Consumers Increasingly Seeking Laser Surgery To Improve Eyesight

By Julius A. Karash, Knight Ridder Newspapers

KANSAS CITY, Mo. -- Craig Schurig is lying down, arms resting comfortably at his sides.

As a suction ring hugs one of his nearsighted eyes, a small flap of tissue from the outer layer of his cornea is lifted by a surgeon wielding a tiny, high-tech tool.

Next, for about 25 seconds, surgeon Daniel S. Durrie trains a laser on Schurig's cornea, flattening the curve a bit. Then Durrie deftly brings the corneal flap back down, and it adheres like Velcro.

''I feel good now,'' the red-eyed Schurig said after the procedure, which took about three minutes. ''The only thing you feel is the drops going in, the numbing drops.''

Schurig has just undergone LASIK surgery at the Hunkeler Eye Centers in Overland Park, Kan. The 34-year-old assistant football coach at Pittsburg State University in Kansas is one of an estimated 807,500 Americans this year who will undergo the procedure first performed a decade ago. That is up from 360,000 last year.

By contrast an estimated 142,500 Americans will undergo a similar type of surgery known as PRK this year, compared with 90,000 last year. PRK is an older procedure that is losing ground to LASIK.

Both procedures are types of refractive surgery, which is intended to improve the eye's focus by changing the shape of the cornea, the transparent covering of the eyeball.

These intricate procedures represent another example of how a growing number of Americans -- notably middle-aged, middle- and upper-income men -- are willing to spend money for surgeries that they want but, in most cases, don't necessarily need.

LASIK patients spend an average of $1,500 to $2,500 per eye, usually out of their own pockets, to correct nearsightedness, farsightedness and astigmatism. Their goal is to set aside their glasses and contacts.

''The thing I like is when you work out in the yard and you get all sweaty, your glasses aren't falling down on your face,'' said Olathe, Kan., resident Kathy Glover, who had LASIK surgery a few months ago. ''I wish I had had it done a long time ago.''

Such enthusiasm is not universal.

Patrick Handley, a Kansas City psychologist who had LASIK surgery in December, is unhappy with the results. Handley, 47, had surgery to correct nearsightedness in both eyes. He paid about $4,500 for the procedure, which was performed outside the Kansas City area.

''I wouldn't do it over again,'' he said. ''At night I see around the scar tissue and it creates a lot of halos, glare, night-vision problems. It's literally impossible to drive at night in the city, where there are lots of lights, or enjoy events such as movie theaters or a high school play, anything where you're in a darkened room and there are lights in the area.''

Handley said the problem was caused by his bigger-than-average-sized pupils. He has tried wearing dark glasses and anti-glare glasses, but they have not helped. He said his doctors had told him they had no solution.

Experts say even patients with normal-sized pupils will probably see halos around headlights at night for a few weeks after LASIK surgery.

Indeed, patient satisfaction is not guaranteed.

According to the June issue of Consumer Reports, the latest studies of LASIK and PRK claim an 80 percent success rate. Success is defined as unaided eyesight after surgery that is 20/40 or better, which would allow you to drive without corrective lenses.

Major complications, such as cutting the corneal flap completely free, occur in fewer than 5 percent of surgeries. Some experts estimate that complications such as glare, ghosting and fuzziness occur in about 10 percent of patients.

Durrie, who mostly does LASIK surgery, said about 5 percent of his patients needed some additional surgery within a year to reach their vision goals. There is no charge for such ''touch-up'' surgery, he said.

''After that, 99 percent of patients don't need contacts or glasses to see at a distance, though they may need reading glasses as they get older,'' Durrie said.

Indeed, skyrocketing numbers of patients speak to widespread satisfaction that spurs demand. Many tell friends and relatives that it was painless and they could see better immediately. The positive reviews spur others to open their pocketbooks and look up at the laser.

''Everybody either knows someone or works with someone who's had (LASIK) done,'' said Joseph Tauber, a cornea specialist and refractive surgeon with the Sabates Eye Centers in the Kansas City area.

Others report a similar surge. John Doane, a refractive surgeon with Eye Care in the Kansas City area, said his group had performed more than 10,000 LASIK surgeries in the last several years.

''Each year we anticipate doing 100 percent more than the prior year,'' Doane said. ''That's pretty much what the market's doing across the nation.''

Such strong demand is particularly notable because almost all of the money is coming straight out of the patient's pocket. Most health insurance policies do not cover this type of surgery, because it is considered an elective procedure. Payment plans usually are available.

Guy Kazirian, an ophthalmologist and media liaison for the International Society of Refractive Surgery, characterized LASIK surgery as a luxury, though it improves the vision of most people who have it done.

Industry studies show that the majority of refractory surgery patients are men aged 35 to 45 with incomes exceeding $40,000 a year.

''Men might be less willing to put up with slipping eye glasses and/or difficult-to-care-for contact lenses,'' said Irving J. Arons, managing director of Spectrum Consulting in Peabody, Mass.

Durrie, who serves on the American Academy of Ophthalmology's executive committee for refractive surgery, said that not just the wealthy were seeking LASIK.

''I have patients who are policemen, firemen, farmers, construction workers, people who really work and use their eyes a lot and think they can do a safer job at their work,'' he said. ''They plan for it, and it's a family decision to spend this kind of money.''

Experts say there is no ideal LASIK patient, but there are guidelines.

Durrie said that LASIK patients should be 18 or older and that the procedure should not be performed on those who are prone to eye infections. Those with unusually large pupils are poor candidates because they will see around the edge of the treated cornea at night, causing them to see halos around lights.

People who are severely nearsighted often are discouraged because of the risk of unsatisfactory outcomes. Even so, Doane said, almost all of the people who come to his office are candidates for LASIK.

''Ideally their vision has been stable for the past year and they have a desire to get out of glasses and/or contacts,'' he said.

When LASIK surgery is performed on those older than 40, surgeons frequently leave one eye a little nearsighted to forestall the need for reading glasses.

LASIK patients wear protective eye coverings when they go to sleep at night for about a week after the surgery, to protect the eyes from pressure. They use drops for a few weeks to keep their eyes lubricated.

Handley, who is unhappy with his LASIK surgery, advised potential patients to be smart consumers.

''I wasn't,'' he said. ''Make sure your doctor gives you a pupil exam in dim light before you have any surgery. Research the pros and cons thoroughly through multiple sources.''

But Glover, the LASIK patient from Olathe, said she could read menus in dark restaurants now.

''The best thing, that I didn't know was going to happen, is that I don't have headaches any more,'' she said. ''I used to have headaches all the time, and it was eyestrain. I just thought it was stress in my jaw.''

Schurig said he could now get up in the morning and ''see the alarm clock, take the dogs out. Before, when my kids would come into our bedroom in the morning, I could only see their outline. Now I can see them clearly.''

Meantime, new techniques are being developed. One of the newest procedures uses plastic implants, known as Intacs, to correct mild-to-moderate nearsightedness. Intacs are implanted in the cornea and can remain permanently, but they can easily be removed by a surgeon if needed.

''I'm not aware at all that I have them in there,'' said Kelly F. Grosdidier, a Hunkeler optometrist who had the Intacs procedure done in May. ''My vision is great.''