Don’t toss your specs just yet

By Lauran Neergaard

Associated Press

WASHINGTON — Considering laser surgery to improve your eyesight? New guidelines should help determine if you’re a good candidate or might be prone to vision-harming side effects.

One key: The guidelines explain what tests are needed before getting zapped, so if your doctor skips these steps, consider picking another surgeon.

"You need to be aware of the complications and the risks," said John Jeter of Reston, Va., who may have narrowly escaped injury. He was scheduled for surgery by one LASIK center but — nervous because workers repeated his eye test six times before OK’ing him — got a second opinion from another doctor who said Jeter’s cornea was too thin to be zapped safely.

Americans will undergo more than a million LASIK procedures this year to correct blurry eyesight. It’s quick and painless: Doctors cut a flap in the cornea, aim a laser underneath it, and with a zap, reshape the cornea for sharper sight.

While the vast majority of patients get better vision, it’s not for everybody — a message often lost in the hoopla of ads promising that people can "throw away your glasses" or offering bargain-basement prices for surgery that usually costs more than $1,000 an eye. And basic LASIK won’t eliminate that middle-age need for reading glasses.

Side effects include double vision, glare, halos or starbursts of light. Occasionally, patients actually lose vision, unable to see as well even with glasses or contact lenses after LASIK as they could before. Others are left with painfully dry eyes, despite eye drops.

The Food and Drug Administration, which approved laser surgery, isn’t tracking problems. Recent studies estimate 1 percent to 5 percent of patients suffer various side effects, although Dr. Roger Steinert of Harvard Medical School, who co-wrote the guidelines, says experienced surgeons can have lower rates.

That’s a small risk, yet with millions undergoing LASIK, it means thousands may suffer some problem.

The FDA has long offered general LASIK warnings, such as to know the risks and consider treating one eye at a time. The American Academy of Ophthalmology recently concluded LASIK is best for moderate, not severe, vision problems.

The new guidelines, to be unveiled today by the American Society of Cataract and Refractive Surgery, offer consumers a different approach — steps to determine if they’re good candidates.

A key is knowing what eye tests to get. Ensure your exam includes a history of vision, including past eye disease or injury, and a discussion of contact lens use. Contacts change the cornea’s shape, and thus cannot be worn for at least three days, and sometimes for several months, before LASIK.

Among the most important tests: Finding out if the cornea is too thin or the pupil is too big. Most patients need half their original cornea thickness — at least 250 microns — remaining after surgery, Steinert explains. Avoiding glare and other vision distortions partly depends on the laser-treated area not overlapping a dilated pupil, so doctors must measure pupils in low light.

Side effects aside, you may need multiple LASIK treatments over months, and not everybody gets perfect vision. You’re not an appropriate candidate for LASIK if you need a new prescription for glasses every year, or have certain medical conditions that affect vision or surgical healing.

Highlights of new guidelines for consumers considering LASIK surgery to correct blurry vision.