Is laser eye surgery safe?

Spice girl Mel G has done it. So has Richard Branson. Actress Courteney Cox says it's saved her career. It's not a wonder slimming drug or a new tantric meditation technique, but a relatively straightforward and relatively new laser treatment to correct short sight. A gaggle of celebs are queueing up to rave about Lasik laser surgery, each in terms more breathless than the last. "It's a miracle, I feel I've been given a new life," Cox says. Before she had the surgery, she could not read cue cards or an autoprompt, and even had difficulty telling her Friends co-stars Lisa Kudrow and Jennifer Aniston apart (one is blonde, the other a brunette). Cox's eyesight was so bad that she qualified as legally blind. Now, she says, "every day is a new experience of vibrant images".

It may sound too good to be true, but Lasik surgery (Lasik stands for "laser in situ kertatomileusis") does promise something little short of miraculous. An almost entirely painless technique to correct chronically poor eyesight, with immediate improvement in vision, the technique takes only 10 minutes for each eye. You can even have it done the day you walk into a surgery, so long as you have £3,000 in your pocket.

Tempted by a while-you-wait one-stop eyesight shop, 12,000 myopic patients in the UK and close to 1m in the US are signing up for it each year. It's now the most common form of elective surgery in America and accounts for 90% of all laser eye operations each year in this country. "People walk into a surgery and 20 minutes later they throw away their glasses," says a spokesman for the Moorfields eye hospital.

It is six years since Lasik treatment was first offered in the UK and five years since it was licensed in the US, but the long-term safety of the procedure is far from proven. In 1998 the Home Office suggested that police forces reject any candidates who had undergone any form of laser eye surgery as its efficacy was unproven. Now some eye experts are questioning its safety, in particular whether it can lead to long-term vision deterioration or even disintegration of the eyeballs.

The procedure, in which the surgeon lifts a sliver of the cornea with a knife, removes some tissue beneath it with a laser and replaces the sliver, is known as "flap and zap" because of its supposed speed and ease. But, warn experts, if the surgery goes awry it can lead to the cornea bulging, or parts of it becoming dislodged. In extreme cases some patients may even need a complete corneal transplant.

John Marshall, professor of ophthalmology at St Thomas's hospital in London and the country's leading expert on laser eye surgery, has this week expressed reservations about the long-term safety of the Lasik technique. He was involved in the development of Lasik's more conservative predecessor, the photo-refractive keratectomy (PRK) treatment, in which microscopic amounts of tis sue are removed from the surface of the cornea with an ultraviolet beam of light. It can take some months for the eyes to heal, during which time there can be some pain and clouding.

"If you are offered two types of surgery, one of which is painless, the other of which involves some pain, there is virtually no doubt that you will go for the former," says Marshall. "If I said in the second operation I will remove less than 5% of the wall of your eye, whereas in the other I'll cut into a third of your eyeball, you might think again. And if I said that in the case of PRK I have 10 years of follow-up data, but in the second I don't know if it will be stable, your decision might be very different.

"I'm not saying that one is bad and the other isn't. It is just that Lasik is a much more aggressive procedure and we don't have a lot of information about the long-term effects."

Certainly Lasik treatment galloped into use in the US, passed by the Food and Drug Administration after only two years. Marshall says he is concerned "because before doing such huge numbers it would have been nice to have had more long-term follow-up."

Those worried about the potential scale of the problem should look to the US, where a support group called Surgical Eyes exists for people whose laser treatment has gone wrong. Executive director Ron Link says it is difficult to measure the scale of the problem, but that he knows of 1,000 people who have suffered long-term eye damage, with another 4,000 potential cases waiting to be assessed.

I'm not saying that Lasik is a bad procedure, but it is not being used appropriately," he says. "Secondly, people do not realise that if they have a bad result, there is no Plan B. The impression is that you can go back into glasses and contact lenses, and nothing is further from the truth." If the surgery goes wrong, you may need reconstructive surgery - or end up almost blind.

Marshall agrees that the key is being as informed as possible before paying for surgery. The treatment is not appropriate, for instance, for those with vision worse than -12 diaopters (extreme short sight). If a private clinic tells you otherwise, be suspicious, and walk away if they offer to do the procedure on the same day as the first consultation. The Royal College of Ophthalmologists publishes guidelines for practitioners and potential patients. The only way the latter will know whether their surgeon follows these guidelines, says a spokeswoman, is to make sure they are well-informed themselves.

"The fact remains that with a 95% success rate, this procedure has one of the highest success rates of any operation," says Marshall. It is just that when it goes wrong, it goes very wrong - and no one knows the real risks. "I'm not saying that it is going to ruin your eyes, but I just want people to be aware that there are potential risks. You have no idea of what will happen in four or five years' time."

Thanks to guardian.co.uk who have provided this article. View the original here.