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Eye surgeons' warning on LASIK

17 Jun 2002

The American Academy of Ophthalmology says that very short-sighted people "should not have" LASIK eye surgery.

A report compiled by the world's largest association of eye surgeons - the American Academy of Ophthalmology (AAO) - has concluded that while laser-assisted in situ keratomileusis (LASIK) is safe and effective for many people, those with very poor natural sight should not undergo the procedure.

The AAO's ophthalmic technology assessment (OTA) reports that severe side effects such as permanent visual loss are rare, but that dry eyes, "starbursts" and reduced contrast occur "relatively frequently".

Christopher Rapuano, who chaired the assessment committee, said: "LASIK is an excellent procedure for many, but not all patients. Those who are not good candidates should not have the surgery."

Rapuano told Optics.org: "Overall, the results were quite good for myopia of less than 8 diopters, somewhat worse up to 10 diopters and then tailed off. Astigmatism results seemed quite good up to 4 diopters, and tailed off up to 6 diopters."

He added that the report is intended to provide physicians with information, but that there are no plans to enforce the guidelines, or to censure those who do not stick to them.

Ron Link, the founder of Surgical Eyes - a patient support group for those with LASIK-related complications - says that while he welcomes the change in stance from the AAO, it is "too little, too late". He says that despite the new guidelines, there are still question marks over whether patients will be fully informed by the individual surgeons performing the technique.

"I have to ask why this information was not given to the public earlier. In 1999, I testified to the Food and Drug Administration panel with the same message," Link told Optics.org. "Many operations that led to complications could have been prevented, if the AAO had been more aggressive and responded earlier."

"The AAO report is commendable, and will have an effect, but it still does not convey to the public that LASIK is a surgical procedure, and that a certain level of complications is inevitable," added Link.

Rapuano says that advances in excimer laser technology and newer microkeratomes may help reduce the number of cases where complications arise. For those with existing problems, Link says that wavefront-correcting contact lenses hold promise, especially for those suffering from dry eyes.

The OTA was based on a review of LASIK-related scientific literature from 1968 to 2001. The results are presented in the January 2002 issue of the AAO journal Ophthalmology.

Michael Hatcher is technology editor of Opto & Laser Europe magazine.

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