Archive for June, 2009

LASIK: Corrective or Cosmetic?

Friday, June 26th, 2009

Not a week goes by that a patient doesn’t ask me if LASIK vision correction is covered by their medical insurance. Medical plans that pay for refractive surgery are the exception to the rule and there are several plans such as Blue Cross & Blue Shield and VSP that offer significant savings to their participants but all too often, patients bear the entire cost of the procedure. That is because the insurance industry has taken the stance that LASIK is cosmetic. The truth, however, is that while many patients may look better out of their glasses, the real benefit is that they function better.

Refractive Errors are a Defect

It is an enigma to me how our myopic ancestors functioned or even survived before the correction of refractive errors were possible. Nearsighted individuals clearly were at a competitive disadvantage.  I would not want to be a poorly seeing mid-evil warrior!

Marco Polo brought the concept of eyeglasses back to Europe from the Orient. But eyeglasses and contact lenses are prosthetic devices just as are hearing aids and ankle braces. For many years, man has strived to permanently correct their vision with drugs, eye exercises or surgery. As it turns out, surgery has proven to be the only, permanently successful solution. Over the past 50 years strives have been made to make vision correction more precise and safer. The fact that a much higher percentage of ophthalmologists have had LASIK than the general population is testament to the perceived success of these goals.

Drew Carey had LASIK

Scores of professional athletes including football players, baseball players and members of the National Basketball Association have had LASIK. Over 80 professional golfers have had LASIK; Tiger Woods being the most well known. Many athletes feel that being free of glasses or contact lenses improves their game and are not having the procedure performed to improve their appearance.  The U.S. Military has seen the advantage of laser vision correction and now provides it for many of their enlisted personnel. Likewise, many active patients find glasses or contact lenses impractical for many activities of daily living.

A growing number of models and entertainers have had LASIK. This might, at first glance, support the concept that laser eye surgery is cosmetic. Obviously appearance is important in this line of work. But if LASIK was being performed as a cosmetic procedure, how do you explain the fact that Drew Carey and Elton John do not really need their trademark eyeglasses; both having had LASIK sometime back? Clearly they feel that reducing dependence on glasses has benefits other than changing the way they look.

Not Just for the Rich and Famous

In recent years, the cost of traditional LASIK has come down. But the educated consumer should not just search out the lowest price. Doing so means that that the individual may not be benefiting from the improved success rates and safety of such advances as wider treatment zones, smoother treatment surfaces, pupil trackers and wavefront technology. Be sure that you are dealing with an experienced refractive surgeon who makes use of the latest technological advances, that the laser room is environmentally controlled and that strict infection prevention controls are in place.

Don’t despair if your medical insurance does not cover your laser eye surgery. Flexible  medical spending accounts and insurance discounts offer real savings. Low or no-interest financing options can help fit LASIK vision correction into most people’s budget. Vision correction is a recognized income tax deduction. Many patients who have had their vision corrected feel that it was one of the best investments they have ever made. More patients are candidates for vision correction today and success rates are higher than ever. LASIK eye surgery is not just cosmetic and there has never been a better time to have your vision corrected than right now.

Patients in the Raleigh NC area can take advantage of our complimentary LASIK consults to discuss whether LASIK is right for you.

Sorting Through Conflicting LASIK Data

Friday, June 19th, 2009

Patients researching LASIK often get bogged down by conflicting data on the success rates or complication rates of the LASIK procedure. I’ll often see success rates published that vary anywhere from 80% to 98%. Likewise the incidence of night driving difficulties after LASIK has been listed to be “as high as 16 percent”. Why the conflicting data? Well, there can be several reasons.

1. Different “yardsticks”. For instance, what do we call success? Does success mean the patient no longer wears glasses? Or, that they are 20/20? How about lowering the bar to 20/40 (the level of vision necessary to have an unrestricted driver’s license in most states)? Success means different things to different people.

2. Advances in technology. LASIK has been around 18 years. As with all medical procedures, newer equipment and evolutions in technique tend to increase “success” rates and decrease complication rates. Often when I see printed data that describes a higher than expected complication rate for LASIK, I find that the author has obtained their information from studies submitted years ago. Unless your surgeon is using outdated lasers and techniques, this older data would not apply.

3. Differences in equipment/lasers used. Certainly you can talk about the fastest speed a car can travel but there is a difference in the maximum speed attainable by a Maserati vs. a Smart car. Likewise there are many different lasers that can be used to perform a LASIK procedure. The VISX Star S4 remains the gold standard for laser vision correction. This laser has the highest reported rate of 20/20 vision in an FDA trial ever reported. When the US military and NASA approved LASIK, it was the VISX laser that was used in their trials. It is also the laser currently being used by military surgeons to perform vision correction on our enlisted personnel.

Patients interested in vision correction are wise to become informed. Skepticism can be a helpful trait and the prudent investigator takes the time to ask: Is the data presented current? Is the information reliable i.e. from an FDA trial vs. unreviewed conclusions provided by a manufacturer or provider with a vested interest in the outcome? Does the data pertain to me? Reviewing conclusions about LASIK done mainly on nearsighted individuals may not have relevance if you are farsighted.

You can maximize your chance of success by insuring your procedure is done with the best available equipment and performed by a reputable, experienced surgeon.

LASIK Enhancements

Friday, June 5th, 2009

In most cases, you can expect a good result following a LASIK procedure. A worldwide study by the American Society of Cataract and Refractive Surgery shows that more than 95 percent of the 16 million people who have undergone LASIK surgery are pleased with their new vision.

But not everyone will achieve crystal-clear, 20/20 vision after just one procedure.

Each case has a unique combination of variables that can affect visual outcomes. So in some instances, you may need additional eye surgery — often in the form of a LASIK enhancement — to give you the sharpness of vision you desire.

A number of factors affect your satisfaction after LASIK:
The characteristics and health of your corneas.
The type of refractive error you have, such as whether you are nearsighted, farsighted or have astigmatism.
The amount (strength) of your prescription needed to correct your vision problem.
The amount of tears you produce and their quality.
Your age.
Your expectations.

Although LASIK successfully corrects high degrees of nearsightedness, farsightedness and astigmatism, younger people with mild nearsightedness and astigmatism generally are the best candidates for a good outcome.

Your expectations before LASIK also may play a key role in how happy you are afterward. Remember, the goal of LASIK is to decrease your dependence on glasses and help you to see acceptably well without corrective lenses. Results vary from person to person.

Although many people who have had LASIK believe they see better than they did with eyeglasses or contact lenses before surgery, not everyone has the same experience. After LASIK, you can expect your vision to be slightly better or about the same as it was with glasses.

A small percentage of people may notice their vision is not quite as good as it was before with glasses. But you should be able to drive safely and perform other routine daily tasks without needing glasses or contact lenses.

How do you decide when Is a LASIK Enhancement Needed?
When evaluating your vision after LASIK, it’s important to be patient. Although you should be able to see much better without glasses the day after surgery, it’s not unusual for vision to fluctuate for several weeks.

As part of your follow-up care after LASIK, your eye doctor will monitor your vision for several weeks.

Though not expected, it’s possible that you may feel uncomfortable driving or performing other visual tasks after LASIK. If this occurs, be sure to tell your eye doctor. If necessary, he or she can prescribe new eyeglasses for you to wear part-time while your vision stabilizes.

If your vision is still noticeably blurred three months after LASIK, you may need an enhancement.

To determine whether you’re a good candidate for a LASIK enhancement, your eye doctor will re-evaluate your corneas with the same methods used prior to your first LASIK procedure. Among other evaluations, your eye doctor will check to see whether you have enough corneal thickness for a second surgery.

Its important to note that having less than perfect vision may not be sufficient grounds to warrant an enhancement procedure. As long as you are able to function independent of glasses or contact lenses, you have achieved a successful outcome. If you are unsure of the need for an enhancement, discuss this with your surgeon who will help you in the decision making process.

As with any elective surgical procedure, it’s important to choose a LASIK surgeon you trust. This means someone who will communicate with you well and show concern about your satisfaction.