March 22, 2001
The hype about refractive eye surgery took on a life of its own a few years back. Everyone knew someone who was thinking about it and now quite a few of us have done it. Peta Newbold investigates.
You'll be free, more attractive. Throw away your glasses and contact lenses, at last!
In Australia, between 20 and 25-thousand of us have used the latest laser technique, LASIK.
It was 40 year old Lance Chin Quan's choice when he decided to have the operation nine months ago. He lives in Darwin in Australia's tropical north and his glasses used to drive him nuts.
Whenever he stepped outside during the wet season, they would steam up, or rain would fog his vision. Contact Lenses didn't suit him either.
LASIK stands for Laser-In-Situ Keratomileusis and its power is awesome. Each pulse of the laser can remove 39-millionths of an inch of tissue in 12-billionths of a second.
The idea is to reshape the cornea at the front of your eye so that the light rays which are refracted by the cornea and the lens can focus more precisely on the retina.
The more precise the focus the more clearly you'll see. To do this the surgeon has to first create a corneal flap using a kind of surgical carpenter's plane.
The flap is approximately 1⁄4 of the cornea's depth and it is lifted to reveal the area that will be reshaped. On average the laser is on each eye for less than a minute and when it's finished, the flap is put back into place and over the next few days, it will heal and bond more securely.
It's all over in about five minutes and those who have done it say it's uncomfortable but not painful.
If you are mildly short sighted, you can opt for corneal rings, sometimes known as Intacs. That's where two plastic crescents are implanted in the cornea, which is then flattened by the weight of them.
That has the effect of achieving the correction and the beauty of it is that although it's considered to be permanent, the rings can be removed and your vision will almost certainly return to its pre-surgery condition.
The other refractive procedure worth mentioning is PRK or photorefractive keratectomy. It used to be the most common laser correction procedure until LASIK nudged it off the podium.
And rightfully so. These days LASIK can correct more severe visual problems with less recovery time and with decreased risks of infection, haze and scarring.
Even better news is there's an exciting new LASIK technique coming on the market that looks as if it could be even more successful.
It's known as wavefront ablation and the manufacturers claim it will be able to customise the laser treatment to the individual. Although it is still in its infancy, it can potentially offer better vision than current treatments, perhaps even better than glasses or contact lenses.
But as with any surgery there are risks and you might be surprised to learn that the popularity of LASIK has spread much faster than any long-term studies would justify.
There are still many unknowns.
No going back
What is known though, is that laser eye surgery permanently changes the eyes focusing power.
That means there's no going back. But to put it into perspective complications are rare and most are not related to visual correction.
They are more to do with the surgery, in particular the corneal flap. It can be incorrectly made, or in exceptional cases it can be shaved off altogether. Sometimes it can become infected.
Laser Eye Surgeon Dr Dan Black says that's why the experience of your surgeon is of paramount importance.
What to ask
He advises potential patients to meet their surgeon before the procedure and ask some pertinent questions:
How many procedures have you done and how many have resulted in serious complications?
"Beware of someone who claims a 100 per cent success rate," says Dr Black, "it may mean they have done very few operations. A complication rate of 1 to 2 percent is acceptable".
What's my chance, in your hands, of being worse off after the operation?
Dr Black says "As a surgeon working to correct someone's sight, there are so many nuances. Visual problems vary dramatically between individuals and you have to weigh them up against your own experience and how good your equipment is. It's a fine balancing act".
More specific questions might be:
Is my cornea thick enough to safely do the operation? If my vision hasn't been adjusted correctly is it possible to have a retreatment?
"Even though the surgeon will be selling you the operation, you have a right to professional and unbiased information, " says Dr Black. "If you don't feel comfortable with any of the answers, find someone else".
In Darwin, Lance Chin Quan was in a better position than most to weigh up the odds of post-operative problems as a result of his LASIK surgery.
He's an optometrist. Infection of the corneal flap was his major worry, plus the possibility that his 3 month-old daughter Isabel might push her fingers into his eyes.
They healed perfectly.
His advice for patients considering LASIK surgery: Don't go for the cheapest option. Buy a package that has follow up examinations included in the price.
He says "Some of my patients have had complications, but they are all fine because their problems were managed effectively and early enough".
Like most patients Lance was also warned that the procedure wouldn't give him vision that was as good as he had with his glasses.
As it turned out, it wasn't as good. It was better.
"I was very lucky", he said. "The results are fantastic, and the best thing is, I can get up at night to check on my baby daughter, and I don't have to grope for my glasses".
Reprinted with permission from Editforce