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What are the risks and how can I find the right doctor for me?
Most patients are very pleased with the results of their refractive
surgery. However, like any other medical procedure, there are risks
involved. That's why it is important for you to understand the limitations
and possible complications of refractive surgery.
Before undergoing a refractive procedure, you should carefully weigh
the risks and benefits based on your own personal value system, and try to
avoid being influenced by friends that have had the procedure or doctors
encouraging you to do so.
- Some patients lose vision. Some patients lose lines of vision
on the vision chart that cannot be corrected with glasses, contact
lenses, or surgery as a result of treatment.
- Some patients develop debilitating visual symptoms. Some
patients develop glare, halos, and/or double vision that can seriously
affect nighttime vision. Even with good vision on the vision chart,
some patients do not see as well in situations of low contrast, such
as at night or in fog, after treatment as compared to before treatment.
- You may be under treated or over treated. Only a certain
percent of patients achieve 20/20 vision without glasses or contacts.
You may require additional treatment, but additional treatment may not
be possible. You may still need glasses or contact lenses after
surgery. This may be true even if you only required a very weak
prescription before surgery. If you used reading glasses before
surgery, you may still need reading glasses after surgery.
- Some patients may develop severe dry eye syndrome. As a
result of surgery, your eye may not be able to produce enough tears to
keep the eye moist and comfortable. Dry eye not only causes
discomfort, but can reduce visual quality due to intermittent blurring
and other visual symptoms. This condition may be permanent. Intensive
drop therapy and use of plugs or other procedures may be required.
- Results are generally not as good in patients with very large
refractive errors of any type. You should discuss your
expectations with your doctor and realize that you may still require
glasses or contacts after the surgery.
- For some farsighted patients, results may diminish with age.
If you are farsighted, the level of improved vision you experience
after surgery may decrease with age. This can occur if your manifest
refraction (a vision exam with lenses before dilating drops) is very
different from your cycloplegic refraction (a vision exam with lenses
after dilating drops).
- Long-term data are not available. LASIK is a relatively new
technology. The first laser was approved for LASIK eye surgery in
1998. Therefore, the long-term safety and effectiveness of LASIK
surgery is not known.
Additional Risks if you are Considering the Following:
Monovision is one clinical technique used to deal with the correction
of presbyopia, the gradual loss of the ability of the eye to change focus
for close-up tasks that progresses with age. The intent of monovision is
for the presbyopic patient to use one eye for distance viewing and one eye
for near viewing. This practice was first applied to fit contact lens
wearers and more recently to LASIK and other refractive surgeries. With
contact lenses, a presbyopic patient has one eye fit with a contact lens
to correct distance vision, and the other eye fit with a contact lens to
correct near vision. In the same way, with LASIK, a presbyopic patient has
one eye operated on to correct the distance vision, and the other operated
on to correct the near vision. In other words, the goal of the surgery is
for one eye to have vision worse than 20/20, the commonly referred
to goal for LASIK surgical correction of distance vision. Since one eye is
corrected for distance viewing and the other eye is corrected for near
viewing, the two eyes no longer work together. This results in poorer
quality vision and a decrease in depth perception. These effects of
monovision are most noticeable in low lighting conditions and when
performing tasks requiring very sharp vision. Therefore, you may need to
wear glasses or contact lenses to fully correct both eyes for distance or
near when performing visually demanding tasks, such as driving at night,
operating dangerous equipment, or performing occupational tasks requiring
very sharp close vision (e.g., reading small print for long periods of
time).
Many patients cannot get used to having one eye blurred at all times.
Therefore, if you are considering monovision with LASIK, make sure you go
through a trial period with contact lenses to see if you can tolerate
monovision, before having the surgery performed on your eyes. Find out if
you pass your state's driver's license requirements with monovision.
In addition, you should consider how much your presbyopia is expected
to increase in the future. Ask your doctor when you should expect the
results of your monovision surgery to no longer be enough for you to see
near-by objects clearly without the aid of glasses or contacts, or when a
second surgery might be required to further correct your near vision.
- Bilateral Simultaneous Treatment
You may choose to have LASIK surgery on both eyes at the same time or
to have surgery on one eye at a time. Although the convenience of having
surgery on both eyes on the same day is attractive, this practice is
riskier than having two separate surgeries.
If you decide to have one eye done at a time, you and your doctor will
decide how long to wait before having surgery on the other eye. If both
eyes are treated at the same time or before one eye has a chance to fully
heal, you and your doctor do not have the advantage of being able to see
how the first eye responds to surgery before the second eye is treated.
Another disadvantage to having surgery on both eyes at the same time is
that the vision in both eyes may be blurred after surgery until the
initial healing process is over, rather than being able to rely on clear
vision in at least one eye at all times.
Finding the Right Doctor
If you are considering refractive surgery, make sure you:
- Compare. The levels of risk and benefit vary slightly not
only from procedure to procedure, but from device to device depending
on the manufacturer, and from surgeon to surgeon depending on their
level of experience with a particular procedure.
- Don't base your decision simply on cost and don't settle for
the first eye center, doctor, or procedure you investigate. Remember
that the decisions you make about your eyes and refractive surgery
will affect you for the rest of your life.
- Be wary of eye centers that advertise, "20/20 vision or your
money back" or "package deals." There are never any
guarantees in medicine.
- Read. It is important for you to read the patient handbook
provided to your doctor by the manufacturer of the device used to
perform the refractive procedure. Your doctor should provide you with
this handbook and be willing to discuss his/her outcomes (successes as
well as complications) compared to the results of studies outlined in
the handbook.
Even the best screened patients under the care of most skilled surgeons
can experience serious complications.
- During surgery. Malfunction of a device or other error, such
as cutting a flap of cornea through and through instead of making a
hinge during LASIK surgery, may lead to discontinuation of the
procedure or irreversible damage to the eye.
- After surgery. Some complications, such as migration of the
flap, inflammation or infection, may require another procedure and/or
intensive treatment with drops. Even with aggressive therapy, such
complications may lead to temporary loss of vision or even
irreversible blindness.
Under the care of an experienced doctor, carefully screened candidates
with reasonable expectations and a clear understanding of the risks and
alternatives are likely to be happy with the results of their refractive
procedure.
Advertising
Be cautious about "slick" advertising and/or deals that sound
"too good to be true." Remember, they usually are. There is a
lot of competition resulting in a great deal of advertising and bidding
for your business. Do your homework.
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