Frightened by headlines about Lasik side effects? Lasik gets all the advertising, but there are half a dozen alternate eye surgeries from a simpler laser approach to implantable lenses that might solve your squint.
They all have their own risks. A key is finding a surgeon who doesn't have a favorite but is qualified to evaluate patients for all of the options, to find the best fit.
Topping the list is a pre-Lasik laser that's making a comeback thanks to precision-improving computer software. It goes by two names: Surface ablation, or wavefront-guided PRK, which stands for photorefractive keratectomy. What's most important is that it doesn't require cutting a flap into the cornea, the eye's clear covering, like Lasik does, a cut widely considered that procedure's riskiest step.
Tragic testimony before the Food and Drug Administration last week reinforced warnings that Lasik does come with risks: lost vision, painful dry eye, glare and other night-vision problems. Serious complications appear rare, affecting 1 percent or fewer cases, and the FDA estimates 5 percent of patients aren't satisfied with the outcome.
Here's the real rub: One in four patients who seeks Lasik and undergoes a battery of pre-surgery testing is deemed a poor candidate.
Lasik alternatives:
-- With PRK, a laser reshapes the cornea's surface, no flap-cutting needed important because making a flap cuts nerve receptors that critics say never fully return to normal, thus increasing the risk of painful dry eye. The trade-off: Patients occasionally suffered haze as their corneas healed, not a Lasik risk.
The updated version is wavefront-guided PRK, using computer software actually developed to improve Lasik. It lets surgeons map subtle irregularities in the cornea before zapping, providing a three-dimensional map that customizes treatment, minimizing but not eliminating side effects in both Lasik and PRK.
-- CK, or conductive keratoplasty, corrects farsightedness or astigmatism by beaming radiofrequency waves around the cornea's edge.
-- Lasers aside, a hard plastic lens can be implanted through a small incision in the eye, in front of the natural lens. These "phakic intraocular lenses" are for severe nearsightedness, too bad for Lasik and PRK. They refocus light entering the eye for improved distance vision. Because the natural lens stays in place, patients seem to retain close-up vision, too.
-- Refractive lens exchange goes the next step and replaces the patient's own lens with an artificial one. It's essentially cataract surgery offered to some cataract-free people who wanted Lasik but are bad candidates, perhaps because of extreme near- or farsightedness. Lens options include a multifocal type that can allow for both distance and reading vision. Again, retinal detachment is a risk.
-- Finally, corneal rings are transparent crescents about the thickness of a contact lens implanted to form a ring around the cornea's edge. Called Intacs, their slight weight flattens the cornea without permanently destroying tissue. While they're only for mild nearsightedness, they can be removed if patients suffer side effects such as glare.
Lauran Neergaard covers health and medical issues for The Associated Press in Washington.
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