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Laser eye surgery: experts prescribe caution

Laser eye surgery: experts prescribe caution

December 1, 2000
Web posted at: 7:10 p.m. EST (0010 GMT)

(CNN) -- The rapid growth of laser eye surgery has given those with blurry vision lots of choices.

But experts warn it's up to consumers to find out about the doctor who's going to be operating on their eyes and explore the problems they might expect after the popular procedure.

"LASIK is the most popular surgery in America," said Dr. Stephen G. Slade, an expert in refractive eye surgery and author of a new book, "The Complete Book of Laser Eye Surgery." "The procedure is very effective but it's not perfect as a surgery."

LASIK -- Laser-Assisted In Situ Keratomileusis -- is a procedure that uses a laser to change the shape of the cornea to correct nearsightedness, farsightedness and astigmatism. But the hi-tech surgery should come with a warning label: unbiased, hype-free information about LASIK is hard to come by, according to The Food and Drug Administration.

To help clear up the misinformation, the FDA launched a Web site this week for those considering having their peepers become part of the 1.4 million eyes to get LASIK this year. The site,, offers accurate consumer information, says David Feigal, who runs the FDA's Center for Devices and Radiological Health.

A similar site on cosmetic breast surgery -- - had some 100,000 document downloads just during the month of September, Feigal said.

The FDA LASIK site offers basic information about the procedure and older surgical methods that reshape the cornea, including radial keratotomy (RK) and photorefractive keratectomy (PRK).

The excimer laser, used in LASIK, was developed in the 1980s and entered clinical trials in 1987. Slade, along with Stephen F. Brint in the early 1990s, was the first to perform the procedure in the United States and now worries that high volume, lower cost laser surgery centers are giving the business a bad name.

The FDA, too, worries about companies competing with qualified ophthalmologists, sometimes by opening offices in shopping malls. Laser eye surgery heavy hitters such as Bausch & Lomb Inc., Visx Inc., Summit Technologies, Lasik Vision and Laser One share the market with small providers. Prices range from $499 to $3,000 per eye.

The FDA site outlines the risks -- the possibility of permanent vision loss, the need for additional treatment or eyeglasses to achieve 20/20 vision and the chance that improvements may not last forever. Those risks sound scary, said Dr. Daniel S. Durrie, a spokesman for the American Academy of Opthalmology, but it's a dose or reality that patients need to hear. He adds that consumers should look into whether their doctor is an experienced refractive surgeon, or just doing eye surgeries to add to a resume and keep business alive.

Durrie, who usually charges LASIK patients closer to the $3,000 range, is the director of refractive services at the Hunkeler Eye Centers, in Overland Park, Kansas. His center is among the offices where thousands of surgeries are performed each year, allowing doctors such as Durrie and others to claim, based on U.S. regulations, post-surgery complication rates of less than one-half percent.

"There is that sense that commercialization leads to the trivialization of truly skilled surgeons," Durrie said. "But it's inevitable that this industry is going to offer a range of cost to its customers." Reputable providers of laser surgery should also turn away patients who would be unlikely to benefit from it.

In the LASIK surgery now used almost exclusively, the surgeon cuts a flap on the cornea's surface, lifts it and uses the laser to burn away some cells and etch the prescription inside the cornea before replacing the flap.

Different kinds of lasers are used in the procedure, with some designed for different degrees of cuts or to accommodate patients with differing shaped pupils.

Feigal said it's up to the FDA to license the equipment and make sure it's safe and effective. The new Web site lists eight approved lasers for LASIK and 16 for the other surgeries like PRK or to correct farsightedness, called hyperopia with astigmatism.

Next year, LASIK is expected to be performed on 2.3 million eyes. The surgery gives some people 20-15 vision, but others wind up with 20-40. The 20-40 standard is often what's required to pass a motor vehicle driver's license test.

Beware, the FDA warns, of eye centers that advertise "20/20 vision or your money back." There are never any guarantees in medicine.

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American Academy of Ophthalmology
FDA - Laser Eye Surgery
Federal Trade Commission
The University of Mississippi Medical Center
Hunkeler Eye Centers
American Academy of Ophthalmology

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