Is Laser Eye Surgery Right for You?
By Debra Gordon

Learn More about Laser Surgery

  • All Refractive Surgery Is Not Created Equal! Here's what you need to know.

  • Questions About Laser Eye Surgery to Ask Your Doctor
  • For more than 20 years, writer Pat Curry’s first action upon waking up was to fumble for the glasses she needed to transform an otherwise blurred world. But on the morning of Jan. 3, that routine changed. Just 18 hours after having laser surgery to correct her nearsightedness, Curry, 42, woke to a crystal-clear view.

    A month after the surgery, she says she still catches herself smiling when she realizes she’s seeing something she couldn't see before without her glasses.

    “Sometimes it takes me a moment to realize that I don’t have to find my glasses before I can see what time the clock says, or before I head out the door to run an errand,” she says.

    Curry is just one of 1.8 million Americans each year who are throwing away their glasses and permanently disposing of their contact lenses in favor of a 20-minute operation on their eyes that, in most cases, provides them with perfect or nearly perfect vision. Called “refractive surgery,” the procedure has taken the ophthalmology profession by storm, becoming the most commonly performed laser eye surgery in the nation – even though patients generally pay thousands of dollars out of pocket for the procedure, since insurance seldom foots the bill. And the demand is expected to continue unabated: about 63 million people in the United States are candidates for the surgery.

    “Refractive surgery is popular today because it has such a huge impact on the patient’s lifestyle,” says Marguerite McDonald, M.D., the president of the American Society of Cataract and Refractive Surgery. Dr. McDonald performed the first laser surgery in the world in New Orleans in 1987.

    “While some people want to get rid of glasses or contacts because of their jobs or hobbies – such as scuba diving, sports – others feel as if their glasses were a cane or walker, making them feel truly handicapped,” she says. 

    The boom in corrective eye surgery has turned what is still a surgical – read, potentially risky – procedure into one often advertised as no chancier than getting your teeth cleaned. The fact that patients pay for the procedure themselves (costs vary, but range between $1,500 and $2,500 per eye) and doctors don’t have to fool with insurance companies, has resulted in a kind of free-for-all among some centers, leading to widespread advertising and even price wars designed to attract as many patients as possible.

    But make no mistake: For all its seeming innocuousness, refractive surgery is still surgery. And it’s surgery on one of your most precious organs – your eyes.

    “The biggest mistake people make these days is to shop price only,” says Dr. McDonald. “Refractive surgery has a wonderful track record for safety and efficacy, but it is surgery.

    And the risks are real. The most common side effects include glare, halos and/or double vision that can seriously affect nighttime vision. Other potential side effects include dry eye and undercorrected or overcorrected vision.

    More rarely, the surgery may result in the development of persistent discomfort, corneal infection, permanent vision loss or flap irregularities or dislocation (with LASIK; see “All Refractive Surgery Is Not Created Equal”) or foreign matter under flap (with LASIK).

    That doesn’t mean that patients can’t get good results from one of the discounters, Dr. McDonald says. “But they should know in advance what the experience will be like and what ‘hidden costs’ there may be.”

    Your best bet for finding a qualified surgeon is to get referrals from friends, professional ophthalmology organizations and ophthalmologists who don’t perform the surgery, experts advise.

    Surgery Not for Everyone

    Despite what some ads may suggest, the surgery isn’t for everyone.  You must have healthy eyes with no visually significant cataracts, glaucoma or severe dry eyes, says laser vision correction specialist Sandra Belmont, M.D. Also, people with extreme nearsightedness or farsightedness may not be eligible, especially if they have a thick cornea, a large pupil and/or an eye that isn’t easy to get to. And, for some farsighted patients, the results may diminish with age as their eyes naturally lose focusing power.

    Speaking of Age ...

    Although there is no “ideal” age for refractive surgery, your age may play a role in how well you see after the surgery.

    “People over 40 will still need glasses to read,” says James J. Salz, M.D., a clinical professor of ophthalmology at the University of Southern California, and a spokesman for the American Academy of Ophthalmology.

    As you age, your eye loses its ability to change focus for close-up tasks, a condition called presbyopia, or farsightedness. Often drugstore reading glasses will suffice. But for those who want to dispense with glasses altogether, ask about a procedure called “monovision,” which, basically, turns your eyes into bifocals. One eye – the dominant eye – is corrected to the best possible vision, while the other eye is left slightly nearsighted. The procedure isn’t for everyone; some people can’t get used to having one eye blurred at all times. And some states may not let you pass your driver’s license requirement with monovision.

    But it worked for Molly Danahy, 41. She had been wearing hard contact lenses since she was 11. In the past couple of years, however, Danahy noticed that she had to stand back a little to read things like prices in the grocery store, and her eyes were becoming drier, making contacts more uncomfortable. Since she was going to have to start wearing reading glasses along with her contacts, she figured the time was perfect for the surgery, which Dr. Salz performed.

    He corrected one eye first, then gave her a contact lens to wear in the other eye to approximate the vision she would eventually have. A couple of months later, she had the surgery on the other eye.

    “It does take some getting used to,” Danahy says. “You lose a bit of depth perception, so in certain situations like driving at night or in the rain you might need glasses.” Otherwise, she adds, “you have perfect or near-perfect distance vision. I can read without having to grab glasses and put them on every five minutes.” Eventually, she may need additional surgery to further correct her vision as her eyes continue to age.

    Her favorite part of her new vision? “Swimming!” she says. “I’m just thrilled to be able to see the end of the pool and if other people are in my lane.”

    More about laser eye surgery:

  • All Refractive Surgery Is Not Created Equal! Here's what you need to know.

  • Questions About Laser Eye Surgery to Ask Your Doctor

    Debra Gordon is a freelance writer who specializes in health issues and wishes she was a candidate for refractive surgery.

  • From Get Up and Go, a United Parenting Publication, June 2004.