Lasik- the REAL Truth

So you’re thinking about having LASIK? You want to get out of your glasses but you want to do your research first before you decide if you should do it and with which doctor. After all we are talking about your vision, your most important sense. You try looking it up on line but you are just inundated with ads and websites all promoting themselves as the place to have it done. We are the best! We have the greatest technology.! We have done the most! And finally, only $299! Well, after 30 years as an Ophthalmologist and also somebody whom has had both LASIK and PRK myself, I am going to give you the facts. No hype, no sell. This is what you need to know before you take the plunge.

1. Is it safe? The answer is a resounding YES with the caveat that the most important part of the whole procedure is the pre-operative exam. If you are not a PERFECT candidate, you should pass. This is not the time to roll the dice. How do you know if you are a perfect candidate or if the doctor is putting his financial gain over your safety? First of all, you should insist that the LASIK SURGEON is the one doing the exam, not one of his employee Optometrists. With this model, often employees are incentivized to convert leads to surgery even if you’re not the best candidate. The surgeon himself sees you the day of surgery only. He doesn’t know if there is a potential problem until one develops after the fact. Then the Optometrist blames the surgeon and the surgeon blames the Optometrist. You are the one stuck in the middle with the problem. Where’s the accountability?
TAKE HOME POINT NUMBER ONE: Make sure the surgeon is the one whom also does your pre and postoperative care.

2. How important is the technology that will be used? This is important up to a point. Where technology definitely matters is what is used to make the flap. You should ONLY have the flap made with a femtosecond laser. There are 3 main companies making femtosecond lasers approved for the US market. They all do a good job. So if one laser center is saying have it here because our laser is the best, that’s just marketing and not reality. NEVER have a flap made with what is called a microkeratome. This is basically a non laser oscillating blade. There is a much higher complication rate with it than a laser flap maker. Why would any surgeom use a microkeratome? Because it’s much cheaper. If you can’t afford all laser LASIK right now, wait until you can. The excimer laser is the laser that actually does the lasik itself, vaporizing corneal tissue to reshape the cornea. Again, there are several companies making good excimer lasers. The brand of laser being used is not a valid reason to pick one center over another. However, you should only use a newer laser. The way to know that is to ask if they use a “wavefront” technology laser. , Finally, to avoid a catastrophic postoperative complication called ectasia (a bulging of the cornea due to a thin area), you need to have as part of the preop testing, BOTH anterior (front surface) and posterior (back surface) topography done to map the shape of the cornea and look for any potential thin areas. TAKE HOME POINT NUMBER TWO- Be sure the flap is made with a laser, they are using wavefront excimer laser treatments and both anterior and posterior topography is done before surgery.

3. Does price matter? Of course it does. These lasers are very expensive pieces of equipment. In addition, every time the laser is used there is something called a “click” fee which is an amount the laser center pays the manufacturer. So, how can a center offer $299 lasik? Well, the first thing to watch out for is the old familiar “bait and switch”. For that price there will be the fine print which will say something along the lines of this price only applies to low level (say under -1.00) nearsighted eyes with no astigmatism. The percentage of patients who fit into that category is probably about 5%. But those prices get people in the door. Don’t be surprised though if after doing your exam they tell you unfortunately you don’t meet the criteria for the $299 LASIK so your cost will be higher. Like any technology, older is cheaper. Since the laser prices and the click fees are the same for everyone, discount lasik may mean the flap is made with a blade instead of a laser or an older technology, non wavefront excimer laser is used that may result in issues like night time halos. Also, some people may need a touch up enhancement laser procedure . Most reputable lasik centers will do that for free for the first year. You need to find out beforehand if there is a charge for it at the center you are considering using. Also, find out what the criteria for a free enhancement is. If they say 20/40 or worse, you need to understand that 20/30 which would not qualify will be significantly worse than what you now see with your glasses and most likely you won’t be satisfied. Find out what it will it cost you for an enhancement if you end up at 20/30? Also, you can sometimes purchase an extended warranty on your LASIK. Sounds like a good idea but it is not worth the money. Most touchups are done the first year when they are free. Also, for the warranty to be good you have to pay for a yearly exam with them or me of their affiliates. If you miss a year, the warranty is voided.
TAKE HOME POINT NUMBER THREE-Realize that if you go the discount route, you will most likely be talked into paying a higher price than you originally anticipated or you will be treated with older technology which has a higher incidence of complications and suboptimal vision results.

4) How long will my LASIK last? If you are nearsighted, for the most part, your good distance vision without glasses should last many years until you develop cataracts in your old age. Small changes may develop as we are dealing with living tissue not machines and you may find yourself for instance needing weak glasses to drive at night years later. Farsighted eyes are less stable and you may start to see some decline in your distance vision requiring glasses starting in your fifties or sixties. Near vision is a different story. In your forties you will start to need reading glasses whether or not you had LASIK. If you already are using reading glasses when you start to think about LASIK or you are near your early forties , you must be aware that LASIK can either correct your distance vision or your near vision but not both. One solution is what is called monovision whereby one eye is set for distance and the other one for near. In fact, this is how I had my own LASIK done. Most but not everyone likes monovision. You most definitely do not want to find this out after you have already had the procedure. The good news is you can take monovision for a test drive before you make a decision using contact lenses to see if you like it. Unfortunately trying it in glasses does not work well for reasons beyond the scope of this discussion. Many of my patients told me there was no way they would be able to handle monovision but were pleasantly surprised they found they liked it when I had them try it in contacts. However, doing a monovision contact lens trial before LASIK requires a lot of doctor exam time and the patient may then decide they don’t want LASIK after all. Many laser centers don’t want to bother with this for that reason which really is doing you a disservice.. TAKE HOME POINT NUMBER FOUR- if you are nearing 40 or over that, , make sure the doctor is willing to do a monovision contact lens trial beforehand.

5) Is it important how many lasik cases the doctor has done? Yes, to a point. Obviously experience is very important. I would not have your procedure done with a doctor whom has only done 50 cases. But if the doctor has done 1000 case or 50,000 cases makes no difference. From a technical standpoint, lasik is not a difficult procedure. Cataract surgery is many times more complicated. Unfortunately for the lay person, there is no way to know if your surgeon is good or not. Even asking a friend is not always reliable. She may have had a good result but she won’t know that 10 other people didn’t with that same doctor. About the best advice I can give is make sure he has done at least 500 cases and has been doing LASIK at least 5 years. If he was not a good lasik surgeon, hopefully after that amount of time and cases he would have decided on his own to no longer do it. TAKE HOME POINT NUMBER FIVE-experience is important but don’t just pick a surgeon because he says he has done more cases than anyone else.

6. My surgeon is recommending PRK instead of LASIK. Should I be concerned? It depends upon the reason he is recommending it. First of all, understand the difference. With LASIK a thin flap is made, retracted and the laser used to reshape the cornea. Then the flap is replaced. With PRK, no flap is used and the treatment is done right to the surface. The results are exactly the same and neither is better than the other. The advantage of the flap is that there is little to no pain afterwards and you will see eye well within a few days. With PRK there is some pain for the first few days and it can take 3 or 4 weeks for you to see well. In some cases, PRK must be done for safety reasons. You have a thin cornea and doing LASIK puts you at risk for ectasia, a localized bulging or the cornea that will cause poor vision and is very difficult to treat. You should be a little skeptical however, if your doctor recommends PRK on everyone. This could be because the overhead is lower with PRK than LASIK so it is more profitable. Also, LASIK is a bit more difficult to perform than PRK and so he may be concerned about his complication rate with LASIK and therefore prefers not to do it. This may be a sign that he is not the most skilled surgeon. TAKE HOME POINT NUMBER SIX-if PRK is recommended, make sure you understand the reason why.

So there it is. What I’ve learned from 20 years of being a LASIK surgeon and also a patient. This is the advice I would give my sister or best friend. Hopefully it will make you more confident that you now have the proper information to decide if you should go ahead with lasik and how to choose your doctor. I hope I have not been too negative or cynical here. As I have said, I have had lasik myself and couldn’t be happier. One of the best things I have ever done for myself and I strongly recommend it. The reason for my cynicism is unfortunately what I have seen this fabulous procedure turned into. Too many non doctors saw LASIK as a cash cow and got involved for one reason only and that was to make money. In their quest for profit, , they have turned the public’s perception of what is a delicate, precise surgical procedure into a commodity like toilet paper. “Everyone can have it done and will have great results” is the thinking. “Just get it done where it’s the cheapest because it’s the same everywhere”. (Seriously, would you pick your heart surgeon because this week only he is having a $500 off sale?) But please be assured, there are many extremely skilled, ethical LAIK surgeons out there whom I would not hesitate to go to. Unfortunately most of them you don’t know about because they cannot afford or choose not to spend hundreds of thousands of dollars per year on marketing . If I can be of any help to you in answering your LASIK questions, please do not hesitate to email me at

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