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Jan/Feb 2000 Remedy
20/20 In 15 Minutes
A reality check on this amazing eye surgery-is it time? Or still too soon?
by Gayle Turim
 Anne Sumers of Ridgewood, New Jersey, speaks enthusiastically about the tools of her trade. "The flapmaking machines" are much better than just two or three years ago," she notes with pride. Is she referring to an innovation in tents or pancakes? No. Sumers is an ophthalmologist and a "flapmaker" is among the precision instruments she and other eye doctors use to perform LASIK, the laser-assisted vision-correction surgery being advertised seemingly everywhere lately, promising farewells to glasses and contact lenses. To hear some satisfied customers describe it, the procedure is nothing short of a miracle.
"In fact, one of my patients did compare it to going to Lourdes and throwing away his crutches," says Mark Speaker, MD, PhD, associate clinical professor of ophthalmology at New York Medical College and also medical director of TLC Laser Eye Center, NYC. Done under local anesthesia, LASIK takes only about 15 minutes and most people feel fine the next morning or even sooner.
But while complications of "flap and zap" surgery are rare, they do exist and you're not likely to hear about them on upbeat radio commercials or animated Web sites. "the procedure is definitely not for everyone," says Michele Miano, MD, an assistant surgeon at Wills Eye Hospital, Philadelphia-even though it is on its way to becoming the most popular surgery in the world.
Clamoring for Clarity
Without question, LASIK-short for laser in-situ keratomileusis-is hot. About 6,000 American surgeons are trained to do it now, up from a few hundred two years ago. Millions of people worldwide-including about 441,000 in the US last year-have undergone the outpatient treatment. Part of the growth is due to a recent improvement: Both eyes are often done at once now, vs. the weeks-apart schedule common in the past.
As the name suggests LASIK uses a laser (specifically, an ultraviolet excimer laser) to reshape the cornea, the clear covering of the eye that's crucial for focusing. Depending on their location, shape irregularities inside the cornea result in nearsightedness, farsightedness or astigmatism. The doctor reaches the affected area by making a "flap" in the outer cornea. The flap is lifted up, the laser zaps the shape problem, the flap is folded back down-and that's it.
The results, says Sumers, "are more predictable than theywere a couple of years back or even a few months ago." One reason for this is the use of microkeratomes-tiny blades-to create a clean flap. They make LASIK quite different from the slightly older laser-asisted procedure known as PRK, for photorefractive keratectomy. In PRK, the inner cornea is reached by scraping through the outer layer. Not surprisingly, the older technique is more likely to cause pain, weeks of uneven vision and other pitfalls.
Opthamologists who perform LASIK take pride in supplying sublime no-glasses-needed vision to grateful patients. But the monetary rewards aren't bad either-especially in this era of fee-squeezing managed-care plans. "For most people this is a cosmetic procedure on par with liposuction," maintains Dr. Sumers. "As such, insurance doesn't get involved. Patients pay for it themselves." The typical charge is about $2,750 per eye, and some doctors offer financing to make this procedure easier to afford.
Beyond Vanity
Many ophthalmologists, however, do not consider LASIK purely cosmetic. "It's often a quality-of-life issue," Dr. Speaker argues. "For instance, people worry that if they couldn't find their glasses, they wouldn't be able to locate their kids or grandchildren if the house caught fire in the middle of the night." Eye surgery can eliminate such concerns.
Even in the absence of such high-drama situations, comfort and convenience can't be discounted. If glasses have driven you to distraction for 20 to 30 years-needing them just to read a bedside clock, feeling them constantly on your nose, annoying you when you play sports-then LASIK's promise to make you much less dependent on them can have huge appeal. What's more, after 50 , dry eyes can make wearing contacts hard, notes Jodi Abramson, MD, director of keratofractive surgery, Montefiore Medical Center, NYC, and medical director, TLC laser Eye Center in White Plains, NY.
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