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Starry-Eyed Over Lasik?

As Rob Stein tells us today, officials at the U.S. Food and Drug Administration (FDA) are likely getting an earful -- or an eyeful -- at this morning's public hearing on Lasik surgery, the popular but pricey procedure in which a laser is used to slice open the eye, allowing the surgeon to reshape the cornea and thus improve the patient's vision, so that he or she can shed those onerous glasses or contacts.

Laser-assisted in situ keratomileusis (Lasik's full name) is generally safe and successful, as many who have undergone it will attest. Even NASA (whose early work with precision lasers paved the way for Lasik) considers astronaut candidates who have had such surgery.

Sometimes -- though it isn't clear how often -- things don't go well, leaving patients with persistent, often unfixable, visual impairments that range from annoying to debilitating. Some suffer intractable dry eye; others see halos, starbursts, or ghosting that can be maddening and can interfere with such activities as driving.

While there were some 700,000 Lasik surgeries performed last year (and more than 7 million since the procedure was approved by the FDA in 1995), there are signs that the procedure's popularity may be waning, perhaps because the weak economy leaves little wiggle room for elective surgeries that aren't typically covered by insurance. Bad news about botched surgeries aren't likely to boost Lasik's numbers.

The FDA hearings are aimed in part at improving the process by which doctors report post-operative problems. They're also meant to help bolster patient education through improving the FDA's Lasik Web site and other documents.

Norman Saffra, director of ophthalmology at Maimonides Medical Center in Brooklyn, has been concerned about Lasik's complications for years. He says Lasik technology has evolved and improved over the past decade, but still some patients don't get the best results. "If we can identify patients at risk for post-operative complications, that would be a good thing," he says.

People considering Lasik, Saffra suggests, should seek "a comprehensive exam by a competent eye-care provider, preferably a board-certified ophthalmologist. And they should think carefully about the risks and benefits of this elective cosmetic procedure."

Well, yeah. I'm fortunate to have pretty good vision, so I'm not likely looking at Lasik, anyway. But even if my vision weren't so hot, I'm not sure I'd be quick to sign up. (And not just because the very thought of it brings to mind that eyeball-slicing scene in Luis Bunuel's Un Chien Andalou.) I'm not too keen on the idea that, in the absence of understanding of Lasik's long-term consequences, everyone who has the surgery is basically a guinea pig.

Post Health reporter Sandra Boodman's been following Lasik and other corrective eye surgeries for years. She says today's hearings are "one of the first formal attempts to discuss the post-market experience with Lasik." Even as the surgery has grown in popularity, she says, "there have been persistent complaints by unhappy patients. Patients have not always been sufficiently warned about the bad things that can happen. Doctors are really interested in doing Lasik because it's fast, easy and lucrative and many patients tend to be thrilled with the results. But there is a learning curve in this surgery as in all surgery. And in some cases the doctors are not as forthcoming as they should be" about Lasik's risks, "and patients sometimes assume it's risk-free. They don't always really read the consent form."

"The Checkup" is not the FDA, but we'd love to hear your Lasik stories -- the good, the bad, and the ugly. We'll read them all -- if we can find our glasses.

By Jennifer LaRue Huget  |  April 25, 2008; 7:00 AM ET
Categories:  Popular Procedures  
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