OK, so you are thinking about having LASIK.  You've heard about all the risks and you have decided how you are going to pay for it .  Like any normal person, you are really excited about the possible benefits, but you are also a bit nervous about the risks, and in particular, you don't want to learn about any hidden risks sometime after you have had the surgery.
 

The only significant risk that I am aware of, as an eye surgeon that no one seems to be talking about, is that once you have had any corrective surgery on your cornea I CANNOT accurately determine the power of implant you need after cataract surgery.

OK, you are probably thinking something like "what the heck does that mean to me", or "ask me if I care".  But actually this is a very big problem, and its one that seems to be completely ignored by the "stop and chop" laser vision centers.

First of all, if you are over the age of 65, YOU HAVE CATARACTS.    They might not be affecting your vision very much, but they are there.  If you are under the age of 65, but you plan on reaching or exceeding the age of 65, YOU WILL GET CATARACTS, and you may already have cataracts.  In summary, if you live long enough, YOU WILL NEED CATARACT SURGERY.

Second: Everyone having cataract surgery gets a lens implant.  If you don't, chances are you will end up wearing extremely thick glasses or contacts.

Third:  Your surgeon cannot accurately determine the power of lens implant you will need IF you have had corneal refractive surgery, such as LASIK (Yes, I already said this).
 

Consider this all too common scenario:  A 56 year old gentleman named Rip Ed Auff recently came to me with blurry vision in both eyes.  He had LASIK, and two enhancements in both eyes done by a "prominent" local surgeon, and he was scheduled for a third enhancement in both eyes when he came to me for a second opinion.  That's 2 surgeries in each eye already, quite a bit of money, lots of visits to the eye doctor, and quite a bit of time off of work.  The reason he couldn't see was because he had cataracts.  Basically his laser vision expert surgeon didn't look carefully enough, or he forgot what cataracts look like.  I explained that he needed cataract surgery, but that our formulas and tests could not accurately determine which lens implant power he would need, and that there was a very good chance that he would need additional operations to "get it right".  The cataract surgery went smoothly in the first eye (I only do cataract surgery one eye at a time), but the first eye was significantly far-sighted.  An additional adjustment was made for the second eye, and one week later after the second surgery he was somewhat nearsighted in the second eye.  Unfortunately he was rather uncomfortable, with one eye far-sighted, and the other was near-sighted, but I had already prepared him for this possibility, and he knew that the next step was to wait.  Three months later, leaving time for the eyes to heal and stabilize, I put a second implant in the far-sighted eye, and we decided to leave the nearsighted eye alone.

In the end this patient patient ended up having 4 operations on the right eye, and three on the left.  Total time invested was over one year.  The cost of the initial LASIK was $2,000 per eye, and each enhancement was $200.  The cataract surgeries were $2,500 each.  The extra lens implant surgery was $1,750.  The total dollar cost to him (no insurance) was $11,550.  Time spent worrying if he would ever be able to see clearly, priceless.  More bad news: Unfortunately the cornea can only tolerate so much abuse before it becomes cloudy, and there is a very real possibility that Rip Ed Auff will need corneal transplant surgery in the future.  Transplant patients often end up with high amounts of near-sightedness, far-sightedness, or astigmatism (very unpredictable), and recovery times can sometimes be as long as one year.  The risk of rejection lasts a life-time.  None of this would not have happened had he had a careful preoperative evaluation.

Had Rip had cataract surgery to start with, the total cost would have been $5,000, the recovery time about two weeks, and cataract surgery in fact is an even more accurate method of correcting vision than any refractive surgery method!!!

In summary, the hidden danger of Laser Vision Correction is that we cannot accurately determine the power of lens implant needed after cataract surgery.  If you have LASIK, and develop cataracts sometime within the next few years, you may have to have multiple surgeries to correct your vision.  Speaking for the community of ophthalmologists, we all anticipate that technological advances will improve this situation in the future.
 
 

I JUST HAD LASIK SURGERY, WHAT CAN I DO NOW?  There is a simple answer to this question, basically KEEP COPIES OF ALL YOUR MEDICAL RECORDS.  One of the methods we use to estimate lens implant power after LASIK is based on knowing your original glasses or contact lens prescription PRIOR to LASIK, as well as a measure of the curvature of the cornea PRIOR TO LASIK.  These numbers will be part of your medical record, so get a copy, and keep it in a safe place.  It may be many years before you need cataract surgery, and you can be sure that the "Bargain Discount Laser Surgery Mart"  will destroy your records as soon as state laws permit.  Many of these organizations have already gone bankrupt, or merged several times, and if you had your surgery a couple of years ago, you can be certain that your medical record is just dead weight to them.  Get copies of your medical record, or better yet, pick an ophthalmologist to do your surgery who can take care of your eyes the rest of your life, rather than choosing a massive corporation that doesn't even want to take care of you the day after your surgery is done!

By the way, if you think that the big corporations can really offer you surgery for under $500 per eye, check out this article in the Washington Post