More than meets the eye

At $490 per eye, laser eye surgery has never been so cheap. But what are the risks?



Online only.


It took a week of sore eyes, crusty lashes and bottles of eye drops for me to permanently see the world with 20/20 vision. And it was worth it.

As an avid backwoods camper and climber, I dreamed of unchaining myself from prescription glasses and contact lenses. So, when billboards on the way to work promised a safe and easy procedure for only $490 per eye, I decided it was time.

I’m not alone. Since the late 1990s, when laser eye surgery (also called Lasik) first became available to the public, more than 28.5 million procedures have been performed worldwide. A small percentage are done for professional reasons—some sports stars and military personnel are required to undergo the surgery. But the vast majority are done for a simple reason: a desire see the world clearly.

The only problem is, not everyone does end up seeing the world clearly—a significant issue that recently prompted a shift in how the U.S. government tracks the safety of the procedure. In 2010, the U.S. Food and Drug Administration and the Department of Defense announced a collaborative study with the National Eye Institute to assess patients’ quality of life after treatment. It’s the first study to take into consideration how a patient’s expectations influence his or her decision to have the procedure performed. It has also helped fuel more discussion about whether Lasik practitioners are adequately explaining the risks of the surgery to potential patients.

So how safe is it?
Despite a crop of websites dedicated to horror stories, the statistics show that at about 95% of all patients report being completely satisfied with the results. This is based on an American Society of Cataract and Refractive Surgery review of more than 3,000 peer-reviewed studies conducted over the last 20 years. Of the 5% to 10% not completely satisfied, most will need an “enhancement”—an additional surgery to rectify an under- or overcorrection.

That’s an acceptable rate, says Dr. Guillermo Rocha, an eye specialist and refractive surgeon at the ImagePlus clinic in Winnipeg. “Eye surgery, in general, is very safe. But it’s surgery, and with any surgery there are always risks.”

Potential laser eye surgery patients should be warned about the possibility of under- or overcorrection, dry or itchy eyes, infection and potentially permanent visual aberrations such as haloes or blurred vision. While these occur in only a fraction of patients, recent criticism by Morris Waxler, an ex-FDA regulatory official, is putting the procedure into the public eye. According to Waxler, Lasik either fails to improve vision or causes serious side effects in over 50% of patients.

It’s a statement that baffles Rocha. “If 50% of our patients had problems, we wouldn’t be performing the procedure. With that kind of batting average, it’s just not rewarding.” Rocha is, however, concerned that the industry is doing a poor job of managing expectations and educating the public. “We consider a surgery a success if a patient’s vision improves to 20/40 or better, and we only expect 70% of patients to walk away with 20/20 vision.”

An eye-opener
That’s a far cry from the sales pitch I heard during my initial visit to a downtown Toronto Lasik clinic last year. Sitting across from a saleswoman—a bubbly lady with absolutely no background in medicine—I was whisked through a six-page document filled primarily with procedure costs and financing options. Every once in a while she would circle the optimal choice and move on. At no time did I meet the surgeon. At no time was I warned that my vision may not be 20/20 after the procedure, or that I may need additional surgeries.

These are oversights that concern Rocha. “Our job as surgeons is not to convince the patient to have the procedure,” he says. “Our job is to present the options with all the pros and cons and help you make an informed choice.”

Hidden options
It’s especially important to know all the options because in some cases, Lasik isn’t the best one. The technique isn’t well suited for people in certain jobs, such as firefighters or boxers, because of their higher risk of eye trauma. With Lasik, a surgeon cuts a flap in your epithelium (the outer layer of cells covering your eye) before reshaping your cornea. This flap begins to close within 48 hours of the surgery and is more than 75% healed within seven days. However, any traumatic damage to the eye could re-open the surgical flap.

For that reason, another procedure, known as PRK, is the procedure of choice for the U.S. military, NASA and sports stars. During PRK the epithelial cells are scraped away. This makes the procedure more painful and the healing process slower—with most patients requiring a week of bed rest. But it’s considered a better procedure for people with large or complicated prescriptions and for people with thinner corneas. Plus it’s 25% cheaper than Lasik.

The next wave
Still, most people opt to pay extra for the convenience of Lasik, which lets you resume activities in as little as 48 hours. If that’s the case, then the next decision will be between the standard or custom treatment (the laser centre may use the terms conventional versus wavefront). With the standard treatment, a laser is programmed with your prescription before it uniformly reshapes your cornea. The custom procedure uses the same laser, but it takes into consideration the individual topography of your eye.

“Wavefront is more customized,” says Rocha, “and this leads to a greater chance of better vision.” Recent studies show that the wavefront procedure has dramatically cut down the number of night vision problems—the most common complaint from dissatisfied Lasik patients. But the new technology comes with a bigger price tag. I was told that the wavefront procedure on both eyes would set me back $3,650 (including taxes and one year of insurance). That’s triple the cost of conventional Lasik.

In the end, I decided to trust my optometrist. She told me that my low prescription, tiny astigmatism, thick corneas, and smaller-sized pupils made me a good candidate for the conventional procedure. However, had I known there was a 97% success rate for 20/20 vision with the wavefront surgery (as opposed to 89% with standard Lasik), I may have made a different choice. Full of doubt, I would have paid more for a guarantee.

But that’s part of the problem, says Rocha. People want guarantees when there are none, and this need for assurances is exacerbated by an industry that can gloss over medical concerns. “Promising 20/20 vision, is not appropriate,” says Rocha. The FDA agrees, cautioning people to “be wary” of centres that advertise 20/20 vision or your money back. “There are never any guarantees in medicine,” writes the FDA on its website, “and even the best-screened patients under the care of the most skilled surgeons can experience serious complications.”

Instead, Rocha suggests looking for a specialist who has a good, long-term reputation. “You don’t have to be a cornea surgeon specialist,” says Rocha, “but it helps.” Also, look for a centre that doesn’t rely on salespeople to talk up the benefits, but focuses more on educating you. Saving $1,000 is great—unless you’re in the 1% of patients who end up permanently damaged from their laser-eye surgery.

The bottom-line, says Rocha, is that price is only a small part of the decision—and it’s one you can’t make with 20/20 hindsight.

12 comments on “More than meets the eye

  1. Great food for thought. As someone beginning a photography career, I have been considering laser eye surgery, but am naturally concerned about the risks. I would love not to deal with contacts drying in the middle of a tricky shot, lost lenses or replacements…but honestly I've been hesitant.

    That said, my parents, my husband and several friends have really loved their results.


  2. I had the most expensive version of Lasik performed by TLC approx. 4 years ago. My vision was awful at -4.5 in both eyes, astigmatism and 20/2400 vision. Following the procedure, the next morning I had 20/20 and could see, just a bit blurry. Within 3 months, my vision improved and has stayed at 20/15!

    It is most life changing procedure I could have had performed. Having been a contact and glass wearer for years, I consider this investment to be the best money I have ever spent!


  3. Excellent article, Romana!


  4. Romana, beautiful piece. I believe the doctor still plays the most important role. Trusted surgeons are way better than cheaper option s is a good resource


  5. I'm suffering from astigmatism and I'm actually planning to undergo a laser eye surgery to regain my 20-20 vision. It's just so alarming that there are lasik operations that are unsuccessful. One really needs to be critical in choosing an eye doctor and eye surgery center where eye operation will take effect.


    • Many hidden cost, trips to the Doctor and weeks of eye drops. Plus rest of my life trips to same Doctor and cost of $995.00 per eye per year. Wish ever day I had never heard of Lasik…


  6. With that said, I had custom LASIK done about 10 yrs ago at TLC in Toronto. The results were nothing short of amazing


  7. It’s been a year and a half and I am back to wearing glasses and even with them my vision is worse than before I got lasik. I paid this snake oil salesman $6800.00 hard earned dollars for this. I went back, twice and was told I had 20/20. Not through these blurry eyes pal. Did I get the only quack in town or are they working together so you think you must be wrong? I wouldn’t recommend this for anyone, especially if the surgeon is on Portage avenue in Winnipeg.


  8. My friend has gone through Lasik Surgery on 3rd July 2015. After that the next day she had so much pain in her eyes and her vision wasn’t so clear so next day she went for check up. Doctor re-lifted her flap and put it back. After that they didn’t ask her for check up. But she was having problem in vision. Her eyes gets dry often. She was not able to look at computer for long. She got vision with halos. She wasn’t able to drive a car. They were saying that this is your vision and it will take sometime to recover. Then she went again after 3 weeks to check up. And there was another doctor who said she has wrinkles on her flap so lets straighten the flap and put stitches. So on 10th of August 2015 they put stitches in right eye and put a lense on it. Her vision was so much blurry in right eye. They said it because of lense. Then they removed the lense on 14th. But it was surprising that after removing lense vision is still blurry. Now they are going to remove lense on 24th of august but today on the 8th day after surgery the vision is still blurry. Will you please guide us and can give us information that what is goin on and what could have happened wrong?


  9. “I will still be able to read without glasses…right?”
    “no” says the Doctor after doing my right eye
    ” stop”
    Now I have mono vision. I need glasses for far away as well as for reading. Worst disision I have ever made!
    I had PRK. Couldn’t see for a week. It was like someone threw sand in my eyes. Now I need drops all the time in that eye because it is dry and itchy. They claimed the eye was 20/20. I don’t think it ever was and it has gotten much worse over the years.
    If I could start over, I would NEVER do this again! Worst mistake of my life!
    Remember you can’t undo the damage.


  10. I have contemplated getting laser eye surgery for several years now. My eyesight is absolutely horrible, but I have been too scared to get the procedure done. I had no idea that the rate of success was 95%. I may reconsider and finally go get that done!


  11. I simply see this as call to action for planners to step up and clearly articulate the value they provide and stand behind charging a professional fee for the services they offer. Clients are a lot more willing to pay direct fees than most planners think – even ones without savings. We’re working with many well-paid professionals who are paying for and getting great results from our planning services and systems to help them get ahead financially.


Leave a comment

Your email address will not be published. Required fields are marked *