Michelle and Kyle Schick of Layton both had LASIK laser eye surgery. His was perfect; hers was anything but.

The Layton couple are extreme opposite examples of what can happen with the incredibly popular LASIK surgery. And their stories point out what people should consider before deciding to have their eyes "done."

It's a surgery that permanently alters the eye. Experts say the results depend on many factors, such as the skill of the surgeon and the thoroughness of the follow-up care, the individual's eyes and how well they are screened to be certain the elective surgery is appropriate. Results will vary, and not everyone will get 20/20 vision.

"I'm a firm believer in LASIK," said Dr. Brian Davis, an ophthalmologist who has done the procedure many times. "I've done my brother, my sister, my mother-in-law, sister-in-law and brother-in-law . People I have to live the rest of my life with and I wouldn't do that if I didn't believe in it. If people have appropriate expectations and someone is following them who is well experienced and knows what is going on, most will be happy."

Dr. Majid Moshirfar also believes in the surgery and performs it at the Moran Eye Center. But the very popularity of LASIK has posed problems. Lots of people want the surgery and "one of the problems we now face is eye factories are being developed around the country. They are chains, almost. . . . You don't see that with other medical fields. I don't feel that a template of the assembly-line approach to eye care is appropriate. If a physician does hundreds of patients in one month, I doubt this physician will follow the case and know exactly what's going on. Those who do the follow-up are doctors who don't have surgical knowledge and may encounter something they don't know what to do with.

"Unfortunately, patients don't know it's a surgery and serious business. The public is not well-informed and they trivialize a lot of things," said Moshirfar, associate professor at the University of Utah and director of the center's cornea/refractive surgery services.

Not everyone is a good candidate. Both Davis and Moshirfar talk about people with large pupils, because they can suffer glare, inability to drive at night and other complications. Cornea thickness can be a problem, as can corneal diseases. Pregnant women and those with rapidly changing prescriptions shouldn't have it. People who already have dry eyes need to know LASIK tends to dry eyes. Food and Drug Administration data indicates a certain percentage of patients experience some glare and halo.

With LASIK, 20/40 or better is considered a success. No more than 60 percent get 20/20 vision.

David Jacks had the surgery and everything was fine at first. Then his vision became fuzzy. Later, doctors determined that the epidermal layer over his corneas was weak and loose. The flap developed wrinkles and never laid down properly. It was lifted different times and stretched to smooth it out. Although his vision is gradually improving, for two months he was legally blind and he still can't see well in low light. He's back in glasses again, but Moshirfar, who took over his care, is "fairly optimistic that over time it will get somewhat better."

Moshirfar warns his patients that the procedure is relatively new and no one knows how someone will do with it "a decade out or two decades out." He's seen a handful of his own patients, who were considered excellent candidates for the surgery and did very well for a couple of years, who now have an irregular stigmatism. "There was no sign they had this condition before."

The Schicks had their surgery in Canada, attracted by very low prices. For Kyle, it was fine. When Michelle developed an infection after she got home, it was hard to find a Utah doctor who would treat her for it. Doctors who didn't do the surgery itself don't want to face possible liability for complications. They fear they'll become the scapegoats. It's also hard to jump on a plane and go back to have it fixed. It costs too much.

"I tell patients the surgeon should be the one who sees you the day after, the month after, long term. The art of refractive surgery is not that four minutes when the procedure is done. It's the post-operative and pre-operative care. I am very proud because one or two of my patients, a day or two after, had major complications. Because I saw them so diligently from the first day, they got better."

More people are unhappy because they feel abandoned than because they got less-than-optimal results, he said.

Davis agrees that aftercare is crucial. One of his patients, in an odd accident, bumped his eye and dislodged the flap that was created. Davis lifted it and floated it into place again. Infections like Michelle Schick's are uncommon, Davis said. But they happen and care needs to be immediate.

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"With careful screening, we basically get good results. That's why I worry about multiple people taking care of a patient. As a surgeon, I would be depending on someone else to screen those things. And the surgery is only as accurate as the prescription was prior to surgery. I don't like depending on someone else's prescription to operate on."

Schick eventually found someone to treat her here and got better, though it took months. She admits she'd do the surgery again, even with her bad experience. But she said she'd have it done by a local doctor who would watch out for her.

And while Jacks said he'd never try to dissuade anyone from having the surgery, "I would encourage everyone to look into it extremely carefully. And I would not go to an assembly-line dealer."


E-MAIL: lois@desnews.com

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