The thought of LASIK (laser-assisted in situ keratomileusis) eye surgery can be frightening for people accustomed to wearing glasses or contacts. Patients are awake during the corrective eye surgery, and most are unfamiliar with how the latest technology is being used.
A common fear for newcomers is that the pain-numbing eye drops administered during the procedure won't work, according to Lasik.com, the website supported by industry leader TLC Laser Eye Centers. According to a help page for new patients, newcomers also frequently worry that the surgery is too expensive, and that there will be complications resulting in permanent or long-term damage.
Dennis Ngo, the operational manager of The LASIK Vision Institute in New Orleans, says most of the center's clients are nervous at first. While LASIK surgery isn't for everyone, optimal candidates for the procedure see a very high success rate.
"You do have that fear factor of the unknown," Ngo says. "We definitely counsel and coach patients throughout the whole process."
Ngo says the laser eye surgery industry has become much safer and more effective than when it was first introduced 25 years ago.
After undergoing the procedure, Ngo says, most patients laugh at how worried they were in the beginning.
"They say, 'That wasn't bad at all,'" Ngo says. "That's how it has been for most of our patients. They say they were scared for no reason."
LASIK surgery reshapes the eye's surface to alter the way light rays enter the eye. By reshaping the curvature of the cornea, vision problems such as nearsightedness can be corrected.
Previously, doctors cut into the eye using fine scalpels — a process that was generally considered effective but had risks. Now, some doctors use a laser to cut out an ultra-thin flap of the thin outer covering of the eye, so they can reshape the eye underneath and improve patients' vision.
A very basic form of the process, called radial keratotomy, became popular in the U.S. in the 1980s. The surgery involved cutting spoke-like incisions to flatten the eye's surface. While the process corrected near-sightedness, it also sometimes caused long-term problems, including glare, reflective vision and night vision problems, according to the website allaboutvision.com
In the mid-1990s, a process called photorefractive keratectomy received approval from the U.S. Food and Drug Administration. Known as PRK, it was the first successful laser procedure used to correct eyesight by removing tissue directly from the eye's surface.
LASIK debuted after that. The most popular of the surgeries, according to Ngo, it involves using a laser to cut a very thin flap in the outer covering of the eye in order to reshape it underneath the cornea.
Now, another form of the procedure, called custom LASIK or Wavefront LASIK, takes the technology one step further. The new surgery uses a tool that measures something known as wavefront, which can detect just how much light travels into the eye and then adjust automatically for vision problems.
"One of the best ways out there at the moment is custom LASIK," Ngo says. "It has the potential to correct patients up to 25 times better than glasses or contacts."
Recovery time is also drastically shorter than it used to be. One reason LASIK is so popular is because the eyes heal so quickly. Patients can expect full recovery in less than 24 hours, and often only experience about six to eight hours of discomfort after the procedure, according to Dr. Pulin Shah, medical director at The Laser Vision Center at Ochsner Baptist.
Problems afterwards are rare. The risk for serious complications (dry eyes, loss of vision, infection) is as low as one in every 10,000 patients, Shah says.
One reason that the rate of post-surgery problems is so low is that only some patients are viable candidates for the procedure, Shah adds. The best candidates are usually young, nearsighted people between the ages of 21 and 45.
Older patients generally don't get LASIK because by the time people reach their 40s, their ability see clearly for reading deteriorates — which means they'll end up in glasses anyway, Shah says.
A prescription has to do with the laser algorithm, Shah says. In short, that means that treatment could regress a little with those who have farsightedness.
"It's still effective, it's just not quite as predictable," Shah says.
Doctors also check the health of the eyes, the anatomy and structure of the cornea, and look for other excluding health conditions. Pregnant women, for example, aren't recommended for the surgery. Some patients who don't qualify for LASIK could be good candidates for other kinds of corrective surgery, Shah says. These procedures include cataract surgery, which can improve sight, and implantable contact lenses, or small, permanent lenses that are surgically attached to the eye.
Shah says LASIK's popularity is on an upswing again, after having taken a dip recently. He attributes the latest ebb of surgeries to the 2008 stock market crash. The surgeries can cost anywhere from $1,500 to $2,000 per eye, depending on the person's prescription.
Because it is considered cosmetic, most insurance companies won't cover LASIK surgery. While some exceptions exist (people who are getting the procedure done in a military facility or for job-related reasons), some customers find the prices a little steep, he adds.
Shah says third-party financiers can offer relief in the form of interest-free payments for up to a year and a half. People whose employers offer flexible spending plans can pay for the procedure with pre-tax income. Patients should think of the surgery as a long-term investment, he says.
"If you're 20-something, add up the contact lenses every month for the next 20 years or so," Shah says. "That's a huge expense. The surgery is actually a big saving over the long haul."
Even with fluctuating economies, Shah doesn't see the popularity of LASIK surgery taking a permanent downturn anytime soon.
"Patients are happy with it in general," Shah says. "The No. 1 thing people say afterwards is, 'Man, I wish I would have done this years ago.'"