A recent study headed by Dr. Dimitri Azar, field chair of ophthalmologic research and professor and head of ophthalmology and visual sciences at UIC, brings into focus a wide variety of options in laser eye surgery.
Published in the December 2006 issue of the American Journal of Ophthalmology, Dr. Azar's study compares the short-term outcomes for two procedures, laser in situ keratomileusis (LASIK) and laser subepithelial keratomileusis (LASEK).
The study concluded that "although there were some differences in the visual and refractive results that favor the LASEK procedure, the differences were not clinically significant," said Azar. "These results are in line with previous smaller studies that we reviewed comparing the procedures."
According to "Yanoff: Ophthalmology," LASIK is performed first with a keratome to lift the anterior flap of the cornea and then an excimer laser to sculpt the stromal bed, changing the refractive error of the eye. LASEK is a surgical technique that combines features of photorefractive keratectomy (PRK) and LASIK in which a corneal epithelial flap, the top most layer of the eye-much thinner than the flap created by LASIK, is elevated by applying alcohol. The alcohol separates it from the layer beneath where it can be replaced at the end of the procedure. Both correct nearsightedness, farsightedness and astigmatism.
While only ophthalmologists, eye doctors who attended medical school and earned an MD, are qualified to perform the laser vision correction surgery, many discount chains use optometrists to examine and explain the procedures to patients. Their ophthalmologists act merely as highly trained technicians, coming in to cut and zap, and then zapping out.
Get at least one opinion from a consultation with an ophthalmologist. Ask how many surgeries your ophthalmologist has performed. Be aware that advertisements may intentionally proclaim a large number of surgeries, having first pooled together all procedures performed by affiliated surgeons, instead of listing the numbers by each individual surgeon.
One anonymous UIC student who considered getting LASIK done said, "I went to two doctors. One said that I was a candidate, but the next one said that my vision was border-line so he wouldn't recommend the procedure for me. Their lack of agreement made me opt not to proceed."
A local ophthalmologist working out of a private office was not surprised to hear about the conflicting opinions. "We turned away two patients this morning that had come for a second opinion after getting cleared for the procedures by chain stores downtown."
Ophthalmologist Samuel Liu, MD, tells the story of how his private practice, Princeton Eye Group in New Jersey, treated patients who had complications from LASIK after having been mesmerized by steep discounts.
"It was this truck that drove from Virginia to Pennsylvania to Connecticut, offering LASIK for $399 per eye and performing laser surgery in the truck. Of course none of them ended up paying that little, and paid close to what we charge. Granted, most of their customers probably recovered with good vision, but you have to ask yourself, are the complications worth the $1,000 discount?" said Liu.
Discounts are even that dramatic within the Chicagoland area. Comparing prices for procedures on both eyes, local discount chain stores range from around $600 to $3,600 while private practices range from around $1,200 to $5,000.
Ophthalmologists at local academic centers, however, are charging several times more: procedures start around $4,000. The most noticeable difference between the procedures performed at private practices and at academic centers is that academic centers use IntraLase. IntraLase is a laser used to make the initial incision, rather than a keratome; it is separate from the actual laser used to correct vision, and costs about $1 million. Most laser vision correction centers do not offer IntraLase because keratomes are just as efficient and more affordable.
IntraLase, a variant of LASIK, was recently developed as ophthalmologists continue to search for more painless and efficient procedures that result in less scarring and fewer complications. LASEK was another effort to find a better technique, but may soon be replaced by a newer procedure called Epi-LASIK. Epi-LASIK was developed with the introduction of a new FDA-approved 'blade,' the Epi-keratome, a vibrating plastic tip. Instead of using alcohol to separate the very top layer of epithelial eye tissue as in LASEK, Epi-LASIK temporarily removes the layer with an epi-keratome. The technique for laser reshaping of the eye to correct the patient's vision remains the same.
Candidates for both LASIK and LASEK must be at least 18 to 21 years old. A patient with unstable vision, requiring a different prescription from year to year, is cautioned when choosing these surgical procedures. Years after the surgery, a patient's vision may start to weaken again, prompting the need for correction by glasses, contacts or additional surgery.
About 5 percent of Dr. Liu's patients come back for a touch up surgery to better focus their vision.
"It's called an enhancement," explained Dr. Liu, "and we do the procedure for free for patients who need one within the first year of the first vision correction surgery."
Another UIC student, who had the LASIK procedure said, "My vision was perfect, I loved it. Then seven years later, things started to get blurry again, so I had to get glasses. But, my eye doctor said that I am still a candidate for another surgery since I have enough tissue left. I'll probably get it done someday when I start getting paid."
Jamian Coleman, research coordinator for Dr. Azar, reminds the university community that "all students and employees at UIC get a 35 percent discount on procedures done at UIC. In a few weeks, a new center called Millennium Eye Care will open on Michigan Avenue where Dr. Azar and Dr. De La Cruz will be performing all laser vision correction surgeries."
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