THE WALL STREET JOURNAL

© 2004 Dow Jones & Company. All Rights Reserved
TUESDAY, JANUARY 6, 2004     VOL. CCXLIII NO. 3

 

Aches & Claims / By Rhonda L. Rundle

 

The New Wave of Eye Surgery

 

LASIK: free consultation - $499 per eye." Teaser ads such as this one promote the erroneous view that laser eye surgery is so simple that buyers should shop for the low­est price.

 

The introduction during the past year of wavefront technology, often called "custom" lasik, has spurred even higher expectations for perfect vision. Developed by astronomers to correct atmospheric distortions, in light waves, wavefront technology has been adapted to map the human eye, and then to customize laser soft-ware before vision-correction surgery.

Studies show that such wavefront­guided lasik can reduce the chances of post-surgical complaints such as night-vision problems, halos and related side effects.  But wavefront doesn't change the risks of conven­tional lasik, which is short for "la­ser-assisted in situ keratomileusis." The procedure still requires a surgi­cal incision to create a flap on the cornea that can become infected, causing permanent damage in the eye. The flap is folded back to ex-pose underlying tissue that is re-shaped by the laser pulses.

 

Better Results Are Reported

Data submitted by laser makers to the Food and Drug Administra­tion prior to wavefront marketing approvals show that patients "had sig­nificantly better results in vision quan­tity and quality," says Glenn Hagele, founder and executive director of the Council for Refractive Surgery Quality Assurance, a nonprofit organization in Sacramento, Calif. However, "even with the best doctor and the best technology you can have undesirable results. There are no guarantees," he cautions.

 

People who are considering laser surgery should be aware of the poten­tial problems. Web sites, including sur­gicaleyes.com and lasikdisaster.com, of­fer up horror stories.,Mr. Hagele's orga­nization operates two sites, usaeyes.org and complicatedeyes.org, which are re-sources for people seeking a surgeon or treatment for a post-surgical problem.

 

There's a lot of controversy surround­ing estimates of lasik complication rates, which generally cluster around 3%. Such estimates, however, rarely in­clude patients who have undergone "enhancement," a second procedure to improve initial results. Some refrac­tive surgeons say that wavefront is reducing the number of unhappy cus­tomers by tailoring surgery to the individual eye and by helping iden­tify poor lasik candidates before they are treated.

 

Procedure Isn't for Everyone

Wavefront typically adds $100 to $400 to the cost of conventional lasik, which runs from $500 to $2,500 per eye. There also are differ­ences among the wavefront and la­ser systems sold by Alcon Inc., Visx Inc.. and Bausch & Lomb Inc. Some systems may be better for some pa­tients, depending on their eyes.

 

One reason that the best lasik surgeons tend to have happy pa­tients and low complication rates is that they decline to treat people who are poor lasik candidates. Peo­ple with very dry eyes, thin cor­neas and large pupils are problem­atic, for instance. And the surgery may be a bad idea for nearsighted people over 40 who simply remove their distance glasses in order to read close up.

"Lasik is a miraculous proce­dure, but it has been overly simpli­fied and overly sold. It is in fact a very complex medical procedure;" says Andrew Caster, an eye sur­geon in Beverly Hills, Calif., and au­thor of a book about lasik. He says he turns away about 30% of the peo­ple who come to him.