Ophthalmologists have been using the Excimer laser to correct nearsightedness, farsightedness, and astigmatism, to free patients from the tyranny of eyeglasses and contact lenses, since it was approved in 1995. The procedure, called Lasik – short for Laser In-Situ Keratomileusis – has emerged as probably the most popular elective surgical procedures in the country.
Dr. A. Joseph Rudick, of Associate Ophthalmologists with offices in the Wall Street area and Midtown, is one of New York’s top practitioners of LASIK, having performed thousands of successful procedures. We recently sat down with him to find out what is new in Lasik, what questions patients should ask when selecting a Lasik surgeon, what the risks are, and, in honor of National Eye Care Month, how to take care of our weary eyes in general.
How do you know if you are a good candidate for Lasik?
A good candidate is someone who has a prescription within the recommended range. We can treat patients with prescription of up to -14D. Most surgeons will treat patients with prescription of up to -12D. There are some doctors who would opt to do a clear lens extraction for patients with prescriptions higher than -8D. That is more complicated and has a longer recovery time. It is the procedure for patients with cataracts. The difference between Lasik and clear lens extraction is that clear lens extraction is much more invasive. You are cutting into the eye and extracting the lens.
The other thing that makes someone a good candidate for Lasik is that they need a thick cornea. To correct nearsightedness with Lasik, we flatten the cornea, so it can’t be too flat or too thin to begin with. If you flatten cornea too much, patients have night vision problems. The higher the prescription, the more the cornea is flattened. Everyone has different corneal curvatures to start with, so the numbers are not solely determinant.
Some people have the procedure too early. Their eyesight has not stabilized. Most people’s vision stabilizes in their late 20s. So, if a 23-year-old comes in my office asking for Lasik, I’ll look at their prescriptions and see if they have been changed in the last few years. If you do Lasik too early, the eye could still change.
What should patients be looking for in a doctor who does Lasik? What questions should they be asking?
You need to go to a doctor who is experienced and not just looking to do surgery. Ask what the doctor’s success rate is. It should be 98 to 99 percent for people to be 20/20 or better. You also want to ask what the doctor’s enhancement rate is. That is the need to go back and fine-tune or do touch-up. If a patient needs that, you know within 4 to 6 weeks. Enhancement rate can range from 1 to 15 percent nationally. Ever surgeon is going to have to do some, because you can never predict the exact way someone’s eye is going to react to the surgery. I am proud to say my enhancement rate is less than half a percent. You also want to ask about the complication rate.
What is new in Lasik technology?
The gold standard is custom cornea/wavefront technology, which allows us to take a topographic map of the cornea. Laser can treat nearsightedness or astigmatism and other aberrations that affect the quality of vision. Because of that custom cornea/wavefront technology, we’ve been able to cut down on halos, glare and night vision problems.
What are the most common complaints after Lasik?
The most common is dryness of the eyes. For the majority of patients, that is temporary. It is over in 1 to 2 months. But there are patients whose eyes are too dry for Lasik. If you have sandy or gritty eyes, or photophobia, which is extreme light sensitivity, you don’t want to do Lasik.
The other most common complaint is glare or halos around lights in the evening. For half a percent of people, that is a problem. Other people have night vision problems, especially around dawn and dusk, which is called contrast sensitivity. This affects less than half a percent of patients and all those numbers have gone down because of wavefront technology.