Clear Vision: Your Source for Eye Health

If you ever fell while playing basketball and watched your eyeglasses go flying into the air, or cleared the dance floor at a wedding reception so you could hunt for a lost contact, you’ve probably wondered if laser vision correction could spare you future embarrassment.

Advances in laser technology have greatly reduced the risks associated with LASIK and improved outcomes for the vast majority of patients, according to W. Neil Wills, M.D., a board-certified ophthalmologist. Even people with highly active lifestyles and those whose careers demand precise vision are often good candidates for LASIK. Your specific circumstances will determine whether LASIK is an appropriate option for you.

Pilots and LASIK

Whether they’re deciphering flight plans, scanning instrument panels, spotting runway hazards or detecting other aircrafts amid cloud cover, an aviator’s vision must be utterly reliable. In the past, pilots who underwent LASIK risked being grounded because the immediate and long-term outcomes of the procedure were still uncertain. A former refractive surgery program manager for the U.S. Navy, states that previous concerns about LASIK have been laid to rest. Civilian aeronautical agencies, the U.S. Air Force, the U.S. Navy and even NASA now allow pilots to undergo LASIK.

With the state-of-the-art technologies now available to LASIK doctors, the risk for serious complications is less than 1 percent. Many of the side effects previously associated with laser vision correction are now uncommon. When problems such as night glare, halos or hazy vision do occur, they are usually temporary or correctable with an enhancement procedure. Prior to proceeding with LASIK, ask your doctor if enhancements are included in the procedure fee. Recognizing that professional aviators cannot return to flight status until their vision has stabilized, Dr. Wills advises pilots — and candidates who are applying for pilot status — to check with their supervisors about waivers, documentation requirements and temporary changes in certification before proceeding with LASIK.

If you’re a civilian pilot, the Federal Aviation Administration (FAA) mandates that you refrain from flying until your vision has stabilized following LASIK. Once your ophthalmologist determines that you meet FAA vision standards, you can resume flying after submitting documentation to the FAA’s Aerospace Medical Certification Division. Check with your aviation medical examiner to ensure that you are complying with the latest FAA regulations.

Athletes and LASIK

Many people with active lifestyles — even elite athletes — are able to enjoy the benefits of LASIK. However, you may need to curtail your activities for several weeks after your procedure. Eye doctors generally advise LASIK patients to stay out of swimming pools and hot tubs for at least a week and to avoid contact sports for at least two weeks after the procedure. If you’re not already wearing protective eye wear during sporting events, your doctor may urge you to make it a permanent habit following LASIK.

The corneal flap created during LASIK can take several months to adhere to the underlying cornea. If you sustain a direct blow to your head or eye during your healing period, the flap could shift out of place. According to Dr. Wills, displaced flaps can be easily repositioned, although this may involve an additional fee. One of the latest advances in LASIK technology involving femtosecond lasers has reduced the likelihood of this occurring. These lasers emit extremely short pulses of light and allow doctors to create flaps that are much less likely to displace than flaps created with older technologies. Still, boxers, cage fighters, martial artists and other athletes who are at high risk for head or eye trauma may want to consider photorefractive keratectomy (PRK). This procedure improves your vision with a series of laser pulses to your cornea, but no flap is created.

The Final Word

LASIK vision correction complements almost any lifestyle. Most people who undergo LASIK experience dramatic improvement in vision. While no medical procedure is perfect, postoperative surveys suggest that more than 90 percent of people who undergo LASIK are satisfied with the results. New technology allows LASIK doctors to provide vision that meets the demands of most athletes and people whose careers require precise vision. Your eye doctor will determine if you are a good candidate for LASIK and help you explore other options, if appropriate.

References

American Family Physician: LASIK: A Primer for Family Physicians

http://www.aafp.org/afp/2010/0101/p42.html

Email Interview with W. Neil Wills, MD, FACS

American Refractive Surgery Council: LASIK Offers Precise Vision Correction, Convenience for Amateur and Professional Pilots

http://www.slideshare.net/OfficialARSC/lasik-for-pilots

Federal Aviation Administration: Information for Pilots Considering Laser Eye Surgery

http://www.faa.gov/pilots/safety/pilotsafetybrochures/media/lasereye_ii.pdf

Federal Aviation Administration: Pilot Medical Certification: Questions and Answers

http://www.faa.gov/licenses_certificates/medical_certification/faq/response12/

U.S. Air Force Waiver Guide: Refractive Surgery

http://aviationmedicine.com/resources/files/PDF/VFS_attachments_07/USAF%20Wavier%20Guide%20PDF.pdf

LASIK is the most popular corneal refractive procedure worldwide, with more than 700,000 procedures performed each year in the U.S. alone. LASIK produces excellent results when performed by a skilled eye doctor, and although it’s not an ophthalmologic cure-all, the technology is adaptable to a wide variety of vision problems.

How LASIK Works

The concept behind LASIK — or laser assisted in situ keratomileusis — is fairly straightforward. Your cornea accounts for much of your eye’s focusing ability, and irregular or abnormally shaped corneas cause blurry vision. Reshaping the corneas with LASIK can often compensate for blurred vision due to these abnormalities, which doctors call refractive errors. During a LASIK procedure, your doctor uses a blade or laser to create a flap on the front of your cornea. The flap is carefully folded back, and the underlying cornea is reshaped with a laser. The flap is then returned to its original position. No stitches are required, and postoperative discomfort is usually minimal. Most people’s vision is markedly improved within two to three days, although full vision stabilization may take longer.

Myopia

People with myopia, or nearsightedness, have trouble focusing on far-away objects. More LASIK procedures are performed to correct myopia than any other vision problem. According to a 2011 review in BMC Ophthalmology, over 80 percent of laser refractive procedures performed at Johns Hopkins Wilmer Eye Institute during one quarter of 2009 were done on myopic patients, 65 percent of whom opted for LASIK. While most LASIK patients are primarily interested in correcting nearsightedness, the procedure is also commonly used to deal with other refractive problems.

Hyperopia

People with  hyperopia, or farsightedness, have trouble focusing on nearby objects. Until recently, LASIK was less satisfactory for treating hyperopia than myopia, and farsighted people were more likely to experience glare and halos following the procedure. However, a study published in the May 2010 issue of Clinical Ophthalmology demonstrated a reduction in these minor complications when a broader area of the hyperopic patient’s cornea is treated with laser. These findings are representative of the ongoing research that continues to improve LASIK’s utility for correcting a variety of refractive problems.

Astigmatism

Astigmatism occurs when your cornea is not perfectly dome shaped. If the surface of your cornea is shaped more like a football than a baseball, the light entering your eye bends unequally. This produces sharp images in some areas of your field of vision and fuzzy images in others. The type of astigmatism you have is determined by the direction and extent corneal warping. Many people with astigmatism also have myopia or hyperopia.

According to W. Neil Wills, M.D., a LASIK doctor, most forms of astigmatism — including those associated with myopia or hyperopia — can be effectively treated with LASIK. A condition called irregular astigmatism is an exception.

Presbyopia

Some amount of presbyopia, or “aging eyes,” is universal in older adults. As you age, the lenses inside your eyes gradually lose flexibility. This becomes noticeable at about age 45 to 50 with loss of the ability to focus on nearby objects. Unlike other refractive errors that are due to structural problems with your focusing mechanism, presbyopia is caused by a loss of your eyes’ ability to change focus. When presbyopia becomes significant, most people require reading glasses or bifocals to read or work at a computer.

Dr. Wills explains that LASIK can treat your eyes, but it cannot affect your age. If you have presbyopia and want to reduce your dependence on corrective lenses, your eye surgeon might suggest a technique called “monovision LASIK,” which corrects one eye for reading and the other for distant vision. Monovision LASIK generally allows you to see well at all distances, but it may impair your depth perception. Although the thought of having your eyes focused at different distances might seem disconcerting, Dr. Wills reports that 90 percent of patients adjust to monovision LASIK within a few months.

High Satisfaction Rate  

More than 95 percent of patients undergoing LASIK are satisfied with the results of their surgery, regardless of their original vision problem. Millions of people have undergone LASIK, and even the NASA and U.S. military have adopted the procedure for their aviators. Before you proceed with laser vision correction, schedule a consultation with a LASIK doctor who will perform a thorough evaluation to determine if LASIK is a good option for you.

References

American Academy of Ophthalmology Clinical Updates: Demographics of Refractive Surgery Patients and Market Trends

http://www.aao.org/vp/edu/refract/v1m5/refractive_management_v1m5.pdf

Eye Surgery Education Council: More than 95 Percent of LASIK Patients Report Satisfaction Rate Worldwide

http://eyesurgeryeducation.org/resources-news.php?id=30&type=news

Email Interview with W. Neil Wills, MD, FACS

American Family Physician: LASIK:  A Primer for Family Physicians

http://www.aafp.org/afp/2010/0101/p42.html

BMC Ophthalmology: Trends in Refractive Surgery at an Academic Center: 2007 – 2009

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3115925/

Clinical Ophthalmology: Predictability and Stability of Refraction with Increasing Optical Zone Diameter in Hyperopic LASIK

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2874273/

If you are one of the 150 million Americans whose natural vision isn’t perfect, you know how inconvenient corrective lenses can be. Over the past 40 years, corneal refractive surgery has become the treatment of choice for people who want to reduce their dependence on glasses and contact lenses. Laser-assisted in situ keratomileusis, or LASIK, is the most popular corneal refractive procedure in the United States, and it generally provides excellent results.

LASIK is a considerable investment, and many health insurance plans don’t cover the procedure. This article identifies other ways you can reduce the cost of LASIK.

Elective Procedure

Insurance companies classify a procedure as elective — some use the term “cosmetic” — if the primary purpose is to change or improve a person’s appearance and there is no medical necessity for the procedure. Although LASIK corrects your vision, it is still considered an elective or cosmetic procedure by most health and vision insurance companies. Check with your health benefits coordinator or agent to determine whether your insurer considers LASIK an elective procedure.

Covered Diagnoses

According to Frederick Fraunfelder, M.D., Director of Cornea and Refractive Surgery at Oregon Health and Science University Casey Eye Institute, an insurance company may pay for LASIK if the procedure is performed to correct a disorder not readily addressed with corrective lenses or other treatments. Examples of these conditions include anisometropia, amblyopia and strabismus. If your doctor determines that LASIK is the best treatment for your particular condition, your health insurance may pay for the cost of the procedure.

Discounts

The cost for LASIK varies, depending on your location, vision correction needs, doctor and technology used during the procedure. Market Scope, a St. Louis company that tracks trends in eye care, cites the average per-eye cost for traditional LASIK at approximately $2,000. However, some of the cost can often be defrayed. According to Terri Rouse, Director of Managed Care at LCA-Vision Inc., health or vision insurance commonly entitles you to a discount on LASIK via in-network, experienced LASIK doctors. Many insurance companies also contract with select LASIK providers to offer discounted rates to plan members.

Other Ways to Save

If you have a flexible spending or health savings account, you can use money from your account to help pay for your LASIK procedure because it is an eligible medical expense. By using these tax-free dollars, you can save $700, based on the maximum allowable contribution of $2,500 and a tax rate of 28 percent.

If you have access to an enhanced health plan that provides an annual allowance that can be used for LASIK, signing up at the next available enrollment date will open up another source of funds to put toward your procedure. You may also be able to secure a health credit card or short-term loan through a healthcare financing company. Whether or not you’re insured, you may qualify for in-house financing through your LASIK provider.

Become a Savvy Consumer

If you are considering LASIK, do your homework before plunging in. First, check your health or vision plan to find trusted, in-network providers who offer a discount. Next, determine whether you are a good candidate for LASIK. Some LASIK providers offer free evaluations to determine whether LASIK is appropriate for you. If you decide to proceed with LASIK, maximize your savings by combining your plan discount with your FSA or HSA dollars, if these resources are available to you. If you need additional funding, explore financing options with your eye doctor or a healthcare financing company.

These ways to save and finance the procedure, along with the long-term savings on glasses and contacts, can go a long way to make LASIK an even better investment.

References

American Optometric Association: LASIK Refractive Surgery: Clinical Considerations for the Pilot

American Family Physician: LASIK: A Primer for Family Physicians

UnitedHealthcare: Cosmetic and Reconstructive Surgery — Definition

Cigna.com: LASIK (Laser In-Situ Keratomileusis) for Nearsightedness

Frederick Fraunfelder, MD, Professor of Ophthalmology at Oregon Health & Science University and Chief of Cornea and Refractive Surgery at Casey Eye Institute: Personal Interview

Duke Eye Center: A Clear-Eyed View of LASIK

Terri Rouse, Director of Managed Care, Laser Centers of America: Personal Interview

One-half of Americans over the age of 20 wear eyeglasses or contact lenses to correct their vision. Most of these individuals have common conditions — nearsightedness, farsightedness or astigmatism — that prevent their eyes from focusing light into perfectly sharp images.

For the past 40 years, specially-trained eye doctors have been performing procedures to reshape the eye and correct these conditions. LASIK, the most popular eye reshaping procedure in the United States, involves laser remodeling of the cornea.

Corneal Anatomy

The cornea is the clear window at the front of your eye. It consists of several layers of transparent skin cells draped over a dome that provides structural and nutritional support. If the surface of your cornea is irregular or the shape is too angular or too flat, the light entering your eye does not focus properly. This causes blurriness or distortion of the images that you see. LASIK eye surgery can fix most structural corneal abnormalities and help improve vision. 

Focusing Mechanism

Your corneas and the thin film of tears overlying them provide about two-thirds of your eyes’ light-focusing capacity. In order to transmit light without distortion, the contour of a cornea — like that of a high-quality camera lens — must be perfectly spherical. However, many people’s corneas are imperfect. Excessively steep corneas cause nearsightedness. Abnormally flat corneas lead to farsightedness. A warped cornea, or astigmatism, is characterized by a blurring of specific portions of the images that you see. LASIK reshapes your cornea to a more spherical form, helping correct the way your corneas focus light.

Procedure

Several types of laser procedures are used to reshape corneas. Your doctor will thoroughly examine your eyes to determine the technique likely to work best for you. The most common procedure involves creating a hinged flap — either with an extremely thin, machine-driven blade or a special laser — at the front of your cornea to expose its undersurface. The doctor then uses a computerized laser to sculpt the exposed corneal tissue and correct the defects identified during your preoperative evaluation. The flap is then returned to its original position.

Mild to moderate visual deficits require less corneal sculpting than severe forms of nearsightedness, farsightedness and astigmatism. The degree of corneal reshaping required to correct your vision affects the likelihood of achieving 20/20 vision after the procedure. Although most people who require extensive corneal sculpting experience a significant improvement in their vision, they are less likely to experience 20/20 vision after LASIK compared to people with less severe corneal abnormalities.

Your vision may fluctuate for up to six months after laser eye surgery as your eyes heal. Your need for corrective lenses may also vary during this period until your vision stabilizes.

Outcomes

While LASIK offers acceptable outcomes for the majority of patients, and many people can perform everyday tasks without corrective lenses, 20/20 vision cannot always be achieved. Postoperative satisfaction is determined by a variety of factors, including the type and severity of your original visual problem, the technique used to reshape your cornea and your expectations prior to the procedure. Your doctor will review these issues before you decide whether LASIK eye surgery is appropriate for you.

References

Archives of Ophthalmology: Prevalence of Refractive Error in the United States, 1999-2004

American Family Physician: LASIK: A Primer for Family Physicians

Ophthalmology: LASIK World Literature Review: Quality of Life and Patient Satisfaction

Considering the financial investment required for LASIK, you’ve probably already compared the cost of the procedure versus the cost of years of continually replacing glasses and contacts. In case you haven’t, this article lays out the details — including a few you might not have thought of.

Based upon discount prices for a popular contact lens brand¹, let’s look at a few figures:

Use this table only as an example; actual figures will vary depending on the type of contacts you wear, how often you replace your glasses and the final cost of your procedure. However, the data suggest that for most patients, LASIK more than pays for itself and yields real savings over time.

If only the same could be said for every monetary decision. Think about how often you pay for convenience: pay more for groceries because the neighborhood store is closer than the discount warehouse, avoid the store altogether and pay for shipping to your door, or gladly hire someone else to do a job that would be inconvenient for you. And you’d never go without text messaging, wireless Internet or automatic car windows, would you?

None of these conveniences offer any real financial return — they just save time and reduce hassle in our busy lives. Yet, we’d never go without them. We don’t really consider the monetary cost because convenience is oftentimes more important. (Time is money, after all.)

When thinking about your eyesight, consider the toll that contacts and glasses take on your lifestyle. Think about the time you spend squeezing in last-minute eye appointments, ordering replacement contacts, and the small (but very real) drudgery of putting contacts in and taking them out every day. According to an independently-conducted survey, the average person spends 63 hours a year managing, changing and cleaning his or her glasses and contacts — that’s more than 2 days. ^²

Glasses and contacts cause other major inconveniences that you simply grow used to. You’ve surely gone for a run or played sports with glasses sliding down your sweaty nose. You’ve messed with your contacts when you travel because sleeping in them irritates your eyes. You’ve run out of contacts when something unexpected comes up. You’ve fumbled for your glasses before checking on your sick kids in the middle of the night. None of this sounds horrible by itself, but repeatedly and over time, you have to admit that relying on eyewear just to see the world around you is a real pain.

Others have been in your place. Tawnya G., a LASIK patient from Arizona, said, “I’ve worn glasses or contacts since I was nine years old. By the time I was 31, I was pretty much blind without glasses or contacts. I was sick of it! I was tired of stumbling around at night looking for my glasses to take care of my kids. I decided to get LASIK, and it was the best investment I’ve ever made! I made sure to have the procedure before a trip to the Havasupai Canyon. I experienced and saw things on that trip that I would have not been able to without LASIK. I truly feel LASIK changed my life.” 

LASIK is one investment that improves your lifestyle and offers positive financial returns. The same can’t be said for most other purchases, where we’re usually faced with tough choices between convenience and cost.

Alex, a LASIK patient from Georgia, said, “My job as a firefighter required me to wear contacts 24/7. As you can imagine, that was often frustrating. I had LASIK in September 2010. My job — my entire well-being — has improved since then. The fact that I will be saving money in the long run also makes this the best decision I’ve ever made. You genuinely have a better attitude with perfect vision. I encourage anyone thinking about LASIK to get a consultation. They will work with you. It truly was a great experience.”

If you haven’t already, take some time to calculate your own numbers. Tally your personal expenditures on glasses and contacts. Schedule a LASIK consultation to get a better idea of the investment it requires. Then go beyond the numbers and recognize that your eyesight is more than just a convenience. LASIK often improves eyesight with one simple procedure. If your eyes are the windows to your soul, make sure yours are automatic car windows.

¹ Nichols, Jason J., OD, MPH, PhD, FAAO, and the staff of Contact Lens Spectrum: Annual Report: Contact Lenses 2010.

Prices from 1800Contacts.

² Independent online study conducted by Empower MediaMarketing — January, 2012.