By JANE E

By JANE E. BRODY

Dr. Mark Shulman, first fitted for glasses at age 5, was never happy about his dependence on them. They would fog up in winter or get clouded with sweat in summer when he pursued the outdoor activities he loved. To see clearly when he did his daily swim, he needed prescription goggles. Contact lenses didn't work for him. So at age 61 he invested about $5,000 in laser surgery to correct his myopia and astigmatisms by reshaping his corneas and to enable him to do everything but read without glasses.

Dr. Shulman, a retired professor of meteorology living in Woodstock, N.Y., couldn't .be more delighted. His distance vision is now better than 20/20. He sees well at night and can drive without glasses despite a slight loss of depth perception.

Reports in the medical literature say that as many as 98 percent of patients have results as good or nearly as good as Dr. Shulman's. Dr. David Wallace, of Santa Monica, Calif., said: "People's response to the procedure is an overjoyed, almost child-like rediscovery of their capacity to participate fully in life's activities without the restrictions of optical devices. It doesn't just change eyesight; it literally changes lives."

But growing numbers of patients are warning others to weigh the risks very carefully before proceeding. Many say they were not sufficiently warned about what could go wrong and that mishaps, when they occur, may not be correctable by wearing glasses or contacts.

Some complain of seeing halos around lights, or of starbursts, clouding, dry eyes or impairment of night vision,-though these conditions may be temporary.

To counter these shortcomings and stimulate research to correct visual problems that surgery can sometimes cause, a grass-roots group in New York called Surgical Eyes has been formed and a Web site established (www.surgicaleyes.org) where people with unsuccessful surgery can post their problems.

What's Involved

Laser vision correction is a major growth industry, with the number of patients nearly doubling annually. Close to a million people in this country will undergo the surgery this year. It can now be used to correct nearsightedness (myopia), astigmatism and farsightedness (hyperopia).

Laser surgery is considered a significant improvement over the original technique that involved making eight surgical slits in the cornea to change its shape. The laser method starts by either abrading the outer layer of the cornea (a technique called PRK, for photorefractive keratectomy) or slitting the cornea at one edge and lifting up a flap (a technique called LASIK, for laser in-situ keratomileusis), then using a computer-guided cool beam of an excimer laser to precisely sculpt the surface of the cornea according to the correction needed to produce 20/40 visual acuity or better. After the surgery the outer layer of the cornea grows back in about a week (in PRK) or the flap reattaches itself in a few minutes (in LASIK).

The entire operation, usually done on one eye at a time (the second is done a week or two later as a precaution against infection), is performed on an outpatient basis with local anesthetic. It takes about 15 minutes. There are no sutures or patches, but PRK patients must wear a bandage lens until the corneal surface reforms. LASIK, the latest twist on corneal reshaping, is said to be painless, with only mild stinging and scratchiness for a few hours after the anesthetic wears off. However, patients are cautioned to protect the operated eye and to use antibiotic and anti-inflammatory drops for about a week. Full vision improvement and stabilization takes several weeks to months. In some cases, a second operation is needed to improve the correction.

Laser surgery is clearly not for everyone. The greater the degree of correction needed (in other words, the more severe the myopia or hyperopia), the more likely there will be complications. People with large pupils and extreme astigmatisms, like Mr. Ferro, are also more likely to have post-surgical problems. Also, ophthalmic surgeons will not operate on eyes that are not healthy to start with or on people with certain health problems, including autoimmune diseases, unstable diabetes, uncontrolled vascular disease, chronic herpes infections, connective tissue disorders or a tendency to scar excessively. Patients should be at least 21 years old, have stable vision and a strong desire to be free of glasses or contact lenses.

There is also the money factor. Because nearly all insurers consider the surgery a cosmetic procedure, most patients must pay for it entirely on their own -- to the tune of about $2,200 an eye. Follow-up exams are required at specific intervals, most of them performed by the referring eye specialist. Sometimes they are included in the cost of surgery, but otherwise they can add significantly to the cost.

Patients must realize that the surgery, even when it results in 20/20 distance vision, does not mean they will be free of corrective lenses forever. Laser surgery cannot correct presbyopia, the loss of clear close-up vision that occurs in everyone after age 40. Presbyopia results from an inflexibility of the lens of the eye, not a misshapen cornea. In fact, most people who are myopic and undergo laser surgery will eventually have to use reading glasses that they might have avoided had they stayed myopic.

A Planned Approach

Careful preoperative homework and consultation is important for everyone considering laser eye surgery to correct visual acuity. Dr. Shulman said he attended a seminar where he was well briefed on what was involved and the risks, including statistics on how often complications occurred. No pressure was put on patients to go ahead with the procedure if they were fearful or did not feel they were good candidates, he said. He also had confidence in the surgeon, who had done nearly 1,000 eyes before operating on his. If you are considering the surgery, be sure you will not be a guinea pig for a surgeon who has done only a few procedures before yours.

Also, if the surgeon you consult doubts your eligibility for the procedure, don't push to have it done anyway or go shopping for another doctor. The effects of laser surgery are permanent, and if things go wrong, you could end up with uncorrectable vision problems far worse than those you started with.