Chat transcript: H. Kaz Soong on eye surgery

(CNN) -- The following is an edited transcript of a chat with Dr. H. Kaz Soong of the University of Michigan Kellogg Eye Center. Soong joined us from the University of Michigan.

Chat Moderator: Welcome to the second of our weeklong series of Health Chats on eyesight, procedures and the future. Our special guest today, Dr. H. Kaz Soong, is here to discuss medical procedures to correct vision.

Chat Moderator: Welcome to chat, Dr. Soong. Thank you for joining us today.

Chat Host: Welcome, everyone, and welcome Dr. Soong.

Dr. Soong: Hello, everyone. Sure glad to be here, and to help you.

Question from wrt: Are there records on the specific success rates of LASIK surgeons?

Dr. Soong: Most LASIK surgeons keep a running tally of their surgeries and results, mainly for their own edification and for research purposes. However, I doubt that these records are easily available to the general public.

Question from OB: Procedural question: Condition: 90-year-old female with macular degeneration has a sudden increase of sight loss. Can't read or dial the phone. Doctors found a buildup of blood in the back of the eye and tell her there is nothing to be done. Is there nothing to be done because she's 90, or is there something that can be done to correct the blood buildup?

Dr. Soong: This is not my field of expertise, but let me give it a shot. The hemorrhage will most likely take a while to reabsorb. Once it does so, the retina doctor may try to find the source of the bleeding and apply laser to it. Whether the laser will work or not all depends upon the severity, location and other factors. Aspirin and other anti-coagulant medications are sometimes associated with a tendency toward a macular bleed such as this. Whether she is 90 or 60 really has little effect on the outcome.

Chat Moderator: How many of these corrective procedures go wrong, where the patient has vision worse than before the surgery?

Dr. Soong: In general, with LASIK and PRK (both laser procedures), the success rate is extremely high, the highest of any surgery I know. Less than 10 percent of my practice have final uncorrected vision of less than 20/25. The results tend to be stable over time. Less than 1 to 2 percent have scarring, severe glare, etc. Even less have disabling degrees of problems.

Question from Candyce: If a person has the LASIK procedure later in life, say after age 50, does it have to be repeated, or repeated more often than for younger people?

Dr. Soong: No, not really. We have to be more careful in some ways when operating on the older folks, because they cannot tolerate mild overcorrections as well as the younger folks. They also have presbyopia (old vision where your arms ain't long enough), and getting rid of their nearsightedness may actually worsen the near vision. Of course, their near vision can be corrected by wearing stronger reading glasses. So you have gained distance vision but worsened near vision in the older folks.

Question from Errin: Dr. Soong, would you advise someone to go out of the country to get LASIK done if they have been turned down for the procedure by a doctor in the United States?

Dr. Soong: It used to be the case that overseas LASIK surgeons (including the Canadians) had far greater leeway and freedom to do these refractive surgeries, because our Food and Drug Administration put lots of constraints on such surgeries in the USA. They have started to relent much more over the last several years, and I believe the U.S. surgeons are very competent now (maybe cheaper fees too!!)

Question from MDB: I am 48 years of age, moderately nearsighted and am having the typical reading difficulties for someone my age. If I get LASIK, wouldn't I still have to wear reading glasses for any close-up work?

Dr. Soong: Yes, you are quite right. Your condition is called presbyopia, and it is a fact of life. You will need stronger readers for close work (so you will still need glasses in your life). You can try "monovision," which consists of correcting one of your myopic eyes to perfection for distance and correcting the second eye only partially, so you remain slightly myopic in one eye. This way you could avoid glasses. Downsides include not so good depth perception, image size differences between the two eyes. In essence you are "cockeyed."

Question from joey: Have you, or members of your immediate family, had the surgery?

Dr. Soong: Not in the immediate family, but two cousins in the Washington, D.C., area have. I didn't do them myself.

Question from Philo: A few years ago, the U.S. Air Force had a policy of rejecting anyone who had radial keratotomy. Does the military have any regulation regarding LASIK?

Dr. Soong: To the best of my knowledge, there are some services in the military that now allow PRK and LASIK. As a matter of fact, the Navy has some refractive surgeons in their medical corps. FBI service is still hedging on refractive surgery in its candidates, the last I heard. Jet fighter pilots, I am not sure. Better call the specific medical corps for the latest info. Also, if you decide to sneak into the military after LASIK, it would be very difficult for their screeners to find out. There are ways, but it would be difficult.

Question from Philo: If they look at your eye, would it be obvious?

Dr. Soong: The rings are visible if you get really close under proper lighting conditions. Intracorneal rings are visible on very close examination of the eye, but not on casual looking. After removal, a mild scar may sometimes remain but is almost invisible. ICR involves placing plastic rings in the periphery of the cornea, outside the line of sight.

Question from jeffp: I heard that ICR sometimes leads to visible deposits on the cornea. Has this been proven?

Dr. Soong: With intracorneal rings, sometimes a faint deposit may be laid down adjacent to the rings, possibly as an inflammatory reaction by the body (?), but it is rare.

Question from lrp: What happens to the 1 to 2 percent of your patients who don’t have good results? Can they go back to contact lenses? Is their vision worse than before?

Dr. Soong: With LASIK and PRK, contact lens fitting is still possible. This is unlike the older RK (radial keratotomy) procedure, where patients would have a heck of a hard time getting the proper fit for contact lenses.

Question from EWF: Is LASIK the best alternative available? Are there any new procedures coming soon that would be worth the wait?

Dr. Soong: A few institutions in the world (us included) are involved in LASIK that does not require any cutting. This is called intrastromal laser (ultrafast laser) technology. The LASIK flap is made with laser without the need of any cuts that lead to the outside surface of the cornea. It should be at least three to six years before perfection. There are other types of lasers (holmium), insertion of intraocular lenses for refractive correction, and a few other goodies. The latter two are now available to the public.

Question from newyork: What if you sneeze during surgery?

Dr. Soong: A good one!!!!!!! With PRK and LASIK, the chance of creating a boo-boo when the patient sneezes is infinitesimal. The surgeon just stops and waits until the sneezing or coughing spell ends. Hopefully none of the secretions land on the eye. With RK, the older surgery, sneezing or coughing could have devastating consequences.

Question from jeffp: How does one get involved in an intrastromal laser Phase II or III test?

Dr. Soong: I think the best way is to keep your eyes and ears peeled for announcements in the lay and medical media on intrastromal laser clinical trials. The trials have begun overseas already, where the FDA constraints are not in effect. Even in those countries, only blind eyes have been treated so far (no seeing eyes have been allowed yet).

Question from lrp: Is there any reason not to have surgery?

Dr. Soong: The decision to have or not to have refractive surgery should be a solemn, very well thought out and well-researched one. You should not have surgery just because so-and-so had it and is raving about it to you. If you are happy with glasses or contacts, you shouldn't feel obligated to jump on the bandwagon. The results of modern day refractive surgery are tremendously good. However, a small percentage of patients will have less than satisfactory results. Read, cruise the Internet, talk to people.... Be an educated consumer!! Good luck and enjoy.

Chat Moderator: Thank you for joining us today, Dr. Soong!

Dr. Soong: Thank you all for your attention. I wish I could have answered every one of your questions.

Chat Host: Thank you, Dr. Soong!

Dr. Soong: Sorry about the time constraints. Goodbye.