Will laser eye surgery suit even nervous nellies?
Sinead Ryan, who had the op in the 1980s, asks if the procedure suits even nervous nellies
Published 25/02/2016 | 02:30
For some, it completely changes their world; for others, the idea of having their eyeball touched, never mind directing a laser beam into it, fills them with cringing dread.
Laser eye surgery is the world's most common elective procedure, with more than 22 million cases carried out worldwide, up to 15,000 of them in Ireland each year. As it happens, this writer was one of the first, in Ireland at any rate, to undergo it.
Then a pioneering and largely experimental surgery first developed in 1974, by Svyatoslav Fyodorov, a Russian ophthalmologist, to cure chronic myopia (short-sightedness), it was brought here in the late 1980s by Dr Frank Lavery using a diamond-tipped scalpel in a procedure known as radial keratotomy (RK).
Requiring a couple of days in hospital, per eye, and a great deal of after-care, it wasn't for the faint-hearted. I recall being forced to watch the procedure on a video so I knew what I was letting myself in for. Given I had enormously poor sight in both eyes it was an all-or-nothing decision, very expensive (it wasn't then covered by insurance), and somewhat risky.
A 10-year study carried out in California in the mid-1990s showed the results of RK had been largely successful, with 53pc of patients registering 20/20 vision and 85pc with 20/40 or better (enough required for a US driver's licence without corrective lenses). Seventy per cent reported not having to return to glasses at the 10-year mark.
I am fully 28 years on, and have only in the last year found the need to acquire low-prescription glasses again. For the vast majority of normal-sighted people, they turn slightly long-sighted with age (around age 45). Those who have had RK or laser surgery return to 'normal' instead, thus meaning they may never need glasses of any kind. However, results are not fully guaranteed in this respect. There are also reports of increasing corneal scarring and 'floaters' caused over the decades, but many would consider them a small price to pay for near perfect vision and the financial savings on glasses, lenses and their accoutrements.
Dr Arthur Cummings is consultant ophthalmologist with the Wellington Eye Clinic. Some 80pc of their work is spent on laser eye surgery and it offers the next best thing to a guarantee - a lifetime warranty, meaning if vision slips below driving standard, they will repeat any procedure at no additional cost.
Nervous nellies will be reassured by his opener: "There is no cutting today. The laser uses air bubbles to create the flap used during Lasik. When someone is not suitable for laser surgery there are other options: implanting a contact lens inside the eye or even replacing the lens inside the eye."
Indeed, Lasik is safer than long-term contacts. "We see two to three very severe contact lens infections each and every year yet have not seen one Lasik infection since starting the procedure in 1994".
Stephen Hannon is clinical services director of Optical Express. "Lasik suits the majority of patients; it's effective and the vast majority have 20/20 vision the day after the surgery. It takes 10-15 minutes and both eyes can be done the same day. One-in-five patients may not be suitable for it either for health or eye reasons and there are other procedures that can be carried out instead, more bespoke methods," he says.
He agrees with Dr Cummings on the low risk of infection. "Fewer than 1pc of patients will develop some complication, the most serious of which is infection, however we see just 1/8000 with this, compared to 1/1000 with infection from contact lenses".
And yet there are still thousands of people who continue to opt for glasses or contacts. Lynda McGivney Nolan, head of the Association of Optometrists Ireland, which has 700 members, says that it often comes down to squeamishness.
"Some people just don't want it done. They don't want the risk, even though it's small, and they're not motivated enough to take the step. Lots of people are happy with glasses - they're a fashion item as much as corrective".
While opticians are always happy to talk through all options with customers, including Lasik, McGivney Nolan warns people to take care in choosing clinics. "Some places are very cheap. We really wouldn't recommend them.
"Some people simply aren't suitable for surgery or they have dry eyes which may be worse afterwards. We're happy to recommend places, but there'll always be that cohort who will choose not to, no matter what".
Does my health insurance cover me?
All four health insurance providers offer some discount off laser surgery, as do a couple of specialist insurers, however, some limit it to specific clinics, and set amounts, so check before you book. Any cost not covered can be reclaimed against tax at 20pc Standard Rate using the Med 1 form available to download from www.revenue.ie
Insurers: what they cover
Glo Health: 20pc reduction from Optilase or Optical Express.
Laya Healthcare: 15pc reduction at clinics including Optical Express, Optilase and Wellington Eye Clinic.
Aviva Health: 25pc reduction at Optical Express on Lasik and Lasek treatment.
VHI Healthcare: 15pc reduction at clinics including Laservision, Optical Express and Wellington Eye Clinic.
HSF Health Plan: Claim up to €800 back on Family Direct C Scheme after 12-month membership.
VSP Vision Plan: Employer-based group insurer offering discounts on laser treatments after waiting period.
1 Assessment. Consultation in many clinics is free of charge to ensure suitability. It is painless and you won't have to commit. The corneal shape and thickness is measured by specialist machines.
2 Different procedures are discussed with the patient. Lasik is used in the vast majority of cases and involves applying a laser excimer to correct the prescription. Stephen Hannon says "it's like opening a 500-page book at page 150 and closing it again". For others there is Lasek (a surface correction used in 12-15pc of cases) or Smile (Small Incision Lenticule Extraction) which removes the corneal tissue through an incision on the surface.
3 Think the procedure through. Talk to friends or colleagues who have had it done. Dr Arthur Cummings from Wellington Eye Clinic says the majority of people come to surgery via word of mouth.
4 Check affordability - surgery is expensive and may require a loan. There is some cover if you have private health insurance, and the balance can be offset against tax, but it will cost you the bones of €4,000 gross for both eyes.
5 There is some aftercare, but drops and eye shields are temporary and you will be able to see perfectly 24 hours after the procedure.