A Lighter, Defter Touch
Years of refinement have made laser eye surgery better than ever
About 3 percent of people who have laser eye surgery continue to suffer from complications six months after the procedure. Now, new technology is making laser eye surgery more accurate and safer. Instead of a mechanical knife, more surgeons are starting to use a laser called the IntraLase to cut the flap for LASIK surgery. With the IntraLase, surgeons can much more precisely control the depth and diameter of the flap. "IntraLase is the closest we've come to getting accuracy that matches surface ablation," says Foulkes.
Precise map. In the past, surgeons simply programmed a person's prescription into the laser to tell it how to trim the cornea. Now, more refractive surgeons are using "wavefront" technology for both LASIK and PRK that creates a more precise map of the unique optical landscape of a patient's eyes. With wavefront, the laser can be set to deal with "higher-order aberrations"-there are about 20 of them-that are responsible for things like glaring and starbursts, says Jim Salz, a clinical professor of ophthalmology at the University of Southern California. "We have a better chance of making your vision 20/20," Salz says, "and fewer optical problems."
Laser eye surgery isn't typically covered by insurance, and it's not cheap, especially using the new technology. At Salz's Los Angeles practice, LASIK with wavefront and IntraLase costs $2,800 per eye. PRK is a bit less expensive, at $2,300 per eye without wavefront. Prices may be lower in different parts of the country, and high-volume centers may charge significantly less than $2,000 an eye. But price and whiz-bang technology aren't the only elements to consider in the decision-making process. "No amount of technology can make up for an inferior surgeon," says Glenn Hagele, executive director of the Council for Refractive Surgery Quality Assurance, a consumer information group. On its website (www.usaeyes.org), the council lists eye surgeons it certifies who meet its standards for postoperative visual acuity and patient satisfaction, among other things. In addition, the group's list of "50 tough questions for your LASIK doctor" tells potential patients what to ask any doctor they're considering for LASIK or other refractive eye surgery.
Not everyone is a suitable candidate for laser eye surgery. People with very high corrections may not get satisfactory results, for example. But even with a good surgeon working on an ideal candidate, the results can be subpar. "There's no smoking gun," says David Hartzok, executive director of the Vision Surgery Rehab Network in Rockford, Ill., which offers support and assistance to people who've had complications following eye surgery. "More than half the time, we simply don't know why some patients have problems."
After laser eye surgery, about 90 percent of patients achieve at least 20/40 vision, the legal minimum in many states for driving without glasses, according to the American Academy of Ophthalmology. Up to 10 percent of patients need enhancement surgery to fine-tune the results of the original procedure. But being able to read an eye chart isn't the only measure of a successful surgery, and it's in this area that many patients continue to have problems.
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