Tom Morrow's

LASIK Info

LASIK is a surgical operation to reduce or eliminate the need for glasses or contact lenses among people who have nearsightedness and/or astigmatism. It is nicknamed "flap and zap", because first the surgeon cuts a flap parallel to the surface of the cornea using a device called a microkeratome, then lifts it up and removes corneal tissue using a laser, and finally lays the flap down.

I have researched LASIK for a few years, and finally underwent the procedure on Jan 2, 1998. I chose it over PRK, another laser eye surgery procedure, because relative to PRK it gives better quality of vision: less night glare and haze. It also preserves the outer layers of the eye, which PRK does not, and has a quicker healing period. The main downsides of LASIK versus PRK are that it has a higher risk of inducing astigmatism, and it is more dependant on the surgeon's skill than PRK.

I have kept a journal of my LASIK experience.

If you are considering LASIK, consider the following things:

It is not a perfect procedure, and it is important that you understand the risks. I won't go into all the risks here, but will outline some of the major ones:

LASIK can reduce your BCVA (Best Corrected Visual Acuity, how well you see with glasses). In practice, some patients lose BCVA, some gain BCVA, and most stay about the same.

After the first LASIK procedure, it may be necessary to have a second operation (called an enhancement) if the first one leaves some residual nearsightedness and/or astigmatism.

After enhancements, approximately 50% of eyes treated see 20/20 after the operation, and about 95% are 20/40 or better, which is the worst that you can legally drive with. Those numbers are averages for good surgeons.

There are two risks that especially concerned me as I considered LASIK:

Night Glare: LASIK patients sometimes report that their vision at night is worse at night than during the day, and that streetlights and oncoming car headlights spread out into a wide fog rather than being seen as point sources. There are many different things that can cause this:
- residual astigmatism or nearsightedness
- a haze over the cornea from the healing process of the eye
- the edges of the flap may reflect light in an uneven way
- the pupil may open up wider at night than the corrected area of the eye (6mm with the lasers approved in the US, or up to 8.5mm with lasers used outside the US)

Most people find that their night glare clears up after 6 months, but for some small percentage (about 1-2% with LASIK, 5-10% for PRK), the glare does not disappear.

You should have your pupils measured, or measure them yourself, under a variety of dim lighting conditions. The best way to measure them is to have a bunch of solid black circles of various sizes, from 4mm to 10mm, and compare the sizes of your pupils with those reference circles. If they open wider than about 7mm, then you might be at increased risk for night glare with LASIK due to the pupil opening past the ablation (assuming the standard US 6mm ablation). Make absolutely sure that you discuss this with your surgeon.

Induced regular or irregular astigmatism: astigmatism means that the eye is not spherical in the area over the pupil. Regular astigmatism is astigmatism that has a "football" shape, and is correctible by placing glasses in the shape of shallow cylindrical sections over the eyes. Irregular astigmatism is irregularly shaped, and is not correctible with glasses or any other means. While LASIK attempts to correct whatever regular astigmatism was there before the operation, it can also induce astigmatism. The induced astigmatism occurs because of the flap. If the flap isn't perfectly shaped, or if it is laid down unevenly, that causes the surface of the eye to be uneven, which is astigmatism. The only way to minimize this risk is to choose an experienced surgeon; beginner surgeons who have only done a few eyes are more likely to make mistakes with the microkeratome. Estimates of the necessary learning curve for surgeons are in the neighborhood of 100 to 500 eyes; make sure that you surgeon has done at least this number of LASIK procedures.

Surgeons

I choose a local doctor, Dr. Gary Kawesch of The Laser Center of Silicon Valley, because he seemed competent and experienced. I got some hard data from him with his quantitative results, and it looked good. I didn't want to have to travel for followup care if complications arose. That turned out to be a good decision, as I ended up needing to see the doctor every day for four days after the procedure because of a complication with the flap. Dr. Kawesch uses the VisX Star laser and has international software to allow him to correct outside the ranges currently approved in the US. As of this writing, he has done 1500 LASIKs, 700 ALKs, and thousands of PRKs and thousands of RKs.

If I were going to travel for the procedure, I would probably go to Canada and have it done by Dr. Machat at TLC (The Laser Center) in Windsor/Ontario. He has done many thousands of LASIKs, and has published many high-quality papers and books on refractive surgery. He is the one name that consistently comes up when people talk about the world's best LASIK surgeons.

Perhaps the most famous LASIK surgeon, however, is Dr. Luis Ruiz, in Colombia. If you can make the trip down to Colombia and speak Spanish, that might be a good place to go.

The most important thing to remember when choosing a surgeon is that you cannot base your decisions on the results of a handful of "testimonial" patients who got good results. I liken LASIK surgery to bowling. Anyone can score a strike every once in a while, but only the best bowlers can do it consistently. And even the best can't do it all the time. So in choosing a LASIK surgeon, make sure you get results that cover a large contigous number of his patients. I could show you videotapes of the times I have bowled strikes but you wouldn't believe I was a pro bowler unless you saw me bowl a whole game. Demand the same of your surgeon. And be wary of surgeons who promise perfection. The best surgeons are the ones that give their patients a balanced picture of the risks that can occur beforehand.

Other Web pages of interest:

Eyeknowwhy is a person who has made a mission out of exposing the risks and downsides to refractive surgery. I find this site rather one-sided in its portrayal of refractive surgeons as the scum of the earth. It also mostly covers PRK, so realize that most of the information on there applies more to PRK than LASIK. But having made those disclaimers, I must state that emphatically that: If you are planning on having refractive surgery, you owe it to yourself to read and understand the risks mentioned on the Eyeknowwhy site.

Chris Behanna is another LASIK recipient who has a good web page on his LASIK experience.

This page was last updated Jan 2, 1998