgeon at the Blackrock Clinic in County Dublin. He believes that when common sense is applied by patients and correct surgical assessments are made by doctors, surgery with a laser produces immediate and tangible benefits to vision.

"The excimer laser has been used here since 1993, and the Lasik procedure has been available since 1997", he said. "During the past three years Lasik surgery has become particularly popular. We use a microkeratome which makes a superficial flap in the patient's cornea. We then use the laser to reshape the deeper surface before replacing the flap. The laser, contrary to popular belief, does not actually burn the eye, but breaks down some of the molecular bonds".

Different experiences

For those who suffer no side-effects, laser surgery undoubtedly is a positive and life changing experience. Richard Branson, the entrepreneur, is a huge fan of the procedure after Lasik surgery transformed him from being 'blind as a bat' to having 20:15 vision in one day. He has since recommended the surgery to many of his employees.

However, Margaret Dolan is an Irish victim of the procedure. Following her surgery, her eyes developed a particularly cruel condition known as Post-Lasik Dry Eye. She needs to add artificial tears to her eyes a number of times a day and even throughout the night. Patients who suffer from dry eye usually have the symptoms for around two months following surgery. However, for some people like Margaret Dolan the condition does not improve and they need to take artificial tears for the rest of their lives.

Margaret Dolan now represents the pressure group Surgical Eyes, which was originally set up in America by fireman Ron Link. When Ron Link discovered that he was not the only person to have experienced negative consequences as a result of eye surgery, he set up the Surgical Eyes organisation to promote awareness of the potential dangers of Lasik.

The little girl crossing the road is barely visible due to a lack of colour contrast. People who experience this side effect of Lasik are no longer allowed to drive, for obvious reasons.

"We have heard from thousands of people with complications after Lasik", Ron Link told irishhealth.com. "Predominantly, the complaints are about dry eye and loss of night vision. The problem is that remedial technologies do not exist to fix us. Also, many of the bad cases could have been prevented. The screening process is not standardised and people are being needlessly harmed. It's just been a tidal wave of misery - jobs lost, marriages broken, people on antidepressants, attempted suicides, all over an elective procedure, something which is medically unnecessary".

Full assessment

At Blackrock, Mr Power has performed Lasik surgery many times and is careful to ensure that people at risk of developing post-operative complications are excluded from receiving surgery. He emphasises that all patients are carefully assessed to ensure that people for whom the procedure is not suitable do not receive it.

"Every patient who comes to our clinic has an assessment appointment where we check the degree of vision in their eyes", he explained. "At the assessment it is very important also to check the general health of the eyes. If we detect any medical reason, such as a tendency towards dry eye or a predisposition to glaucoma, we will not go ahead with the surgery".

The Lasik procedure is not recommended for anyone who:

•   is under 18

•   is pregnant

•   has a history of eye disease including optic nerve damage, cataracts or problems with the cornea such as corneal thinning

•   has extremely large pupils (bigger than 7mm can cause problems with Lasik)

•   has very thin corneas

•   has very strong prescriptions

On the left, a road at night as seen through normal eyes. On the right, the 'starburst' effect some people experience following Lasik surgery.

Around 70% of patients in Ireland have both eyes treated simultaneously. Most patients can expect to see an improvement in their vision within 24 hours. Patients are advised that between 75% and 85% of their vision improvement will be evident within a day. This means that those who have both eyes done at once can expect to be free from glasses and contact lenses from day one.

Claim tax relief on surgery

Lasik surgery costs around 4,000 Euro for both eyes and is not available under the public health service nor is it covered by the main health insurers in Ireland. The one exception is the Garda Medical Aid Fund. For others, the best way of reducing the cost of Lasik is to declare it against income tax. This can be done by obtaining a receipt from the clinic at which the procedure is performed and submitting this with a Med 1 form to the Revenue Commissioners at the end of the tax year.

Anyone considering undergoing Lasik surgery should discuss it carefully with their family doctor or optician first. They can recommend a reliable clinic and surgeon, and will also be able to advise whether there is any reason why Lasik might provoke a complication in any case.

"After surgery, I suggest that patients use their common sense", advised Mr William Power. "Their eyes have been operated on and need extra protection in the short term. I tell my patients to avoid contact sports for a couple of months at least to allow the eyes to heal properly. You can imagine what might happen if a boxer had Lasik and went back into the ring six weeks later. It is a common sense thing".

Anyone who has experienced a bad reaction to laser eye surgery may wish to contact Surgical Eyes to discover more about their symptoms and how they can be alleviated. Margaret Dolan and Ron Link can be contacted via the organisation's website at http://www.surgicaleyes.org.

The final piece of advice is to consider the full implications of laser eye surgery before you decide whether to proceed or not - look before you leap as they say.


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