Men's Health: Guide to Getting Lasik

June 28, 2001 -- With Lasik getting more popular and much cheaper, it pays to look hard at the man behind the laser.

This year, approximately 1.8 million people are expected to get it done — and lower prices also encourage more people to see the light. A couple of years ago, Lasik surgery could run up to $5,000. But now, it can be had for as little as $499 an eye, and the guy behind the laser may still be working his way through the owner's manual.

"The dark side of Lasik is that in some cases it has moved from a surgical procedure, which should always be carefully considered and researched, to an impulse buy," says Dr. Roy Rubinfeld, the ophthalmologist in Chevy Chase, Md., who operated on my eyes.

For the most part, Lasik is a safe procedure, resulting in about 98 percent of patients with 20/40 vision or better. The procedure entails using a microsurgical instrument to create a corneal flap that's approximately a quarter of the cornea's depth. Then, a laser beam is used to gently reshape the cornea. When that's completed, the surgeon puts the flap back into place on the eye.

However, the remaining 2 percent have problems. Some get better with a follow-up procedure, but some don't, resulting in permanent vision impairment or loss.

How to Chose a Doctor

If you're considering Lasik, here's a three-step plan to help you become a satisfied customer.

Step 1

Realize that Lasik isn't for everybody. Rubinfeld says you're not a candidate for Lasik if:

You have extreme near- or farsightedness, or severe astigmatism. Doctors consider that your vision impairment is "extreme" if you can't see clearly even with glasses or contacts. The worse your vision is to start with, the lower the chances of successful surgery.

You're under 21. Your vision continues to change as your eyes mature. If you have Lasik at 18, you'll almost certainly need follow-up surgery in your early or mid-20s.

You're over 40 and just want to avoid wearing reading glasses. Middle-aged men generally need help reading small type. The good news: Two pairs of drugstore reading glasses will set you back only 10 bucks.

You have extremely thick corneas, severe glaucoma, or retinal problems. Your eye doctor should be able to tell you if you have these conditions, which would make Lasik a risky proposition.

Step 2

Choose your surgeon wisely. A personal referral is an ideal start. In the absence of that, try referring to the International Society of Refractive Surgery, run by the American Academy of Ophthalmology, or the American Academy of Ophthalmology Web sites. Your optometrist or ophthalmologist might also offer a referral, but be warned: He may have financial incentives to send you to a particular surgeon.

The hands-down worst way to find an eye surgeon is through advertising. With these deep discounters you may see advertised on the subway or newspaper, you never know if they're going to be in business a few months down the road. One example, Lasik Vision, a chain of 28 cut-rate Lasik centers in the United States and Canada, ran out of money this spring, leaving patients and employees stranded.

Step 3

Ask a lot of questions, including:

How long have you been doing Lasik? You want the answer in years, not hours.

How many surgeries have you performed? More than 1,000 is optimal.

What's your complication rate? You want to hear that less than 1 percent of his patients had complications from surgery, and that 5 percent or less required follow-up procedures.

What changes can I expect in my eyes? Most likely, you'll have blurry days, and your eyes may feel dry for three to six months and require artificial tears. You may see halos (the secular kind) or starbursts around objects when you drive at night, and this could last for months, or even years.

How old is your laser? Your doctor should've had his laser upgraded in the past year. Experts say that the newer, "flying spot" lasers improve results.

Who will be doing the surgery? The doctor who examined you and answered your questions about the procedure should be the one performing the surgery. (Often, that's not the case.)

Finally, keep in mind that even the best surgeon can't guarantee a 20/20 outcome. The difference between the best and the rest is that the good surgeons can fix the problems that arise during their procedures. And they'll actually be in business long enough to do so.