Lasek Lasik Comparison Essay

Posted on by Bar

Laser eye surgery - pros and cons

Comments

Anonymous - 09/09/2002 14:21

Interesting. There are many pros and cons. Has anyone had a really bad experience?

margaret(maggie2003) - 09/09/2002 15:04

Three years later i still suffer from severe dry eye and night blindness.I was deemed a perfect candidate for the surgery. I set up the iIrish support group for sufferers here in Ireland and have travelled to the USA to meet Ron Link of the www.surgicaleyes.org which has sufferers posting on a daily basis from all over the world. Please read your pre-op information and make sure you ask to have your eyes checked for any tear film abnormality or dryness.Ensure all complication including dry eye are on the consent form. Irish support group..0868261801 or email margaret@jacurranda.ie.Also check out www.surgicaleyes.org

Ron(SurgicalEyes) - 09/09/2002 15:08

Dear Reader, I suggest a visit to www.surgicaleyes.org. Therein you will find doctors and patients from around the world intereacting on a variety of topics regarding improper screening and the paucity of long-term solutions for those who have problems after surgery. It's all in the numbers. Even with a 1% complication rate, in the US alone that adds up to over 10,000 people per year. The bottom line is that this surgery - plain and simple. It is being marketed as a commodity which is the root cause of many of the problems my constituency is faced with. Improper screening, i.e., lack of accurate portrayal of individual risk and not enough attention being given to how to fix problems once they've been created. You can't bring back your eyes and exchange them for another pair, getting your money back does not give you back you eyes before surgery and the effects are for a lifetime. Again, bottom line is that this surgery involving the most precious gift of sight. It is NOT a commodity. We maintain contact and involvement of many patients from the UK and Ireland who are looking for solutions to longer-term problems created by LASIK and other refractive surgeries. Many have posted on our bulletin board in search of answers. Sincerely, Ron Link Executive Director The Surgical Eyes Foundation http://surgicaleyes.atinfopop.com/4/OpenTopic?a=cfrm&s=636293455

Sandy(sandykeller) - 09/09/2002 15:25

I have had a very bad outcome. Please see my website at www.lasikdisaster.com

Rebecca(rebeccap) - 09/09/2002 15:59

I have had serious vision problems ever since my July 2001 LASIK surgery, which was performed by a reputable surgeon in San Francisco (we now live in the UK near London). The problems include double vision and a number of other distortions as a result of which I cannot drive, cannot read signs past about 10ft and struggle with reading, among other things. My new vision is not correctable with spectacles nor with soft contact lenses. Further, due to dry eye induced by the surgery itself, I can't wear rigid contacts - the only kind of lens that can help me see reasonably well. My bitterest feelings about the process are that they failed to warn me that an unsuccessful surgery might be more than just being longsighted or shortsighted afterwards but rather that I might never again be able to see properly through glasses. "High myopes" (those with, say, prescription of 8 diopters or more) are particularly at risk for the kind of complications I have had.

saps123 - 09/09/2002 16:06

I had a very bad lasik outcome. My vision and life have been virtually destroyed by it. How I long for the days were I could just put on my glasses and see clearly.

Mary Kenny(gloomsburg) - 09/09/2002 16:07

I was not warned before having Lasik surgery two years ago that my previously diagnosed "dry eyes" would be made much worse by the operation. I have spent over $40(US) per month, every month, for more than two years just trying to restore some health to my damaged eyes. And although my pupils were measured as relatively small and my degree of nearsightedness was considered moderate, my post-Lasik night vision problems make driving a difficult challenge (starbursts at night, like the ones depicted emanating from car headlights in the above article). I had no idea before having the Lasik operation that activities such as night driving might be difficult or even impossible if the surgery ends up -- no one quite knows why in my case --creating problems in how one's eye processes light. Please, think very, very, carefully about how much you risk when you risk your two precious eyes to such an operation. MKBadami@aol.com (USA)

Glenn(ghagele) - 09/09/2002 16:35

While the occurrence of long-term refractive surgery induced complications can be devastating for those who are affected, an informed patient can take many steps that will reduce the possibility of problems from LASIK, PRK, LASEK, and other forms of surgery to reduce the need for contacts or spectacles. An important point is what the patient requires to be satisfied. The most you can expect from refractive surgery is the convenience of a reduced need for corrective lenses. To attain that convenience, a patient must accept some risk. Depending upon your individual circumstances, that risk may be acceptable or too great. Our organization believes success can most likely be found with the combination of an informed patient and an excellent surgeon. Our website contains hundreds of pages of objective factual information about refractive surgery. We also provide a list of 50 Tough Questions For Your Doctor that will help a patient screen their potential surgeon. Refractive surgery is not for everybody, but for the millions worldwide who no longer require glasses or contacts for daily needs, it has been very beneficial. Glenn Hagele Council for Refractive Surgery Quality Assurance http://www.usaeyes.org

Cindy(CindyB) - 09/09/2002 17:33

I had my lasik surgery 5/10/01 and have suffered severe dry eye ever since. In my case, dry eye has caused painful corneal erosions and fluctuating vision. Lasik gave me irregular astigmatism which is not correctable at this time. I miss my crisp, clear vision I used to have with my glasses. My glasses were nowhere near the bother my lased eyes are. I had an experienced surgeon, had no pro-operative conditions that would indicate I would have problems. It wasn't until the first flap was cut that the surgeon discovered I have loose epithelium which became very flimsy and would not lay down properly. Because of this, I have wrinkles in my flaps right in my field of vision. Why the doctor went on to do my left eye, I will never know. I have to purchase special artificial tears (called Dakrina) from a pharmacist. OTC drops do not work. Cindy(Tron)

Miles(BlkIrsh) - 09/09/2002 18:15

I had radial keratotomy surgery in 1984 and though the techniques have changed the risk assessment and risk appear to have changed very little. If you are a perfect candidate and the operation is with out error then you are in the high percentage bracket for having a successful refractive surgery experience. If not there is a high probability that your problems will not have a medical solution and they are permanent. If you have a job that requires twelve hour shifts at night then your risk assessment should be different than someone who works an eight hour a day job in an office somewhere downtown. A quote from a person after an examination " "I doubt very much that many people really are capable of making decisions based on "failure rates". I know that I'm not, and I think the numbers game is a very peculiar way of achieving "informed consent". When making a decision there's much greater value, in my opinion, to be had by skimming the experiences of others and letting all that extra grey matter do its job. If you let numbers convince you to go against your instinct your misery is all the greater should the situation turn bad." The writer after his second pre op examination further stated "The most unsettling item, however, is the observation that the doc I've been working with doesn't seem to see ANYTHING I say as a contraindication. Rather, my concerns are merely things which need to be patched up before we do the procedure. As many other messages on this board indicate, the LASIK practitioner's idea of "Informed Consent" seems not to be informing the patient of her/his specific risks and issues, but rather simply saying, "LASIK is really great and will solve almost everyone's vision problems, but really anything could happen up to and including total loss of vision and there's really no guarantee or way of predicting that it won't happen to you. So anyway, I've got an opening next thursday afternoon; is thursday good for you?" Sarcasm aside you should trust your feelings when making your final commitment. Remember if the surgery is unsuccessful it is not just a matter of requiring glasses but the sickening feeling of one who sees their visual acuity fading. Miles Mulloy

Barbara(artistwoman) - 09/09/2002 18:23

I, also, had a very negative outcome from Lasik surgery in July 2001. Side effects include loss of night vision; loss of contrast sensitivity; foggy, ghosted, "vaseline" indoor vision; huge haloes, starbursts and arcing; regression and uncorrectable visual acuity; dry eye and associated corneal/epithelial erosions; corneal scarring (Sands of the Sahara) in the right eye, correctible only through corneal transplant; multiple vision; significant fluctiation in vision from day to day, sometimes hour to hour; frequent eyestrain and headaches; and a never-ending tic in the left eye. I've been an artist my whole life, it's who I am. I'm now investigating possibilities for a new career, as my ability to work as an artist is so seriously compromised. The vast majority of activities I once enjoyed are no longer availalbe to me, since they required good close-up vision. I have no decent close vision, and wearing glasses doesn't help. I am not able to wear traditional contact lenses, and by the circumstances of my Lasik-reduced income, cannot afford to pursue RGP lenses, the last possible solution open to me. A corneal transplant is very high risk due to autoimmune problems. I was a miserable candidate for this surgery, with a number of contraindications, including a long history of dry eye, large pupils, an autoimmune disorder, a very high degree of myopia, a very large number of floaters, and very poor healing response, all of which were known to the surgeon. I had no idea, until I found the Surgical Eyes web site, that I was such a poor risk. Three surgeons told me a was a great candidate (my check would clear the bank). I was the recipient of miserably inadequate post-operative care, overseen by an OD who knew nothing about post-lasik complications. The corneal scarring that appears as a milky film in my right eye was a result of stage 4 diffuse lamellar keratitis (DLK) which went untreated. The surgeon was completely disinterested, and pronounced me a success. Fortunately, I found Surgical Eyes, where I was able, at least, to discover what was wrong. I also found an outpouring of caring and support there—nowhere else does anyone seem to want to acknowledge that we, the refractive surgery disasters, do exist. Would I recommend this surgery to anyone? Oh yeah, just about as quickly as I'd recommend skydiving without a parachute...

C.(CAeyes) - 09/09/2002 18:53

Having Lasik Surgery was the worst thing I could have ever done. I thought I was giving myself a wonderful gift, instead it stole my quality of life. I have many complications which I will not get into. I would rather share with you what I can no longer do or can only do in a limited way because of starbursting, glare, haloes, flaring etc. -Going out to dinner in restaurants -Night Driving -Swiming in pools -enjoying any sort of night activity like enjoying the moon and stars, fireworks, camping, city lights, bars, sunsets. -Cannot light candles anymore. -difficulty reading. -difficulty with computer screens. -annoyed by indoor halogen lighting and bright incandecants. -Cannot read to my little girls in their dimly lit bedroom at night anymore. --Depression, anxiety, panic attacks, agraphobia due to my poor vision. -Fear of flying, making decisions, change of enviroment, new things, travelling for pleasure, the future. -Fear of being hit in the eye. -Fear that my job could be at risk. -Lack of desire to advance my career (which will mean more travel. -cannot participate in extra curricular activity after work because of driving at night. -overall decrease quality of life. -dry eye pain. -irritated, red eyes -I have had to put tape over all the LED displays on my Stero system and clocks. -have my house lit up like a lighthouse all the time (day or night). -More sunglases than the "Sunglass Outlet" stores. -eye socket pain that radiates back to my ear. -Floaters that interfear with my ability to enjoy a beautiful landscape. Did I mention that I was considered a good candiate.

Sheree - 09/09/2002 19:10

Educate yourself before taking this great risk with your eyes. The complication rates have been quoted as low as 1% and as high as 15%. Evidence that the risk of complication is not fully known or studied. One having refractive surgery must not only be a gambler, but someone strong who can accept the loss of their present lifestyle if a complication occurs. That lifestyle change will be very unpleasant both emotionally and physically. The 'fixes' for known complications result in traveling/communications across countries. The majority of complications can not be fixed. Ask yourself if you are willing to take this risk? Would you risk destroying your most precious sense - your eyes ?? I wish someone asked me these questions and didn't instill a dream of seeing 20/20 without glasses and contacts. Today, three years later I have no solutions for my complications, have searched to exhaustion for help and have accepted that my poor decision made three years ago will live with me until I die. Think of the NIKE slogan in reverse when tempted with refractive surgery.....JUST DON'T DO IT!!

margaret(maggie2003) - 09/09/2002 19:37

While Richard Branson underwent the surgery and had a good outcome, in a major tabloid interview last year he refused to allow his daughter to undergo lasik due to the complications that were published in the USA.

Bryce(lonewolf) - 09/09/2002 21:21

Hi lads and lassies from all of us here in America. And thanks to the SurgicalEyes bulletin board for making me aware of this discussion. LASIK surgery is truly a miracle of modern technology. With the right candidate, the right technology, and the right doctor it routinely produces excellent results, and many people are able to throw away their glasses or contacts forever (except for reading glasses in those over 45, or so). However, even under the best of circumstances there are risks -- and some of them can be serious -- so no one should consider LASIK without first doing their own due diligence so as to fully understand all the possible risks as well as all the potential benefits. My advice is to avoid slick sales and marketing pitches, and evaluate surgeons based on a thorough review of positive patient referrals, extensive experience performing LASIK, a very high success/satisfaction rate, and a very low complication rate. Price should not be the deciding factor. LASIK can be a wonderful blessing, but it is not for everyone, and remember, this is delicate micro-surgey on your EYES we're talkin' about here, so proceed, if at all, with great care and caution. lone wolf

geri(gerielkins) - 10/09/2002 00:48

lasik done 6/2001. since then, i have had trouble doing my job as a nurse, and cannot do direct patient care in many cases. i have lost my ability to drive at night due to visual aberrations caused by lasik. i cannot be corrected with glasses, and am trying to see with rigid contacts, which are uncomfortable and do not give me the vision i used to have,either with glasses or soft contacts. the informed consent was a joke! if my doctor had told me what the statistics really were, i would have run......and there are hundreds or thousands of "good candidates" for this surgery who have had bad results. is this procedure worth risking your precious eyes? use the web to research this procedure, and realize that any bad thing that happens to anyone can happen to you, and that the odds of that indeed happening, are much greater than your lasik doctor will ever tell you. please think very hard. if you can live with the risk of not being able to see your child across a room, or don't mind being trapped at home at night, or can bear the pain of dry eyes, then maybe lasik IS for you. if you value the smalls joys of life, then reconsider.

Phyllis(pknapp) - 10/09/2002 02:06

I had lasik in Jan 00. I was -8.75 and -9.50. I had always worn glasses. Tried contacts twice. Once in my 30's and again a few years before lasik. Never did very well and did not pursue matters. I was probably not a good candidate for Lasik. However, the docs minimize your risk. Lasik caused me to have dry eye syndrome, corneal erosions, EBMD (surface of the eye becomes slushy and prone to problems) starburt, glare, photophobia and most of all pain. Painful dry eyes that hurt 24/7. Eyes that hurt so bad that you cannot keep your eyes open at times. I've had to use drops as often as every 20 minutes during the day for months on end. I've been to six or seven "second opinion" doctors. No one has any "fixes." Enough of my droning on. If you don't get the point, keep reading SE until you do get the point.!! I was afforded a bit of relief the past few months with Aqueous Pharma drops. These are from Texas and you can only obtain them one place. Not really what I had in mind from Lasik. OH, and for good measure, I was diagnosed with cataracts about 20 months post op. There are quite a few people on the bb who have suffered cataracts after Lasik. Personally, I think the surgery brought the cataracts on, or possible earlier than they would have naturally. The doctors do not buy this. I cannot drive at night. My best corrected vision is 20/50 with my glasses. Glasses, oh yes. I've had a bunch of glasses since my surgery. It has been proven that higher myopes have more post lasik problems. I fit into that category as do many on SE. With new info available that was not 'in the open' 2 or 3 years ago, people must take precautions to not jump into something they will regret. Most of us did not have the opportunity to hear of anyone with bad outcomes. Let me tell you, we are here and we are many. Don't add to the pot. Get some good contact lens and save yourself lots of money, trouble and most of all your eyesight!

Anonymous - 10/09/2002 13:15

Does anybody know the number of serious complications that have been experienced in Ireland due to lasik surgery

S(RainyDay) - 11/09/2002 09:28

I wonder about the long-term effects. As Lasik came to Ireland in 1997, there is no-one here who has the treatment more than five years ago. Therefore, we can't have any real visibility (no pun intended) to the long term effects.

Anonymous - 11/09/2002 09:32

I am sorry guys, but even with some side effects like dry eye - which can be considerably helped using eye drops or gel tears - this procedure is the biggest miracle that I have been lucky enough to "suffer" in my life! I had lasik done a year and a half ago and words cannot explain how amazing and almost immediate the results are. They have certainly changed my life for the better. I know , as with any procedure, there can be the percentage that it doesn't suit but, and pardon the pun, let's not lose sight of what is a fabulous technological development.

Anonymous - 11/09/2002 09:32

Does anyone have a good story? Anyone Irish? And of course people realise its a surgical procedure and that there are inherent risks. Thats why I havent had it done yet!

Philomena(psmythe) - 11/09/2002 09:38

Thank you for providing this very informative information.

Anonymous - 11/09/2002 09:40

I have had LASIK surgery in the last six months and have never looked back. I had constant problems wearing lenses and would never be able to wear them for a week - the freedom I now have. Also I play alot of sports and swim so the benefits there are huge

Anonymous - 11/09/2002 10:01

I had lasik eye surgery one year ago and it is the best thing I ever had done. I would have no hesitation in recommending it. Many of my work colleagues have also had lasik surgery carried out having witnessed the success of my surgery, and they too are extremely happy. Often its only the bad experiences that get publicity. I had my surgery carried out in Dublin.

Anonymous - 11/09/2002 13:54

I too had laser surgery this year and have had no problems, in fact, I think its one of the best things I have ever done and has improved my quality of life. I also had surgery in Dublin.

Anonymous - 11/09/2002 14:30

I feel like a success story - myself and 2 other colleagues have had the surgery carried out by the surgeon in the above article. I found him & his team to be so professional they really put me at ease. As for results, I agree sports especially swimming are so much easier now.

Anonymous - 11/09/2002 14:46

I had lasik eye surgery last November, one of my friends had it done in January and my sister had hers done in March. All in Dublin. Thankfully none of us have experienced anything like the horror stories written about here. We all think it's a miracle, We're all swimming, driving and playing sports and none of us are experiencing the dry eye phenomenon. It's the best thing I ever did!!! Lasik is not all doom and gloom.

margaret(maggie2003) - 11/09/2002 15:37

Some of these people with complcations are Irish but still need treatment and hence the reluctance to post.I notice not one person with a apositive result in Ireland has posted their names.If its so good an outcome unfortunately unlike my own and i did have it in a top DUBLIN CLINIC are so many Irish Refractive Surgeons in Nice(FRANCE) THIS WEEK DISCUSSING FORUMS ON HOW TO ALLEVIATE THE COMPLICATIONS WHICH CANNOT BE CURED.yOU ONLY HAVE ONE SET OF CORNEAS ONCE THEY ARE LASERED YOU CAN NEVER GET THEM BACK.Some sufferers here in Ireland are still unable to use their computers and like myself have a specially adapted screen and programme.We do have complications here and would love to see the Medical Community come on board to help us with their expertise just as they are now doing in the USA and The United Kingdom. The Irish support group can be contacted at margaret@jacurranda.ie or www.surgicaleyes.org.

margaret(maggie2003) - 11/09/2002 15:53

Shane(rainy day),Yes Lasik was introduced here in 1997 and unlike the USA where i have done most of my reserch for the long term side-effects and complications did not have to be passed by the FDA.If we look to the USA where it was approved they are now documenting the serious complications from Lasik and have had Representatives from the WWW.SURGICALEYEES .ORG SPEAK BEFORE ITS PANEL. Considering we use the same lasers and now the new wavefront technology,we too are now experiencing a percentage of serious and minor complications here in Ireland,hence the set-up of the support group for sufferers here.Refractive Surgeons in the USA are now actively helping these sufferers from Lasik and PRK and have invited speakers such as Ron Link Administrater and interviewee of this feature to speak on the complications of PRK and Lasik and use their expertise to help these victims. I wish for that help now here in IRELAND for our sufferers,many who are deeply depressed and overwhelmed by the losss of their vision.I travel to the USA and London to gleam more information from fellow sufferers and have now set up a support group here in Ireland. 0868261801(9-5pm)Any person with any queries or complications please contact me on email Margaret@jacurranda.ie.

Anonymous - 11/09/2002 15:54

Are there further considerations for someone of 50 years of age?

Anonymous - 11/09/2002 15:55

Are there further considerations for someone of 50 years of age?I understand that because of normal deterioration in sight, ssurgery on both eyes is not recommended for someone of 50? Any views?

edward(edgrainger) - 12/09/2002 08:23

I had my Lasik surgery done on one eye only in January 2001. I had serious thoughts as I always beleived that the eyes are the windows to the soul and felt that interference in this manner woulkd in some how disconnet me from my spirit. The operation was a sucess and I have achieved great freedom and been involved in many sporting activities that I would not have taken up prior to this.However I would not recommend the operation as I beleive that eye is not just merely an optical nerve and lense but our vision is how we navigate and experience the world. I would recommend a book called Take Off Your Glasses and See by Dr Jacob Libberman to anyone considering Lasik. The best of luck to anyone who proceeds. Regards Edward

Anonymous - 12/09/2002 12:26

What an eye-opening article [no pun intended] as you can see from the last few comments a lot of people in Dublin seem to have had good experiences and as someone who is (was) considering LASIK I was only hearing good reports, I never heard any down-sides. I wonder if this is because it is only done in relatively few places still in Ireland and the people carrying it out are highly-specialised compared to the UK and USA where LASIK clinics seem to be getting more frequent...maybe the people operating these clinics aren't as specialised. Although it may bring the costs down the qulaity of surgeons may be reduced? We should ensure that high standards are maintained in Ireland and the Government should set strict criteria before letting just anyone opening a clinic.

Anonymous - 12/09/2002 13:13

I had Lasik surgey carried out at the Blackrock Clinic in September, 2000. Both eyes were -5.5 and I was advised that I was a suitable candidate. I was fully informed of a long list of potential risks and I discussed them with the surgeon beforehand. Three of my brothers had the Lasik procedure carried out before me and my fourth brother had PRK. The brother who had PRK had no problems and now has normal eyesight. Of the three who had Lasik, one is still very slightly short-sighted in one eye, another is still short-sighted in both eyes and still requires glasses but he is pleased because there has been a significant improvement in his vision; and the third is pleased because he has normal vision with no complications. Since the treatment, I have found that my eyes are drier than they used to be and I now suffer from poor night vision. I cannot drive on unlit country roads at nights and drive extra slowly at night on lit City roads due to difficylty seeing. I also find that I have to work in natural light because if I read or use the computer under artificial light my eyes feel very strained. Also, if I am in a poorly lit pub or restaurant, I have difficulty seeing the edge of steps and have to be extra careful so as not to fall. Overall, I'm glad I had Lasik treatment. I no longer have to wear glasses or contact lenses. I enjoy playing sports, swimming and cycling and it is great to be able to engage in these activities without wearing glasses or lenses.The side effects which have occurred are a nuisance but, on balance, I feel that I am happy to put up with them in return for the benefit of normal vision in natural light.

Anonymous - 13/09/2002 10:59

Two replies to the above comments and i wish to clarify i am not a medical Doctor or Refractive Surgeon.(1) If you are over 50years of age ,you are most certainly long sighted.Lasik is done in certain cases.Make sure that you ask for a complete tear film test and dry eye testing as the eyes tend to dry out after the age of 40yrs. (2)After three years searching for a cure to my complicatios i intend to lobby the government here to set up a National data base for reported complications and safety of excimer lasers,some of which have been recalled in the USA. (3)The loss of night vision and ghosting descibed by Annom. above although considered a sucess with his/her daytime vision are causing much discussion in the USA and LONDON at confereneces.I refer to an article in TIME magazine 2000 by a Renowed Refractive Surgeon,Dr. William Jory who gave up lasik because of the serious night time vision loss.He also featured on the Watch dog programme BBC 1.His email is jory@Lcrs.co.uk,website www.Lcrs.co.uk. If you continue to have peoblems with ghosting and night vision there are contacts that may help.They need to be fitted by an expert in this field.Hope this helps.Nearer to home there is a doctor in Waterford is also an lasik expert and has taken the time to do reserch on Taxi drivers and night vision reserch post-lasik.He also attends most of the conferences world-wide as He also carries out all the pre-op checks for dry eyes.

patrick(gustra) - 13/09/2002 23:17

I've heard people talk on laser corrective surgery and although expensive

LabRat - 14/09/2002 00:42

I am so envious of people who have had good lasik results! I wanted to see like a normal person, not be afraid of something like a wilderness trip, breaking or loosing my glasses - being nearly blind without them. My eye doctor for over 22 years was thrilled about lasik for me. When I talked to him after watching a video about the frightening complications, he said, "Do you think I'd let that happen to you? In the medical & teaching community he is highly respected, considered an eminently qualified refractive surgeon. All this led me to believe that any complications were doctor related; such as skill, training, pre-op screening, knowing patient history, equipment, caring, and so on. I now believe (too late) that there are things over which the doctor has no control. here are a few post lasik challenges: I have a wrinkled flap = distorted vision; 3 years post lasik non-correctable. two flap lifts, unsuccessful attempt at removing wrinkles. The right eye should be retreated (enhancement) but there are too many things that could go wrong and it is the one eye that can be improved with glasses. I have heard lasik is not physically painful. Wrong. plus muscle pain & spasms. Difficulty focusing/ 7 months of double vision with severe headaches, nausea. Unable to get a reading lens = restricted reading. Difficult; house hold chores, shopping in a store, reading price tags/labels, declining interest in many things, such as how I look, since there is so much I am unable to see. Many activities I used to enjoy have been dropped. Glasses for my right eye have permit me to drive again - daylight only. Fluctuating vision - goes from regular blurry to really disturbing drive you crazy diminished vision! can brings on reoccurring episodes of double vision w/accompanying symptoms. Low Light problems = going into dim space it seems as if one eye is "seeing grey" (ex. restaurant impossible to read menus or see faces; or falling down stair missing a step.) PVD posterior vitreous detachment; little specks (tiny flies, cobwebs, smudges) floating across field of vision. And/Or like mine - a larger dislodged glob of gel that looks like a dirty film covered contact, a cloud of fog, or a gauzy grey curtain that floats in and out of -or- is suspended in, my line of vision. It is very distressing, and I wonder if I will slowly loose my vision. Believed to be caused by the suction ring that is applied before making the cut through the cornea during the lasik procedure. Trying to discover what was wrong, was a journey of hope being knocked down at just about every doctors appointment ( 22 in first 5 months). Eyes are the first thought in the morning, last at night! wake, open eyes, then remember, stomach drops and starts rolling! want to close eyes, have it all disappear! Why/how did this happen, what did happen, and how am I going to get through this. what is my future? the true health of my lasik restructured eye? My vision after all the pain, suffering and money, is worse that it ever was with my thick glasses. I have no idea why I was not one of the lucky ones. Like so many, I would pay double the money to not have ever had it done

Anonymous - 15/09/2002 20:11

I am 60 yrs of age and I need glasses for reading. I used to have 20/20 in my left eye. My right eye always had poor sight and I could never see clearly with it, neither short distance or long distance. Everthing was alway a blur. It has been like this since early childhood. Is it possible that laser surgery could improve my right eye. I am also on medication for angina.

margaret(maggie2003) - 16/09/2002 11:29

Patrick(gustra),I was a very healthy individual no medical problems,active in sports and running my own company.Although the risk of complications are reduced,looking at the statistics per head of population in Ireland,they are on par with the USA.Read Jim Clarkes article again...one in six will have a complication with lasik.

margaret(maggie2003) - 16/09/2002 11:36

Labrat,sorry to hear about your post-op complications.On the www.surgicaleyes.org website a few people have had vision helped post- flap wrinkle with a cornea transplant,use the search engine or email me. With regard to the promised enhancement i feel the REFRACTIVE SURGEON clarify pre-op the inability to use this second surgical proceedure if severe dry eye,flap wrinkles or erosion develops.Vision with flap wrinkles post-lasik is like looking through cling film roll,most distressing.Do not suffer alone there are support groups available to help you gain information and medical assistance. margaret@jacurranda.ie.(irish support group)www.surgcaleyes.org(usa and most countries)

Anonymous - 16/09/2002 11:47

60yr old annom. Ask your optician to check your prescription and any changes over the past year especially.Talk to he/she about your ?on laser eye surgery for the eye,make sure to inform them of all medical problems and medications and go to a major hospital Refractive Surgeon for an appointment.

Anonymous - 17/09/2002 10:13

For those of still considering this miracle surgery,go to the www.surgicaleyes website,clik on the BB on the open forum ,to a posting of "I want my life back" AND SEE FIRST HAND THE HUMAN TORTURE a bad lasik outcome does to your life.

margaret(maggie2003) - 17/09/2002 10:35

A further point to consider about lasik eye surgery,it is not covered under VHI or BUPA and if you are unfortunate enough to end up with complications of any sort you will have to fund them privately. So when you go to your Refractive Surgeon for your pre-op visit ask HE/She free of cahrge if you experience any complications and receive same in writing.I advise this point because even a minor complication such as dry eye can leave you with a lifetime symptom,and a weely cost for eye drops for a very long time. Other major complications will require intensive treatments which are very exspensive and you may have to travel abroad to alleviate some complications. Also ask your surgeon his complication rate for this proceedure and if he has none get a second opinion. Bring a member of the family with you for the pre-op visit as you will not take in all the medical information during one appointment. Ask for a copy of the informed consent and take it home with you prior to yor surgery,dont leave it until the morning of the surgery. This is elective surgery so ask your local optician to do an eyecheck as they will know your history and discuss all aspects of the surgery.They will be able to check your prescription. Ask the Surgeon during your pre-op visit for a detailed printout of your prescription,topographs and if they intend to induce monovision(i.e. making one eye over-corrected)if you are under 40yrs.it is a risk,and you may experience spasm if the eye regresses. Ask your Surgeon to test your pupils for dim/darkness with the pupilometer(not always accurate as witnessed by the posts of night time blindness). Do your research,checkout www.surgicaleyes.org and click on the pre and post-op list of questions. This surgery can be a miracle when the outcome is good but it can also change your life beyond imagination with even the most minor of complications. And finally report any complications and seek support if you are overwhelmed by a bad outcome .SOLO(sufferers of lasik outcome..irish support group,email margaret @jacurranda.ie.

Anonymous - 30/09/2002 16:06

WOW - I have mildly short sighted, and have often considered going for laser treatment to 'fix' my eyesight - however, I think I will leave well enough alone. I've managed with lenses and glasses now for 17 years - and think I will continue to manage fine. I have relatively few problems and take good care of my eyes and eyewear, with regular trips to my eyecare specialist. I can think of more usefullthings to spend my few thousand euros on. As has been mentioned so much in this discussion, you only get one pair of eyes - and its too much of a risk to meddle with them.

Anonymous - 30/09/2002 19:46

Would any medical personnel know a specialist who treats dry eyes here in Ireland?

Anonymous - 20/11/2002 09:41

I had Lazer Surgery a couple of months ago and it was the best thing ever! i did have a complication after it though - some cells started growing under the flap in my left eye so i had to have it lifter again and the cells removed. no damage was done as my vision went blurry as soon as the cells appeared so i had it dealt with straigh away. but even with that, i'm so glad i had it done. my eye sight was within the'ideal' range for the best outcome, i was about -4 to -4.50. I used to wear contacts but usually only if i was going out for the night as otherwise i found it too much hassle, one of them was bound to come out before the end of the night. i hated wearing glasses - i felt very frumpy and unattractive, i couldnt see when it rained, or if i went into a warm room from outside they would steam up, i couldnt go swimming without contact lenses or i wouldnt be able to see anything, and the worst was the fact that when i woke up in the morning the first thing i had to do was reach for my glasses. BUT NOW i can see as clear as a bell. i feel like walkiing up to people i see on the street wearing glasses and telling them to get this done. People who dont wear glasses cant understand, i hear ' its an awful lot of money to spend when you can just wear glasses instead' but the difference is amazing and i'm so glad i got it done.

sarah(twoblue) - 20/11/2002 12:29

Have always wanted to get the surgery done as i have really bad vision. Will think twice now had no idea that so many people have had such bad experiences! Is there anywhere that i could get the numbers of successful and unsuccessful operations?

margaret(maggie2003) - 21/11/2002 23:41

Sarah(twoblue)the statistics are one in five approx will have some sort of complication here in Ireland,always ask your surgeon his statistics and get a full pre-op checkup. www.surgicaleyes.org

Joyce(rowntree77) - 30/11/2002 04:44

My eyesight is fairly bad. My vision is -6.2 -7.5. Am 25 yrs old and have been wearing glasses since I was 9yrs old. I consider things like being out in the rain a real nuisance as I can't see properly. I don't enjoy swimming because I can't see without my glasses and feel totally lost and vulnerable!! However, 99% of the time I am perfectly content, although to wake up in the morning, open one's eyes and see, would be brilliant. Laser treatment often crossed my mind, especially since I know 2 people who have had it done with great success. However, I would prefer to use glasses/contacts and have small annoying problems like I mentioned above, than have any of the terrible complications that are very possible with this treatment. I may be very fortunate and have a very successful outcome, but most definetly am not going to risk jeoprodising my future just so I can see clearly when I'm walking in the rain. The risk is far too great. It could be worse. Thousands of people wear glasses and/or contacts and are perfectly content. Why rock the boat? Be happy that there's not something more seriously and disabling wrong with you.

Anonymous - 08/12/2002 16:43

What is the cost of laser eye surgery in Ireland?

margaret(maggie2003) - 09/12/2002 11:06

Joyce some very good points.As i stated the complication rate is about one in five even in Ireland,so you must weigh up that decision.As head of the Irish support group i am travelling to the Surgical Eyes organization headquaters next april 2003 and will meet up with doctors and medical personnel who are helping those suffering from lasik complications.New drops have come on the market that have changed many of the sufferers livi am the first here to avail of thnew treatment and will publish my findings in the near future as i have been suffering for three and a half years with severe dry eyes post-lasik,so this will offer some hope to people with that painful complication here. polease do not hesitate if you suffer from severe dry eyes to contact me via the irishhealh.com editor..or email marharet@jacurranda.ie.

Ado(ado_t) - 09/12/2002 14:42

over the past week ive noticed a sifnificant change in my eyesight,i.e. it has gotten worse.normally i am only slightly shortsighted,something around -0.75 or -0.50 im not sure at the mo. im still not sure though whether or not to go ahead with the surgery as i am currently applying to the Gardai. im 21, what should i do???any suggestions?or an any advice from guards out there who have had this done?im trying to decide if the risk is worth taking even though ill be ver very very very disappointed if i cant get into the Gardai because of my eyesigtht.HELP!

Anonymous - 12/12/2002 09:45

I'd just like to ask for advice on normal post-surgery standards in Ireland. 4 years ago I had laser surgery performed on my eyes in a hospital. I was told my short-sightness was cured for life. In the past 6 months I noticed that one of the eyes(the then stronger one) is again going short-sighted. I set up an appointment with the surgeon. He did nothing other than prescribe eye-drops and confirm the weakening-suggesting another appointment. I refused to pay euro100 to his secretary for this. Now she is insisting by letter that I will have to pay this at the next appointment. I find it hard to accept that I should have to pay anything, given that I paid £2,000 for a life-long operation-and that includes even any corrective surgery that I may have to undertake. Can you give any idea of norms in such a situatiion and how best I should proceed?

margaret(maggie2003) - 12/12/2002 11:11

Dear Annom, you have not stated your age which would be a big factor if you are now over forty years of age.As you know by my outcome nothing is 100% in the outcome of this surgery and you sign this on your consent form pre-operatively.You can only have retreatment frre of charge during the first year if the eye regresses i.e besomes short sighted again.As i am currently trying to lobby the medical board for this information to be published you must understand lasik eye surgery is considered cosmetic and no matter what complicvations you get,your private medical insurance will not cover any of your costs. I run a support group here in Ireland and now EUROPE and we are having a full conference with some of the top people from the USA and London to discuss all these issues,remedial ttretament for those with complications,help and support for those with major complicatios from this surgey and hopefull some insight into our rights as people who continue to suffer and bear the cost of trying to get our sight and quality of life back.Unfortunately the numbers are growing as the year now heads into the 5 year mark and more and more cases are beimg reported and now documented. editor of this site has my contact email and cell number if i can help you with anymore information. I advise you also browse through the www.surgicaleyes.org website,which will give you afull understnding of the magnitude of the post-lasik complications now comming to light worldwide.They sre currently attending a conference through to Saturday in order to get help for these people suffreing post-lasik complications. hope this helps. p.s. i am not a dotor,just a surviver of this surgery who has set up a support network here for the many emails i now get on a dail basis.

Anonymous - 10/01/2003 09:24

does having conjunctivitis affect eye laser surgery?

margaret(maggie2003) - 10/01/2003 09:36

conjunctivitis is an inflamation in the eye.If you still are considering lasik eye surgery make sure you fill this out in your pre-op check list and also inform the surgeon as this may be an indication of melobian gland dysfunction which may lead to increased dry eye problems post-lasik as is a counter indication for lasik eye surgery. please discuss with your gp and surgeon and local optician.

margaret(maggie2003) - 10/01/2003 09:41

Irish sufferer from post-lasik complications of three years duration of severe dry eyes and spasm goes on trial eye drops from top research programme in Dallas.All the baseline checks are documented and the first twelve weeks have radically changed her life again.This will be the first positve remedial trial here and will keep you posted of results. any further information contact maragaret @jacurranda .ie

Ado(ado_t) - 10/01/2003 12:23

maggie2003 i was just wondering if you or anybody else would have any comments,suggestions,advice or opinions on my previous posting from the 9/12/2002?????

margaret(maggie2003) - 10/01/2003 16:43

reply to ADO... ADO you say you have had significant eye prescription changes in a short period of time.I would strongly advise you to go to your optician and record the findings of each visit and eye changes. If you read carefully the pre-op contra-indications they state you must not experience significant prescription readings and they must be stable for at least 6 months on the same prescription,prior to lasik surgery. You intend to apply to the GARDA and therefore must have no night-time driving problems with glare,halos etc.Unfortunately one of the most common complications and this is considered minor is night-time glare and halos.The surgeons now use a pupilometer which measures the pupil in dark light pre-op but this has not always proved to work 100% and it is only post-operatively that these complications can be seen regardless of pupiul size pre-op. I would strongly urge you to read all the data and check out numerous sites and even post your question to a wider audience of post-refractives and lasik surgeons now treating these complications. check out www.surgicaleyes.org. www.asklasikdocs london centre of refractive surgery who conducted the time magazine nightime survey in 2000, talk to the GARDA RECRUITING OFFICER to make sure they now accept lasik surgery. OR you may email me directly and i will give you more contacts who can answer your question. margaret@jacurranda.ie

margaret(maggie2003) - 10/02/2003 16:45

FYI..plese see february 2003 edition of Which article on health"your sight in their hands"..just how safe is laser eye surgery?by journalist Colin Meek.Excellent article on all the pros and cons on this surgery DR Dan Reinstein leading usa now Harley street refractive eye consultant was asked to develop new guidelines to ensure safety standards are met by its members.We need a similar body now in Ireland. For further information please contact me by email margaret@jacurranda.ie

margaret(maggie2003) - 11/02/2003 09:05

This morning,Feb 11 2003, on the bbc breakfast programme the above Dr Dan Reinstein was interviewed with a patient suffering severe visual complications following lasik eye surgery two years ago.He stressed the need for experts in this field to do more than weekend workshops in lasik, and promotes that they have at least a year in this speciality.He himself is the leading USA expert with over two years and developed the ultrasound to detect abnomalities in the epithelium prior to lasik surgery.Many now travel to London where he sees major complications from this surgery,this will include myself in early march 2003. If you are suffering major/minor complications or are considering this lasik surgery i urge you to watch on BB1 tonight at 7.pm the "watchdog programme" that is doing a special feature on lasik complications and their life-long effect! any queries on Irish support, please feel free to email me on margaret@jacurranda.ie or mobile 0868261801..

Anonymous - 19/02/2003 16:34

I'm happy to tell you that I had LASIK surgery on both eyes 3 years ago. My only regret was that I had the eyes done seperately. Because I had them done one at a time I suffered wobbly vision for a few weeks. The surgeon I consultet was very professional and frank and explained all the pro's and con's. I felt very comfortable in his care and I was happy to recommednd him to friends.For sports and driving my vision had improved to a very acceptable level and I no longer have to fiddle with contacts or worry about breaking glasses. The procedure itself is very quick and completely painless. Please do not be put off by other comments but consult a reputable surgeon yourself to assess your suitabllity - and good luck!

margaret(maggie2003) - 20/02/2003 09:35

Dear Annom 19/02/2003, i am glad you had a good outcome.I would like to clarify that even the best of surgeons still document complications after screening the patient.The ability of the tear film to compensate cannot be measured prior to lasik eye surgery and hence some patients suffer long term dry eye complications,Although this is not considered serious it will affect your ability to do some sports such as golf,swimming etc. With reagard to bilateral lasik eye surgery,it is still advised to have one eye done within 24hrs to eliminate and access the surgery, a few weeks of wobbly vision is better than a corneal transplant. irsih support group for bad lasik outcomes...SOLO.

naomi(naomismith) - 23/02/2003 16:01

I had Lasik Surgery just under 2 years ago in Blackrock Clinic, and like everyone else was extremely worried about the outcome, however I have to say I can't believe it took me so long to get my eyes done, I have had no problems, both my eyes are now -0.25, before surgery one was -5.5 and the other was -6, I can drive and swim fine, I used to be afraid of swimming because I couldn't see. My eyes will never be 20/20 vision, that's ok because I haven't had that since I was about 5 years old (am now 25), and couldn't wear contacts found them too uncomfortable, and glasses stopped me doing a lot of things. Good luck to anyone who is going for the surgery.

Siobhan(siflynn) - 24/02/2003 16:17

I read recently that the worse your vision is the better the outcome...Is this true? I have -3.25/-3.75 vision and have an appointment in the next 3 weeks to have Lasix surgery done!!

margaret(maggie2003) - 27/02/2003 10:54

Siobhan(siflynn)that information is not accurate.The more shortsighted you are the more cornea needs to ablated..eg,if you were -6.5-8.5 you would need more of the cornea to be lasered! You are considered only minor with a prescription of -3.5.The higher the prescription the greater the risks of night time glare and halos although this can also happen with minor prescriptions. Ask your surgeon to do the dry eye test,tear film test and to measure your pupils in dim light. I had -2.5 scripts prior to lasik surgery and the eye regressed to this post lasik surgery.If YOU ARE UNDER 38YRS MAKE SURE TO ASK THEM ABOUT MONOVISION,which some clinics here are still doing on clients,this is permanent and needs to be discussed in detail as it may lead to accomadative spasm in younger clients which is very painful and life-long. see www.surgicaleyes.org for independent information and 10 questions to ask your surgeon prior to surgery. or email margaret@jacurranda.ie the Irish support group for bad lasik outcomes here and in the United Kingdom. do your research and good luck.

fi(minny_fi) - 02/03/2003 20:16

I'm considering getting this surgery done soon. I'm only 20, but have had glasses and contacts since I was 7 years old, and I hate them (to say the least)!! This site is a great help- but does anybody recommend anywere to get the surgery done? Or does anybody know somewere I shouldn't go? (Somewere in Dublin would be great!)

margaret(maggie2003) - 03/03/2003 09:21

fi(minny-fi).If you are wearing glasses since 7 years of age and also contacts you may have a very high presciption so the only thing i can add is to go to a reputable surgeon who will give you his statistics,get him/her to check for tear film considering the use of contacts,make sure they test your pupils pre-op for night-time vision,also now ask if Lasek or Lasik is more suitable for your prescription and eye as there are now two options. This surgery as with all surgery is not fool-proof so almost all surgeons will have documented complications and if they dont move on and get a second opinion. Ask them how long they have personally preformed the surgery,their type of laser? and most important their post-operartive care if complications should arise. checkout the 10 questions to ask your surgeon pre-op on www.surgicaleyes.org. checkout the latest\" which\" healthcare article of march 2003 and make sure the clinic you choose offers all of the above. In brief do your research on surgeon,clinic,statistics. best of luck, the mater,blackrock clinic and terenure laser clinic provide information and all clinics have qualified surgeons some using the latest wavefront lasers..All clinics can be viewed on the web. Ask as many people as you can about these clinics and their outcomes and make your decision based on your own evaluation of your pre-op findings.

gavinc - 23/03/2003 12:48

I notice that the above posts mainly relate to Lasik surgery. I was wondering if anyone has experience (good or bad) from having PRK done? Having read the feedback on Lasik, which seems to be more negative, I am considering this other option. I have worn contacts for about 7 years but am starting to react to solutions (maybe even lenses), so my optician suggested laser as a possibility. My eyes are both -2, so are in the low region and my research indicates that PRK might be more suitable in this case. Would people consider this surgery to be as risky as Lasik, or more so? Any comments appreciated!

margaret(maggie2003) - 31/03/2003 13:37

Gavinc,just a quick reply to your question.Firstly i am not a doctor,just a consumer of this lasik industry and a person with c omplications following lasik surgery over three years ago,here in Ireland. My knowledge is not as good on PRK and the main difference in surgery is the lack of a flap creation.The healing may be slower and i do know first hand of people with long term night vision complications directly related to this surgery.I run the Irsih support group for these people with lasik and refractive complications,Ron Link is the founder of the www.surgicaleyes website for in depth information ,and i know for a fact having visited him in the USA, that he set up that site following his vision problems after prk. I would strongly advise you to email him on www.surgicaleyes.org to get more information before your surgery,your low prescription does not omit complications.Please tell him Maggie from the Irish support group gave you his email. best of luck. email margaret@jacurranda.ie if you need any more information.

margaret(maggie2003) - 25/04/2003 01:02

The ASCRS 2003 conference which almost all Irish lasik doctors are certified with, issued a 53 page document of seesions relating to Prevention,Recognition,and treatment of PRK,Lasik,and Lasek Complications.It also wrote two paragraphs of Malpractice Prevention Guidelins as the casualties are rising over the globe. It States the Patient should take home the consent form and review it several times before the surgery.Another important point is to explain off label use of lasers on consent i.e lasers that are not approved by The FDA and still under trial,ask your surgeon which laser he uses as some of these are used for hyperopics(longsightedness) and the guidelines for such treatment are now+4.Under consummer protection laws,eg,deceptive trade practices,treble damages are allowed. Anymore information or pre-lasik questions email margaret@jacurranda.ie or if you need support following a bad lasik outcome.

margaret(maggie2003) - 28/05/2003 12:34

Due to the increasing number of complications from lasik eye surgery, and the quest for information for candidates and people with long term vision complications ,a new support and information website has been designed by volunteers and will assist those sufferers and potential candidates in the United Kingdom,Northern Ireland and the Republic of Ireland. margaret@jacurranda.ie. The new infromation website is www.lasermyeye.org

Anonymous - 30/05/2003 09:55

My sister is about to go ahead with corrective surgery next week in a Dublin hospital. I have major concerns and am trying to discourage her. Would like to hear from anyone who has had surgery, both good and bad.

margaret(maggie2003) - 16/06/2003 13:36

All of the above messages and some on another thread here list the positive outcomes of this laser surgery and also unfortunately the complications still suffered by others who continue to need rehabilitation and visual recovery. There is now a volutary website dedicated to helping candidates and casualties here and in the United Kingdom www.lasermyeye.org. You will find all the necessary questions to ask your surgeon prior to surgery and make sure your sister takes home the consent form at least one week pre-op and discusses it with a family member. There is also a n email address if she should require any more details to ask her surgeon or what should be available to her if she needs help after laser eye surgery. best of luck. margaret@jacurranda.ie(Head of Irish support group). Admin..www.lasermyeye.org

christine(kentucky46) - 23/07/2003 18:23

both my sons had laser. one 10 yrs ago .he has slight stigmatism in one eye. the other 6 months ago he is perfect no problems he is very happy with his.they were both done in dublin. the only problem is the tax man. my son had to travel from limerick and pay hotel and taxis to and from hospital. he got tax refund on laser bill but not expences. can anyone advise on that.

Anonymous - 24/07/2003 21:05

IAM VERY SHORTSIGHTED BUT NOT A SUITABLE CANDIDATE FOR LASER SURGERY HOWEVER SURGEON MENTIONED CONTACT LENS IMPLANTATION -I.C.L. I WOULD LOVE TO HEAR FROM SOMEONE WHO HAS INFORMATION / EXPERIENCE OF THIS PROCEDURE.

karlflan - 25/07/2003 15:32

I had PRK laser treatment a number of years ago in London which has been a great success. It costs about 500 Stg per eye at Optimax clinics. I would highly recommend it.

Patrick(emtpat) - 11/08/2003 20:38

I am thinking of having LASIK treatment as an alternative to wearing Glasses, Some of my friends have had it carried out at the Blachrock Clinic and the Mater Private Hospital and are verry happy with the result. My question is is it better to have the two eys operated on at the same time or seperatly. Is there other places that carry out this operation that I can contact in the dublin area.

Anonymous - 09/09/2003 14:38

Has anyone had this surgery in Cork? I am considering LASIK and currently researching into pros and cons.

margaret(maggie2003) - 11/09/2003 00:23

To my knowledge there is no lasik clinic in Cork.Plese feel free to visit our voluntasry website www.lasermyeye.org for pros and cons of this surgery from fellow patients.

paul(gymrun) - 28/12/2003 17:48

Why is it that very often when you see eye surgeons interviewed,including senior eye surgeons who,for example, take stints on a converted airliner which now acts as a mobile eye hospital in many third world countries exclusively for the removal of cataracts and other simple procedures like that,nearly all,if not all the Doctors/Surgeons are still wearing spectacles/Glasses?...Obviously,If laser eye surgery was so good and reliable and they are the experts,....Yes! You've guessed it,Why have'nt they had it done?...remember, they are the top eye surgeons of the world!

Anonymous - 05/01/2004 10:23

i need to have my vision corrected before I join the gardai as this is the only thing stopping me at the moment. is there anyone who has had a similar experience, and what did they do?

Anonymous - 14/01/2004 12:59

Three of my family members have undergone Lasik surgery in the last year(in Ireland). One in her 70s and two in their 30s and in all cases with great success and no complications. Two were done in the Wellington Eye clinic and one in the Blackrock clinic.

margaret(maggie2003) - 09/02/2004 18:02

In London tomorrow a delegation of eight consultants involved directly with laser eye surgery and One independant Patient Advocate, are meeting before Parliament to discuss legislation to safeguard and regulate laser eye surgery in the United Kinkdom.Each Representative will have an eight minute time frame to take the floor on their speciality and this will be a landmark to help bring in these safeguards and regulate the Irish laser eye industry.We have sought this legislation for the past four years due to the rising number of casualties from this cosmetic surgery. BBC will broadcast this on February 11 2004. The website nominated is lasermyeye as it is totally independant and was established by Rebecca Petris (in London) and Margaret Dolan (Ireland) to help casualties and inform potential patients about all aspects of this surgery. Will give update, Margaret Dolan,head of irish support group.www.lasermyeye.org 0868261801

Anonymous - 02/03/2004 10:59

I had lasik treatment done on both my eyes in the Wellington Clinic in October last year. It's the best thing I have ever spent my money on. It hurt at first, but my eyes felt great after a few weeks. I'd recommend it to anyone. No more wiping glasses after rain... No more steaming up when you walk inside... No more getting in the way if you're reading in bed... No more getting in the way of your day to day life! It's great!

Anonymous - 29/03/2004 09:38

Hello I was wondering if there is any way to find out the risk statistics for a particular surgeon who performs laser eye surgery. I have booked in to get the treatment done next week and am becoming increasingly nervous the more I read about it. Kind regards

Anonymous - 05/04/2004 00:12

to christine(kentucky)46 I have a daughter of nine years who has a squint in one eye (her lazy eye).I am considering laser surgery at some stage to correct this.However an eye specialist has said that because she has 3D vision in this eye she would'nt recommend it.Any thoughts from anyone.Did your son have something similair and is it very traumatic for a child to have it done.I am also from Limerick so I would have the same expenses.Incidentally how much does it cost and why is it not covered by health insurance.Any advice appreciated. Yours MM

niamh(nosinator) - 07/04/2004 08:59

I underwent laser eye surgery in an eye clinic last year and it\'s the best thing I have ever done. I found the staff very professional and there were many tests performed (including test for dry-eyes) on my eyes and I was warned of possible complications beforehand, and I know of one person who was rejected for the treatment in this clinic because of dry-eye who got the laser surgery in London. The clinics that don\'t warn poeple of the possible side-effects, or who don\'t carry out proper tests should be shut down by the health authorities as they are a danger to the public.

Ann(annmkavanagh) - 07/04/2004 18:55

I had it done on rt eye 5 yrs ago for myopia + astigmatism - I was -7. I had to have it repeated a yr later as my sight had gone cloudy. The same thing happened again so no more repeats. It HAS improved in so far as I'm now only -1.5, but have a bit of difficulty in dusk or darkness. Driving at night is out as it's haloes round lights. But I don't regret having it done as I knew there was a slight risk 'cos of the astigmatism: my eye kept going back to it's original shape. I wish anyone luck gettting it done - not painful but a big decision and hope it's more successful now.

Anonymous - 25/04/2004 13:50

I am due to have lasik surgery in a few weeks in the Mater Private in Dublin. Has anyone been treated by Dr. Susan Fitzsimons ? If so how did it go? I'm extremely nervous about the operation and would appreciate some feedback about the Mater Private and this Surgeon. Cheers

Anonymous - 30/05/2004 11:45

Has anyone had laser surgery in Kilkenny and if so with what results.

Helen(HelenCC) - 31/05/2004 09:44

Had lasik in Cork at start of March. Had mild dry-eye but nothing too uncomfortable. Otherwise delighted with the outcome.

margaret(maggie2003) - 31/05/2004 14:40

Abstract

Objective

Most procedures to treat refractive error are based on laser surgery, but other techniques are available. We review the relative advantages and the risk associated with the different surgical options.

Areas of agreement

Laser refractive surgery is now a safe and effective alternative to glasses or contact lenses.

Areas of controversy

Because refractive surgery is an area of rapidly developing technology, the relative benefits of the different surgical options remain uncertain.

Areas to develop research

Controlled trials are needed to provide better guidance as to the relative merits of the different surgical options. Better interventions are required to minimize the biological response after laser surface treatment to eliminate the need for mechanical cutting of a flap for laser in situ keratomileusis. An effective surgical treatment for presbyopia is awaited.

cornea, refractive error, refractive surgery, excimer laser

Introduction

There have been dramatic advances in refractive surgery over the last two decades and it is still a rapidly developing area of ophthalmology. Short sight is the most common type of refractive error in people under 45 years of age.1 In most cases, this can be corrected by permanently changing the radius of curvature of the external surface of the cornea to adjust the focusing power of the eye. A high-energy ultraviolet excimer (excited dimer) laser can remove minute amounts of tissue (0.2 µm per pulse) from the corneal surface by a process called photoablation. Most refractive surgery is performed using a ArF gas-filled excimer laser (λ = 193 nm), although solid-state lasers (λ = 213 nm) have also been evaluated.2 Other types of refractive error, such as long sight and astigmatism, can also be corrected with this method.3 Intraocular lens implantation surgery is an alternative intervention that is usually reserved for higher levels of refractive error that cannot safely be corrected by laser. Newer developments in refractive surgery aim to preserve or restore reading vision in older patients (Fig. 1). The purpose of this review is to describe the techniques that are available, the indications for treatment and the clinical results in terms of safety and visual outcome.

Fig. 1

Typical notation of refractive prescription provided by an optician. In the right eye, there is 2 D of myopia with one dioptre of astigmatism at axis 20°. The dioptre (D) is the unit used to describe the power of a corrective lens or the refractive error of the eye. There is no requirement for a near prescription for reading.

Fig. 1

Typical notation of refractive prescription provided by an optician. In the right eye, there is 2 D of myopia with one dioptre of astigmatism at axis 20°. The dioptre (D) is the unit used to describe the power of a corrective lens or the refractive error of the eye. There is no requirement for a near prescription for reading.

Refractive errors

The curved interface between air and the tear film on the external surface of the cornea contributes almost two-thirds of the 60 dioptres (D) of total refractive power of the eye. The more curved the corneal surface, the greater the focus power. The crystalline lens within the eye provides the majority of the remaining power, as well as enabling the eye to change focus to view near objects (accommodation). When a distant object is fixated, light should be brought to a focus at the fovea of the retina; this is termed emmetropia. If light is brought to a focus in front of the retina in the relaxed state, the eye is short-sighted (myopic) and distant objects are blurred while close objects are in focus. This can be corrected with a concave lens that is thinnest in the centre. When light is brought to a focus beyond the retina, the eye is long-sighted (hyperopic), and distant objects are clear or blurred but near objects are more blurred. This is corrected with a convex lens that is thickest in the centre. If the radius of curvature the cornea is different in the vertical and horizontal meridians light cannot be brought to a focus at a single point without the addition of a cylindrical lens (astigmatism). When, with age, the lens within the eye can no longer accommodate to bring a close object into focus, the eye is said to be presbyopic, a condition that is corrected by readers. Although the prevalence of refractive error varies in different ethnic groups, myopia being particularly common in some Asian groups, the most frequent error is low myopia with astigmatism.1 This type of refractive error is usually readily amenable to treatment using laser refractive techniques.

Measurement of vision

A Snellen chart viewed at 6 m (20 feet in the USA) is commonly used. A normal visual acuity is defined as 6/6 (20/20), although the majority of young people can read two lines better (6/4). The UK driving licence requirement is slightly worse than 6/9 (one line less than ‘normal’). The Snellen chart uses high contrast images and if used to assess outcomes after laser surgery, it will underestimate any effect of glare.

Laser refractive surgery

Techniques

Laser refractive surgery must treat the fibrous layer of the cornea (stroma) if it is to have a permanent effect. Techniques can be classified as either surface treatments, in which the epithelium is mechanically removed before the underlying stroma is treated, or laser in situ keratomileusis (LASIK), in which a hinged flap of stroma is cut and reflected before treatment is applied to the exposed stromal bed, after which the flap is repositioned.4,5 The surface treatment techniques can be subclassified as follows according to the method used to remove the epithelium. In photorefractive keratectomy (PRK), the epithelium is abraded and discarded, whereas in laser-assisted subepithelial keratectomy (LASEK) and epiLASIK, the epithelium is reflected intact as a sheet following the brief application of dilute ethyl alcohol or mechanical stripping, respectively, after which the epithelial flap can be replaced or discarded.6 In LASIK, a flap of 120–180 μm thickness (the normal minimum central corneal thickness is ∼520 μm) is cut either by an oscillating blade in a microkeratome or by a femtosecond laser (Nd:YLF laser, λ = 1053 nm).7 Because there is minimal disturbance to the surface epithelium during LASIK, there is minimal post-operative discomfort, little stimulus for scar formation and rapid visual recovery when compared with surface treatment. However, all the treatments use the same type of laser.

The patient's perspective

The principal difference between surface treatment and LASIK lies in the speed of visual recovery and the discomfort associated with the procedure. Following surface treatment, if the epithelial flap is discarded, there is a large central epithelial defect that must regenerate. This takes a minimum of 3 days, during which the eye may be uncomfortable, photophobic and blurred. Symptoms are reduced if a bandage contact lens is worn continuously until the cornea has re-epithelialized, and topical anaesthetic drops may also be used under supervision. Even if the epithelial sheet is replaced (i.e. after LASEK or epiLASIK), it is uncertain whether the epithelial cells survive and this may actually increase the time until the eye is comfortable, with no proven benefit for refractive outcome. After bilateral sequential surface treatments, a patient typically requires a week off work, whereas after LASIK, the epithelium is intact within hours, and the rapid visual recovery means patients can often return to work within 48 h. The convenience of LASIK has helped it become the most popular option.

Prevention of scar formation

Laser refractive procedures remove tissue and thin the cornea. The natural response of the body is to replace this lost tissue. Any regenerated (scar) tissue is initially hazy, which can cause light scatter, visual loss and a loss of the refractive effect. Early after the introduction of PRK, it was recognized that correcting higher refractive errors meant more tissue was removed with an increased risk of scarring. However, after LASIK, when the wound is immediately covered with an intact layer of epithelium and stroma, there is less scarring and the induced change in refraction is more stable. However, balanced against this advantage, the creation of a flap for LASIK requires expensive instrumentation and additional surgical skills when compared with surface treatment and there is a small risk associated with cutting a flap. In parallel with the development of LASIK, there have been improvements in the techniques of surface treatment, notably, the introduction of the topical antiproliferative agent mitomycin C 0.02% which is applied to the wound for 10–60 s after surface treatment to inhibit the scarring response. The range or refractive errors treatable by surface treatment or LASIK are now similar. Interestingly, because cutting a stromal flap for LASIK may actually introduce optical error, there has been a renewed interest in surface treatment.8

The treatment process

Laser refractive procedures are usually performed bilaterally at a single outpatient procedure. After instillation of a topical anaesthetic and an antiseptic (e.g. povidone iodine), a speculum is inserted to keep the eye open. The patient does not need to hold the eye open during treatment or avoid blinking. Most lasers have an infrared tracking mechanism that locks onto the pupil image and adjusts the beam position up to 4000 times per second to follow eye movements, and if fixation is lost, the laser treatment is stopped. Integrated iris recognition software rotates the treatment to correctly align the axis of astigmatism. These developments have greatly reduced the risk of a decentred ablation. The treatment is almost painless, although a smell of burning accompanies tissue ablation.

Wavefront-guided treatment

Conventional refractive surgery aims to correct refractive error as defined by the spectacle prescription. However, more subtle optical errors are always present. These higher order aberrations usually only account for 2–5% of the total refractive error. The aberrations are measured by determining how a linear wavefront of light is altered as it enters or leaves the eye, typically detected with a Schack–Hartmann microlens aberrometer. This information is then linked to the laser platform for treatment. In practice, despite the supposed accuracy of the information, most surgeons then incorporate ‘fudge factors’ to adjust for discrepancies between the wavefront measurement and the spectacle correction. Wavefront treatment removes more tissue than conventional treatment and the benefits have been questioned. The principal reservation is that a single image is used to calculate the treatment, although higher order aberrations fluctuate rapidly over time. It is not even certain that patients can appreciate the subtle improvements in vision achieved if higher order aberrations are eliminated.

Pre-operative patient selection for laser surgery

General points

This is an opportunity to identify patients who are at risk of complications or a poor visual outcome. Evidence (e.g. optician reports) should be provided that the spectacle refraction has been stable to within 0.5 D for the previous 3 years and most surgeons apply a lower age limit for treatment of 20 years to ensure eye growth is complete (Fig. 2). Treatment should be deferred if patients are pregnant or breast-feeding. Some systemic diseases (rheumatoid arthritis, diabetes and HIV-AIDS) are relative contraindications for treatment unless the disease is well controlled.9 The high electronic charge produced by an excimer laser means that patients with a pacemaker cannot be treated unless the laser is shielded.

Fig. 2

Suggested algorithm for the surgical management of refractive error. The values of refractive error that determine management thresholds may vary between patients. IOL, intraocular lens; RLE, refractive lens exchange; ICL, intraocular contact lens; PRK, photorefractive keratectomy; LASEK, laser-assisted subepithelial keratectomy; LASIK, laser in situ keratomileusis.

Fig. 2

Suggested algorithm for the surgical management of refractive error. The values of refractive error that determine management thresholds may vary between patients. IOL, intraocular lens; RLE, refractive lens exchange; ICL, intraocular contact lens; PRK, photorefractive keratectomy; LASEK, laser-assisted subepithelial keratectomy; LASIK, laser in situ keratomileusis.

Specific occupations

Patients may seek treatment to fulfil the visual requirements for entry into the armed forces, police or the fire brigade. Regulations can vary even between regions, so patients should confirm that refractive surgery is acceptable before undergoing treatment and whether there are restrictions on the type of treatment that can be performed. Patients at risk of ocular trauma, e.g. combat forces or contact sportsmen, are normally advised to have surface treatment because of the risk of traumatic flap displacement after LASIK.10 Military aviators who develop low refractive error are also recommended to have surface treatment because of the risk after LASIK of experiencing dry eye symptoms when flying in un-pressurized aircraft at altitude. The requirements for civil pilots also vary, but the UK Civil Aviation Authority does not recommend refractive surgery to obtain certification. A certified pilot is considered ‘temporarily unfit’ for 3 months after LASIK and for 12 months after surface treatment. Recertification then requires a favourable ophthalmologists report on the refractive and visual outcomes.

The ocular examination

Before measurements for surgery are taken, it is recommended that soft contact lenses are left out for at least 1 week and rigid contact lenses left out for at least 2 weeks. This is because a contact lens can mould the cornea and change the refraction. Measurements then include the refractive power of the eye, the shape and radius of curvature of the cornea, the pupil diameter in dim light and the thickness of the cornea. Autorefraction and wavefront sensing should corroborate these results, and any discrepancy or hyperopia re-evaluated after the focus of the eye has been temporarily paralysed with cyclopentolate 1% drops. A careful assessment of corneal shape is required to exclude keratoconus, which is an inherited and progressive corneal thinning disorder that can be dramatically exacerbated by laser treatment. If a clinical assessment of the tear film suggests dry eye, an objective measurement (Schirmer test) should be performed. Conditions that may increase the risk of infection or inflammation (e.g. blepharitis) should also be treated before surgery. Treatment is contraindicated if there is a history of herpes simplex corneal disease because surgery may re-activate the disease. The lens and retina should be examined to detect early cataract or retinal disease that could affect visual outcome. Patients with glaucoma may be suitable, although the thinning of the cornea produces a spuriously low reading for intraocular pressure after treatment that needs to be taken into account at subsequent assessments.

Patient goals and expectations

Patients should have realistic expectations of laser refractive surgery. The treatment is unlikely to improve vision beyond the best acuity they can achieve with a contact lens or glasses before treatment. The goal should be functional vision, which can be defined as the ability to perform daily tasks such as driving, work or recreation without feeling visually restricted. The acuity needed to achieve this independence will vary between individuals, and requirements should be discussed before surgery. A general guideline for outcome is that 90% of patients will experience a 90% reduction in their refractive error, which, for a patient with a pre-operative myopic refraction of −7 D would result in an outcome of −0.7 D or less, which would probably give the acuity needed for driving unaided (Table 1).11 Presbyopic patients (>45 years) must understand that they will still have to wear glasses for reading. However, by leaving the dominant eye emmetropic and the non-dominant eye slightly myopic (e.g. −0.75 D), it is possible to reduce the reliance for reading glasses (termed monovision). Reduced depth perception and blur mean that monovision is not always tolerated and this option can be evaluated as a contact lens correction before treatment is performed.

Table 1

Outcomes of laser refractive surgery using pooled data from studies reported by the US Food and Drug Administration agency and the National Institute of Clinical Excellence.

Treatment method Pre-operative refraction (D) Outcome measure 
±1 D (%) ±0.5 D (%) UVA ≥ 6/12 (%) UVA ≥ 6/6 (%) Loss of acuity of 2+ lines (%) 
LASIK3,110 to −7 96 81 96 72 
−7 to −12 80 61 89 48 
LASEK3,11Grouped data 74 94 74 
PRK11Grouped data 71 94 61 
LASIK3,110 to +6 90 67 90 63 
LASIK13,15Grouped data 91 77 0.6 
LASEK13,15Grouped data 92 75 
PRK13,15Grouped data 89 69 0.5 
Treatment method Pre-operative refraction (D) Outcome measure 
±1 D (%) ±0.5 D (%) UVA ≥ 6/12 (%) UVA ≥ 6/6 (%) Loss of acuity of 2+ lines (%) 
LASIK3,110 to −7 96 81 96 72 
−7 to −12 80 61 89 48 
LASEK3,11Grouped data 74 94 74 
PRK11Grouped data 71 94 61 
LASIK3,110 to +6 90 67 90 63 
LASIK13,15Grouped data 91 77 0.6 
LASEK13,15Grouped data 92 75 
PRK13,15Grouped data 89 69 0.5 

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Treatment limits

The amount of refractive error that can be corrected by laser is determined by the curvature and the thickness of the cornea. If the cornea is steepened or flattened excessively, the image quality is degraded, and if too much tissue is removed, the cornea can be structurally weakened. The higher the refractive error that is corrected, and the wider the treatment diameter, the more tissue is removed.12 The residual thickness after LASIK should be at least 250 μm, which equates to a maximum treatment of about −10 D of myopia. Correction of more than +6.0 D of hyperopia is associated with a loss of best-corrected visual acuity and tear film instability.

Safety and outcome of laser refractive surgery

The rapid evolution of laser refractive surgery makes it difficult to compare current practice with many published results. However, there are several reports that suggest that LASIK is safe and effective for the correction of low-to-moderate myopia (−2 to −7 D) and for moderate astigmatism (<2 D).13,14 On the basis of a systematic review of the literature, the UK National Institute for Clinical Excellence reached similar conclusions.15 For high myopia (greater than −7 D), the results are more variable. For low-to-moderate hyperopia (less than +6D), LASIK is also effective and safe.16 Similar systematic reviews of outcome and safety after surface treatment (LASEK and epiLASIK) are in progress.

Complication of laser surgery

Visual symptoms

Excessive residual refractive error is the most common optical risk of refractive surgery. In most series, 2–4% of patients are dissatisfied enough with their vision to request re-treatment (enhancement). However, because the risks of re-treatment are similar to primary treatment, but the gain is less, most surgeons will hesitate before attempting to correct less than 0.75 D of residual error. Re-treatment is usually delayed for at least 1 month after LASIK (up to 6 months after surface treatment) to ensure that the refraction is stable, and it is then only be possible if there is sufficient residual corneal thickness. Re-treatment is easy to perform after LASIK as the original LASIK flap can usually be re-lifted even after years, and there is also minimal discomfort and rapid visual recovery. Re-treatment after surface treatment is less predictable because there is a greater stimulus for subepithelial scarring, which can affect the accuracy of the visual outcome. New visual symptoms such as difficulty in driving at night have become uncommon (<5% of eyes) because modern lasers treat up to 8.5 mm diameter on the cornea. However, glare can still occur if the treatment is not centred on the cornea, if there is post-operative scar, or if the LASIK flap is displaced.17 After LASIK for low-to-moderate myopia, ∼0.5% of treated eyes lose a line of corrected visual acuity, compared with 0–2% of eyes after similar treatment for hyperopia (Table 1).

Physical complications

Minor physical complications after laser refractive surgery include subconjunctival bleeding from the microkeratome fixation ring during LASIK, discomfort and epithelial abrasion. Microwrinkles in the repositioned flap and small foreign bodies under the LASIK flap are common, but of no measurable visual consequence. Transient dry eye is the most commonly reported symptom after LASIK occurring in 25% of patients.18 Dry eye develops because the superficial corneal nerves are cut and hence the corneal sensation and the supply of neurogenic cytokines to the epithelium are reduced. Restoration of tear flow returns over 4–6 months after LASIK as the nerves regenerate,19,20 with faster recovery after surface procedures.21,22

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