LASIK surgery promises to restore normal vision, but watch out for risks

A new technique promises to restore normal vision to even those who can barely see simply by reshaping the cornea. But watch out for the risks.


Deepakshi Rawat was just beginning life. At 24, she had a bachelor's degree in physics from Delhi University, and a job as a market development executive at Ranbaxy Laboratories.

There was only one hitch: with a power of minus 10 in both eyes, Rawat was virtually blind without her contact lenses. "It was always such a hassle," she says. "My parents worried that my eyesight might affect my marriage prospects."

Then last year, she sold a bottle of eye solution to a Delhi ophthalmologist who sold her the idea of LASIK surgery, the miracle cure for myopia. "Think about it," he urged persuasively, "you'll have perfect vision and never need those lenses again."

A month later, Rawat popped discreetly into a Vasant Vihar polyclinic where a doctor quickly cut open the outer layer of her corneas to create a flap. Then an excimer laser reshaped the curvature of the delicate inner layer to adjust their refractive power.

Next, the flap was carefully put back in place. The procedure took less than a hour and cost her Rs 25,000. Practically overnight, Rawat's lens number fell to minus 1. "It was unbelievable," she recalls, "almost like being born again."

In Calcutta, Arundhati Hazra had a minus 6 number in one eye and minus 7.75 in the other. She also had cylindrical vision and was forced to wear chunky glasses since she was nine years old.

"My head would hurt and my eyes would water if I read for more than half an hour," she recalls. Finally Hazra tried LASIK. Now she can sit for her M.A. examinations "without those bulbous things on my nose".

Lasik: In a simple operation, a laser beam painlessly reshapes the cornea in less than a minute
Shilpa Malani agrees. Malani was what you could call a prize catch on the marriage market. She was 28, good looking, held a degree in business administration from an American university and owned a flat in south Mumbai. Yet, proposals were not exactly pouring in.

Reason: a lens power of minus 8 in both eyes. But Malani's world changed after a 10-minute surgery that cost Rs 40,000. "Now my vision is near perfect and those ghastly glasses have been trashed," she beams. And yes, she is tying the knot soon. The miracle has indeed worked.

Facetiously called "flap and zap" by more skeptical ophthalmologists, LASIK - short for "laser in situ keratomileusis" - is actually the most sophisticated form of cosmetic microsurgery available today.

Based on laser technology, it promises to restore normal 20/20 vision even to those who can barely see by merely restructuring the cornea, the transparent outer surface of the eye.

The "operation" itself seems almost absurdly simple. After applying a local anaesthetic, the doctor uses a delicate cutting instrument called a microkeratome and slices sideways through the cornea's upper epithelial layer, leaving one side attached to create a "flap".

Then he feeds the patient's current lens power into a computerised excimer laser which calculates the degree of corneal "ablation" or reshaping required to correct the patient's vision.

Short sight is corrected by flattening the surface of the cornea and long sight is corrected by steepening it while removing microscopic amounts of tissue from the outer periphery. Next, the patient is instructed to focus on a red light on the machine.

"The procedure has immense therapeutic value, especially for people who want to cut down a high minus power."
Dr Jyoti Dave, contact lens specialist

The doctor then presses a peddle and the laser automatically carries out the procedure painlessly in less than a minute.

After this the flap is manually replaced and "rebonds" with the rest of the cornea within minutes.

No wonder people are queuing up, cheque books in hand. Today, with over 60 LASIK centres across the country, hundreds of Indians are forking out from Rs 25,000 to Rs 60,000 for this surgery.

The prime targets of these centres: young, unmarried women whose dowry rises with their lens power.

But the promise of instant vision is also luring everyone from bankers to athletes and young boys applying for the army. The Better Sight Centre in Calcutta is packed with young engineers and technocrats, since most MNCs specify a lens power between plus 3 and minus 3.

Soumiyadip Biswas, a 26-year-old mechanical engineer, was turned down after a successful interview with a large MNC because he had a lens power of minus 5. Today, thanks to LASIK, Biswas looks forward to joining his dream organisation with razor sharp vision.

Applicants for defence and railway jobs-mostly from a middle-class background are other candidates who scrape together their savings for this costly procedure. At the top end of the social scale are NRIs looking for discounted rates since LASIK costs upwards of $5,000 (Rs 2.15 lakh) in the US.

Sadly, miracles can sometimes boomerang. A few months after the LASIK operation, Rawat's doctor persuaded her to re-operate, with the promise that she would have perfect 20/20 vision. Delighted by his earlier success, the young woman agreed.

Today, she lives in a foggy world, struggling with the most basic tasks. And those hated lenses are back. The diagnosis: irreversible damage causing opaque white patches on both corneas.

No one quite knows what went wrong. From the miraculous to the disastrous, Rawat has seen both sides of LASIK surgery.

"It is absolutely untrue that excimer surgery is 100 per cent safe and successful. A third of the cases still require glasses after LASIK."
Dr K. P. S. Malik, Ophthalmologist

Sanjiv Reddy (not his real name), a 23-year-old student who aspired to a career in the merchant navy, was rejected because he had a power of minus 5 in both eyes. He forked out Rs 45,000 for LASIK surgery to correct his vision, but can now hardly see.

"For some reason the outer flap of the cornea started growing inwards after the operation and obstructed his vision," says ophthalmologist Dr Sujal Shah who is currently treating the devastated young man. No one knows exactly why it happened.

Even in the US, where five lakh operations were performed last year using the latest techniques and equipment, nearly one in every 20 LASIK operations ran into trouble. Although there is no data available, the failure rate could be much higher in India.

Reason: slapdash surgery conducted by inexperienced doctors armed with no more than a weekend crash course in LASIK surgery.

Also, LASIK does not ensure perfect vision. Patients often find that while their lens number has dropped, the quality of sight is affected: they may not be able to differentiate between shades of blue, for instance, because LASIK tends to reduce the eye's contrast sensitivity. Others complain of seeing objects less sharply defined and most see haloes in dim light.

This is because the pupils widen in the dark, allowing light to filter through even the uncorrected parts of the cornea. This is more likely in case of a dramatic correction - say a minus 16 power dropping to minus 6 - that creates sharp differences in the sculpted and unsculpted parts of the cornea.

These may be the most minor of the problems related to LASIK. Dr K.P.S. Malik, a senior ophthalmologist at Delhi's Safdarjung Hospital, claims he has seen several patients who have developed serious complications after undergoing the procedure. "It is absolutely untrue that excimer surgery is 100 per cent safe and successful," he says flatly.

"There are several risks involved." Besides, says Malik, 30 per cent of the cases, especially people who have a lens power of over minus 6, require glasses even after LASIK. "About 3 per cent of the patients develop irreversible complications," he adds.

Sometimes the upper epithelial tissue inexplicably starts growing inwards. Or the outer flap may not be correctly replaced, causing wrinkles in the cornea that bring visual distortions like double vision. Thin corneas easily get damaged during surgery. In extreme cases, a weak retina might even rupture or detach causing total blindness.

This is due to the pressure exerted on the eyeball by the suction required to lift the outer corneal flap. "People with inherently weak retinas or those with thin corneas measuring less than 500 microns are especially vulnerable," warns Dr Lalit Verma, senior ophthalmologist at AIIMS, Delhi.

Incidentally, LASIK can never be performed on minors since the human eye continues to grow and change long after puberty. It also does not correct presbyopia, the gradual degeneration of the lens during middle age.

The ideal candidate: adults in the age group of 18 to 45 with defective vision ranging from plus 5 to minus 15 and an otherwise healthy eye. More importantly, those with a lens power higher than minus 6 can expect to have a residual number even after surgery.

Dr. G.N. Rao, director of the L.V. Prasad Eye Institute in Hyderabad, one of the top eye research centres in Asia, says intensive training for those using it, choice of quality laser machines and proper selection of patients are crucial for the safety of those opting for LASIK. But, he warns, at present only one in five using this technique in India can perform the procedure well.

A qualified LASIK expert first takes a vision test to establish the patient's number in both eyes. Next he uses a corneal topographer to map the cornea and look for surface irregularities that could cause trouble. Then the retina is checked for holes or tears.

"The long-term impact of LASIK is still unknown. The technology will find wider acceptance once its effects on the cornea is fully understood."
Dr G.N. Rao, director, LV Prasad Eye Inst.

"The skill and professional practices of the surgeon hold the key to LASIK's success," says Dr Kasu Prasad Reddy, medical director, Maxvision, Hyderabad.

But high financial stakes often cause these vital preliminary checks to be neglected, if not totally ignored. Since the equipment itself costs up to Rs 2 crore, few are willing to turn away a prospective client, however unsuitable he may be for LASIK surgery.

It doesn't take a medical licence to import an excimer laser. Since the machine is completely computerised, even a relatively lay person can be trained to operate it. "I have heard that even ordinary opticians are offering this surgery," says Malik grimly. And this is where a line must be drawn between business and ethics.

"The long-term impact of LASIK is yet to be determined," shrugs Rao. "The technology will find wider acceptance once its effect on the eye is fully understood." This, however, does not mean that the technology itself is harmful.

"LASIK has immense therapeutic value, especially for people who want to cut down a high lens power," says Dr Jyoti Dave, a leading Mumbai contact lens specialist. "But this is essentially a cosmetic surgical procedure and like any other surgery, there are risks involved." In other words, normal vision comes at a price. Many are paying for it.

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