LASIK eye surgery
Wikipedia: LASIK or Lasik (laser-assisted in situ keratomileusis) is a type of refractive surgery for correcting myopia, hyperopia, and astigmatism. LASIK is performed by ophthalmologists using a laser. The procedure is generally preferred to photorefractive keratectomy, PRK, (also called ASA, Advanced Surface Ablation) because it requires less time for the patient’s recovery, and the patient feels less pain overall. However, there are special instances where a PRK/ASA procedure is medically justified as being a better alternative to LASIK [citation needed]
Many patients choose LASIK as an alternative to wearing corrective eyeglasses or contact lenses. Nearly 8 million Americans have undergone LASIK, laser refractive surgery and not everyone is satisfied with their results.
The LASIK technique was made possible by the Colombia-based Spanish ophthalmologist Jose Barraquer, who, around 1950 in his clinic in Bogotá, Colombia, developed the first microkeratome, and developed the technique used to cut thin flaps in the cornea and alter its shape, in a procedure he called keratomileusis. Barraquer also researched the question of how much of the cornea had to be left unaltered to provide stable long-term results.
Later technical and procedural developments included RK (radial keratotomy), developed in Russia in the 1970s by Svyatoslav Fyodorov, and PRK (photorefractive keratectomy), developed in 1983 at Columbia University by Dr. Steven Trokel, who in addition published an article in the American Journal of Ophthalmology in 1983 outlining the potential benefits of using the Excimer laser patented in 1973 by Mani Lal Bhaumik in refractive surgeries. (RK is a procedure in which radial corneal cuts are made, typically using a micrometer diamond knife, and is completely different from LASIK).
The operation is performed with the patient awake and mobile; however, the patient is sometimes given a mild sedative (such as Valium) and anesthetic eye drops.
LASIK is performed in three steps. The first step is to create a flap of corneal tissue. The second step is remodeling of the cornea underneath the flap with the laser. Finally, the flap is repositioned.
Patients are usually given a course of antibiotic and anti-inflammatory eye drops. These are continued in the weeks following surgery. Patients are usually told to sleep much more and are also given a darkened pair of shields to protect their eyes from bright lights and protective goggles to prevent rubbing of the eyes when asleep and to reduce dry eyes. They also are required to moisturize the eyes with preservative-free tears and follow directions for prescription drops. Patients should be adequately informed by their surgeons of the importance of proper post-operative care to minimize the risk of complications.
Scores of Pro Athletes have had Laser Eye Surgery
Many, like Woods, have upgraded their vision to 20/15 or better. Golfers Scott Hoch, Hale Irwin, Tom Kite, and Mike Weir have hit the 20/15 mark. So have baseball players Jeff Bagwell, Jeff Cirillo, Jeff Conine, Jose Cruz Jr., Wally Joyner, Greg Maddux, Mark Redman, and Larry Walker. Amare Stoudemire and Rip Hamilton of the NBA have done it, along with NFL players Troy Aikman, Ray Buchanan, Tiki Barber, Wayne Chrebet, and Danny Kanell. These are just some of the athletes who have disclosed their results in the last five years. Nobody knows how many others have gotten the same result.
Does the upgrade help? Looks that way. Maddux, a pitcher for the Atlanta Braves, was 0-3 in six starts before his surgery. He won nine of his next 10 games. Kite had LASIK in 1998 and won six events on the Champions Tour over the next five years. Three months after his surgery, Irwin captured the Senior PGA Tour Nationwide Championship.
According to Golf Digest, Woods aimed for 20/15 when he signed up for LASIK. This probably didn’t strike Woods as enhancement, since he was already using contacts that put him at 20/15. Now ads and quotes offering 20/15 are everywhere. One LASIK practice takes credit for giving Irwin 20/15 vision. Another boasts of raising Barber to 20/15 and calls the result “better than perfect.” Other sellers promise the same thing and offer evidence to back it up. Last year, they report, 69 percent of traditional LASIK patients in a study had 20/16 vision six months after their surgery, and new “wavefront” technology raised the percentage to 85. Odds are, if you’re getting LASIK, you’re getting enhanced.
The medical spin for LASIK, as opposed to the entrepreneurial spin, is that it’s corrective. Your eyesight sucks, you go in for surgery, you hope for 20/20. Maybe you get it, maybe you don’t, and that’s that. But it isn’t that simple. If you don’t like the results, your doctor might fire up the laser for a second pass. In the business, this is literally called an “enhancement.” Hoch, the golfer, got four enhancements in 2002 and 2003. He ended up 20/15 in one eye, 20/10 in the other.
Nor do you need poor vision to find a willing doctor. Most states think you’re fine to drive a car without corrective lenses as long as your eyesight is better than 20/40. Cirillo, then a third baseman for the Seattle Mariners, was 20/35 in one eye and 20/30 in the other when he went in for LASIK two years ago. He came out 20/20 and 20/12. Cruz, an outfielder for the Toronto Blue Jays, was 20/30 when he went for an eye exam. Five days later, he was under the beam. “The doctor kind of talked me into it,” Cruz told the Toronto Star. He came out 20/15. According to the Orange County Register, Gary Sheffield, then an outfielder for the Los Angeles Dodgers, had eyesight better than 20/20 when he asked for laser surgery to raise his batting average. His doctor talked him out of it.
Why risk surgery for such small increments? “Every little half-centimeter counts,” Cruz told the Star. Last year, the Seattle Times reported that Troy Glaus, a power hitter for the Anaheim Angels, had gotten LASIK because he “felt his contacts were sufficient, just not always ideal. A windy day or a wave of dust could tip the advantage back to the pitcher.” Often, coaches play a role. The Minnesota Twins training staff successfully encouraged several players to get LASIK. Maddux told the Atlanta Journal and Constitution that the Braves gave him “a little push” to get LASIK in 2000. Meanwhile, the Braves’ manager, having talked to the same doctor about getting LASIK, in his own words “chickened out.”
This is the difference between therapy and enhancement. You don’t need bad vision to get the surgery. Wavefront, if you’ve got the bucks for it, reliably gives you 20/16 or better. If your vision ends up corrected but not enhanced, you can go back for a second pass. Players calculate every increment. Pro golfers seek “to optimize any competitive advantage,” a LASIK surgeon told the Los Angeles Times. “They’re already tuned in to the best clubs, the best putter, the best ball. … Clearly having great vision is one of the best competitive advantages you can have.” Eyes are just another piece of equipment. If you don’t like ‘em, change ‘em.
The sports establishment is obtuse to this revolution. Leagues worry about how you might doctor bats, balls, or clubs. They don’t focus on how you might doctor yourself. Look at the official rules of Major League Baseball: A pitcher can’t put rosin on his glove, but he can put it on his hand. A batter can’t alter the bat “to improve the distance factor,” but the rules don’t bar him from altering his body to get the same result. Baseball now has a dope-testing policy, but it isn’t in the rules; the players negotiate it. That’s why it’s weak.
At last month’s hearing, baseball commissioner Bud Selig testified that in 1998 and 1999 he sent his executive vice president to Costa Rica to check out reports that juiced-up baseballs were causing an epidemic of home runs. Selig was looking for the wrong kind of juice. The U.S. Golf Association’s Rules of Golf share the same blind spot: You can’t use a device to warm the ball, but you can use it to warm your hands. You can’t use a device to measure distance or “gauge the slope of the green,” but you can get the same powers through LASIK. In the age of biotechnology, you are the device.
FDA to study negative effects of Lasik eye surgery
Now the US Food & Drug Administration is getting involved. They have convened a special hearing to explore ways to comprehend the scope of the problem, ways to reduce LASIK complications and ways to improve preoperative communications with consumers.
Data provided by the American Society of Cataract and Refractive Surgery indicate that 95% of LASIK patients see better after surgery and are pleased with the decision to undergo LASIK (averaging $2000 per eye). 5% are dissatisfied and 1% of all LASIK patients encounter severe complications like chronic dry eye, blurry vision, poor night vision or visual distortion. Here’s some speed math: 5% of 8 million is 400,000 cranky people!
FDA is organizing an expert panel to collaborate with the National Eye Institute and gather accurate information about LASIK results and complications. Skeptics claim FDA is recruiting foxes to study the hen house! Some advocate utilizing non-ophthalmologists to collect and interpret the data as has been done in assessments of coronary bypass procedures and joint replacement surgery. Certainly, ophthalmologists who do not perform LASIK could add valuable input to these proceedings.
Many LASIK experts believe that more scrupulous patient selection can prevent many of these unhappy outcomes. A patient who is told they are ineligible for LASIK will frequently keep shopping until they find a doctor who will agree to perform the procedure. Had the first surgeon spent a few more minutes clearly explaining the reasons for disqualification and the dangers associated with pursuing LASIK.
The Food and Drug Administration announced plans Thursday to study the scope of problems connected with laser eye-correcting surgery, which include blurred vision and dry eyes.
The FDA says it will work with the National Eye Institute and the Department of Defense to determine the percentage of patients who experience negative side effects following surgery.
The first phase of the project is already under way, with plans for an online questionnaire to help patients gauge their quality of life following surgery, according to an FDA statement.
The project will also include a clinical trial tracking patients who undergo the procedure, which is expected to conclude by 2012.
“This study will enhance our understanding of the risks of Lasik and could lead to a reduction in patients who experience adverse effects,” said Dr. Jeffrey Shuren, the acting head of FDA’s medical device division.
An estimated 6 million Americans have undergone Lasik surgery, which permanently reshapes the cornea, a clear layer covering the eye. There are no guarantees of 20/20 vision and the long-term safety of the procedure is still unknown.
Ophthalmology societies report that about 95 percent of patients are satisfied with their new vision.
But a small number of patients have reported permanent damage to their eyes following the surgery, including double vision, dry eye and halos around objects at night.
The FDA agreed to look into the problems in 2008 after years of complaints. The agency said last summer it received 140 reports of Lasik-related problems between 1998 and 2006.
Lasik procedures have fallen off in the past year as consumers cut back on the pricey surgeries, which can cost between $1,500 and $5,000
Makers of Lasik lasers include Advanced Medical Optics Inc., Alcon Inc., and Bausch and Lomb.
Also on Thursday, the FDA announced warning letters sent to 17 Lasik surgery centers for inadequate adverse event reporting procedures. Regulators periodically send letters to facilities that don’t follow federal guidelines for reporting patient complaints.
“The inspections did not identify problems with the use of the Lasik devices at these facilities,” the FDA stated.
More inspections of Lasik centers are planned in coming months, according to the FDA release.
