When one of Kristina Alton's contact lenses fell out at her office in New York City, she had to make the hour-long commute back to her apartment to get a replacement. "It was such a disaster," she says. "I just couldn't function without them." That will never happen to Alton, 23, again. After undergoing LASIK surgery at Duke University Eye Center in early June, she now has better than 20/20 vision. "I'll never be [making rounds] in clinic and have a contact fall out and have to leave," says Alton, who recently started medical school.
During LASIK surgery, your ophthalmologist cuts a thin flap on your cornea – the clear, outer layer of the eye – using either a laser or a surgical blade. Once the flap is folded back, he or she uses a cool-beam laser to remove pieces of corneal tissue, sculpting your cornea into the ideal shape to focus light on your retina and create sharp images. The laser is controlled by a computer, preprogrammed by your doctor for your unique set of vision problems. If you're nearsighted, the laser will remove tissue to flatten your cornea; if you're farsighted, it will make your cornea steeper; and if you have an astigmatism, it will trim your cornea to be more spherical. The flap is then closed and eventually heals into a seal.
Patients stay awake for the procedure but are given numbing eye drops and, often, a Valium to relax. Alton says her surgery took just about 10 minutes. And although she could hear the "popping sounds" of the laser and smell pieces of her cornea "burning," she didn't feel any pain, just a little bit of nerves. When the surgery was over, "I remember I smiled so big because I looked up and I could see the ceiling tiles were crystal clear," Alton recalls. It's common to experience fluctuations in vision following the surgery, but Alton did not.
"Any surgery that you do carries risk with it. Fortunately, LASIK eye surgery is one of the safest procedures we perform in all of ophthalmology," says Alton's ophthalmologist, Terry Kim, a professor of ophthalmology at the Duke University School of Medicine, chief of the cornea and external disease division, and director of refractive surgery service at Duke University Eye Center. But like any surgery, it's important to seriously consider the risks and do your research before going under the laser.
Here are a few things to consider if you're contemplating LASIK:
Am I an eligible candidate?
"I'm not going to offer an elective procedure to someone who's not a perfect candidate," says Kendall Donaldson, an associate professor of ophthalmology and medical director at Bascom Palmer Eye Institute in Plantation, Florida. In order to qualify as a perfect candidate, you must have generally normal, healthy eyes. Conditions such as dry eye need to be considered before you can undergo the procedure, as LASIK is likely to exacerbate symptoms. If you have large pupils or thin corneas, which your ophthalmologist will be able to tell you, he or she may recommend a different refractive surgery, such as PRK, to minimize risk of complications. Autoimmune conditions, which can predispose patients to developing dry eye, may also disqualify you, Donaldson says. And if your prescription hasn't been stable for more than a year or you're pregnant, LASIK will have to wait.
What are the potential gains?
"We never guarantee 20/20 vision," Donaldson says, "even though that's what most patients do get." More than 90 percent of eyes (one eye for some patients, two eyes for others) reach 20/20 vision or better, and 99.5 percent get at least 20/40, according to an analysis of articles published between 2008 and 2015. Overall 20/20 vision is considered "perfect" and 20/40 is half as good, but good enough to pass an eye exam at the DMV. If you don't get your desired eyesight after the initial surgery, an "enhancement procedure," which entails lifting your corneal flap and applying a little more laser to tune your vision closer to 20/20, is an option. These procedures are fairly rare and are more commonly needed in those who had worse eyesight to begin with, Donaldson notes.
What are the risks?
Short-term side effects after LASIK are common. A 2014 study by the Food and Drug Administration found one or more visual side effects, such as glares or halos, in around 45 percent of the participants who had no visual symptoms before surgery three months after LASIK surgery, and dry eye in about 28 percent in the same time frame. Still, 95 percent of participants in the study said they were satisfied with the improvements in their vision, and less than 1 percent said the side effects seriously affected their daily lives. Usually these side effects clear up within six months, but in rare cases, they can persist. Kim and Donaldson say more serious complications that can cause vision loss, like inflammation and corneal ectasia, are also possible but occur in less than 1 percent of patients.
"LASIK is one of the few surgeries that we do both eyes on the same day," Donaldson says. For larger surgeries, like cataract surgery or glaucoma surgery, doctors do one eye at a time to mitigate risk. "If we had significant reservations about the safety of LASIK … then we wouldn't be doing two eyes at the same time," Donaldson says. And technologies used during the screening process and the surgery itself are only getting better and safer, Donaldson and Kim agree.
What kind of LASIK surgery should I get?
"All-laser LASIK" or "bladeless LASIK" uses a laser instead of a blade to create the corneal flap. Although the FDA website states that "there is no absolute agreement among eye surgeons on the better choice of flap creation," both Kim and Donaldson consider all-laser LASIK safer.
You can also choose to get "custom LASIK," meaning your eye doctor measures your vision with a "WaveScan" of your eyes and is able to provide more precise guidance for the laser treatment than with the conventional measurement system. "It treats the eye like a fingerprint," Kim explains. "No one else is going to get the same treatment, even though they wear the same glasses or contact prescription." He highly recommends that patients ask for custom LASIK, in addition to all-laser LASIK, as studies have shown it increases the chance of patients getting 20/20 vision.
How much does it cost?
The average national cost for custom bladeless LASIK is about $2,500 per eye. However, LASIK surgery prices can vary significantly depending on your location, the technology used and whether follow-ups and enhancement procedures are included in the price. At Bascom Palmer Eye Institute, the price tag falls right around the national average, $2,500 per eye, and at Duke University Eye Institute, the tab per eye is a little less: $1,950. LASIK is an elective procedure so insurance will rarely help you cover the cost.
How long do improvements last?
The vision gains that patients obtain through LASIK "typically last them a lifetime," Kim says. However, your eyesight can still naturally weaken over time. If your vision becomes significantly worse, you may have to choose between getting an enhancement procedure or returning to an external fix like glasses. According to a 2008 study in the American Journal of Ophthalmology, about 20 percent of people underwent an enhancement procedure 10 years after LASIK. More recent long-term studies are considerably lacking, but experts estimate that enhancement rates are now less than 10 percent or even less than 5 percent. Kim attributes the lower estimates to the technology advances we've made in the last few decades. Meanwhile, presbyopia – the gradual loss of near vision that develops with age – is a condition that everyone, including those who have undergone LASIK, can count on facing around age 40.
The vision gains that patients obtain through LASIK "typically last them a lifetime," Kim says. However, your eyesight can still naturally weaken over time. If your vision becomes significantly worse, you may have to choose between getting an enhancement procedure or returning to an external fix like glasses. According to a 2008 study in the American Journal of Ophthalmology, about 20 percent of people underwent an enhancement procedure 10 years after LASIK. More recent long-term studies are considerably lacking, but experts estimate that enhancement rates are now less than 10 percent or even less than 5 percent. Kim attributes the lower estimates to the technology advances we've made in the last few decades. Meanwhile, presbyopia – the gradual loss of near vision that develops with age – is a condition that everyone, including those who have undergone LASIK, can count on facing around age 40.
This story originally appeared on the US News and World Report website