LASIK FAQs

Over the course of the past two decades, LASIK has become the most well known name in refractive eye surgery in the US. Millions of Americans who suffer from myopia (nearsightedness), hyperopia (farsightedness), and astigmatism (misshapen cornea) have achieved heightened improvement in their eyesight having undergone this wonderful and highly effective procedure. But for those of you who have yet to experience its transcendent results, you may be questioning how the procedure works.
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There are many myths associated with LASIK Laser Eye Surgery. Some of the most common misconceptions are: Vision gets worse with age, so you have to get LASIK again later in life; if you wait a few years, LASIK will be cheaper; Astigmatism can’t be cured with LASIK; and, if you get LASIK you will need to begin using reading glasses.

I know of no patient, case study, or case report of a patient ever going blind from a LASIK procedure.

Many patients who were told they were not candidates are now candidates through the advancement in technology over the past several years, the use of aspheric, naturally shaped corneal ablations, the use of thin flap LASIK, the use of specialized techniques for extremely high corrections, and the use of advanced procedures such as Epi-LASIK and hybrid Lasik/PRK combinations. I have seen many patients who had previously been told they were not candidates who have done extremely well with laser eye surgery at our center.  We encourage patients to come get a complimentary consultation to find out the right choices for them.  We will even refer patients to another center if we do not do a procedure that may help them.

Hyperopic treatments have been around for over a decade, and the latest treatments on the Wavelight EX500 system are by far and away the best I have ever seen with very rapid, stable results, and the ability to comfortably treat hyperopia even up to 6 diopters.  This has also made the treatment of hyperopic patients who need Balanced Modified Monovision to assist with reading vision as they get older even easier due to the high accuracy of the EX500 hyperopic treatment.

This is one of the strangest myths I have ever heard. Astigmatism has been treated with lasers for 12 years now, and since most people have some, it is commonly treated part of a LASIK procedure. In fact, we have treated some of the highest astigmatism in the world at 9 diopters of correction, which is 9-18 times what people commonly have.  Frankly, in our opinion laser vision correction provides the most stable vision a person with significant astigmatism has ever had.  We specialize in treatment of high astigmatism cases, and can often perform LASIK when other centers suggest PRK.

Glasses and/or contacts need to be replaced on a continual basis due to use and wear and tear. There is the added cost of solutions, doctors visits, and the cost of problems that arise. If you spend $50 on contacts and solutions per month , the cost would be $600 per year. Factor in the $75 to see the doctor per year, and within about six years you would exceed the cost for Lasik. If you got nice glasses every year at a cost of $500-$600, you would be in the same ballpark for cost. This doesn’t even include the fact that LASIK is tax deductible, or you can use your Flex Fund or Health Savings Account to pay for it. That would give a discount for the amount of tax you would pay on that money, which could save you a third or more of the cost of the LASIK.

It is a common misconception that vision keeps changing. Most people have had their prescription stabilize by 18, as the eye lengthens and changes shape as we physically grow and get taller. A few people who intensely read and study may have it change through their very early twenties. After this time your prescription does not change, and you would not need to re-do your LASIK just because you got older. The American Academy of Ophthalmology recommends LASIK for those 18 and older, and I have even done LASIK on those under the age of 18 if they have achieved what is believed to be their maximum height.

That’s the need for reading glasses for people in their 40’s and older: Approximately 60% of my practice historically has been patients in their 40’s, 50’s, 60’s, and 70’s who suffer from presbyopia, or the loss of reading vision. Loss of reading vision is like death and taxes, it happens to everyone. For many years we have utilized a technique that we have developed over a decade called Balanced Modified Monovision for presbyopia patients that works extremely well. The technique requires extreme accuracy with the correction, and careful balancing of the refraction between the two eyes. With that great care, it works very well in the vast majority of patients that I have performed it on. In fact, it is something that Dr. Motwani has had performed on himself, and trusts it enough to have performed on his parents, family members, and close friends.  Although there have been other techniques and procedures that have received much hyper over the years, they have come and gone and Balanced Modified Monovision has stood the test of time.

With the Balanced Modified Monovision technique that Dr. Motwani has developed, patients absolutely do not close one eye or the other. This technique works best with both eyes open, taking advantage of the fact that the brain prefers one eye over the other for distance vision. That is why we all have a dominant eye – we look through a telescope, shoot a gun, or aim at something consistently with the same eye. Using this system, the brain gets a clear distance image from the dominant, fully corrected eye, peripheral vision from the reading eye, and uses the information from the reading eye when looking at things up close. It’s important to remember that the eyes just gather light, and it’s the brain that actually sees.

The need for reading glasses is purely dependent on age, and has nothing to do with getting LASIK. If LASIK is properly done it will not have any impact on either your need/non-need for reading glasses or at what age you will need them. As discussed elsewhere, when reading glasses are needed this can also be compensated for with LASIK.

In this technology age we expect everything to eventually become cheaper. That is not true for LASIK, as the technology just hasn’t gotten cheaper, and in many ways it has gotten more expensive. Lasers are not less expensive, especially if the technology is up-to-date. Other equipment has actually gotten more expensive as we have added new types to ensure safety and proper analysis. Medical supplies have only gotten more expensive, and servicing for the equipment is a continuous cost. Staff is no less expensive, advertising is no less expensive, rent is no less expensive, and part of the cost is an experienced surgeon who can deliver excellent results. Finally, it is important to remember that you are also paying for the care before and after the surgery, not just the surgery itself. Poor measurements before the surgery are subject to the age old law of garbage-in, garbage-out. In other words, if the measurements aren’t good, and the wrong numbers are fed into the laser, the best laser and the best surgeon in the world can’t give you a good visual result. Poor post-op care can end up with patients not seeing well, having dry eyes, or even with untreated problems such as corneal flap wrinkles, infections, or epithelial ingrowth. Although there are centers that have and will continue to advertise insanely low prices, those prices are bait and switch for procedures that very few people actually qualify for. If you look at the above list of costs just mentioned, you can see what goes into LASIK, and there is no way to magically lower prices. The decreased cost has to come from somewhere, in either inferior equipment, less expensive staff, a “less expensive” surgeon, cheaper supplies, less pre and post-surgical care, etc.

Across 15+ years of practice in San Diego I have done LASIK on professional athletes, police officers, firefighters, Marines, Army and Navy personnel, Navy SEALS, pilots, and uncountable numbers of amateur athletes, and I have only seen ONE case of a flap loss. This was from a firefighter during the wildfires of 2007 who walked around a fire truck into a shovel blade that cleaved his flap off. His prior Lasik had been done 4 years before, and after trauma treatment and PRK for refractive error treatment he is 20/15 (better than 20/20) in that eye. LASIK flap loss is an incredibly rare phenomenon, and as my experience has shown, a treatable one.

The best visual results come from aspheric/prolate corneal ablations, which create a very natural cornea post-LASIK. Dr. Motwaniwas one of the first in the country to do aspheric corneal ablations in late 2002, and his results have been excellent for many years. The Wavelight EX500 is faster and more accurate, and has even bettered those visual results for better than 20/20 vision and accuracy. Technology for most patients has plateaued with the Wavelight EX500, and further improvements are focusing on very complex, difficult, irregular cases. For the vast majority of patients the technology and visual results have not changed significantly for a number of years, and we don’t expect things to change in any significant way for years to come.

Dry eyes are something that can happen temporarily post-LASIK, but as the cornea heals the amount of tears made increases again. If there is any issue, treatment with a course of Restasis is extremely effective. For those patients that have dry eyes ahead of time, treatment with Restasis and punctual plugs is extremely effective. Patients may like the feel of artificial tears and use them long term, but virtually all dry issues post-LASIK can be treated so the use of artificial tears long-term is not a necessity.