Many patients ask me about Lasik surgery. I'm naturally conservative when it comes to surgery; I think that altering any body tissues should never be taken lightly.

Lasik is considered elective surgery and there are risks. Much of the marketing and public relations downplay or ignore the risks and side effects. You're much more likely to hear from successful patients than from those experiencing problems.

That said, there are several factors I consider when discussing Lasik with patients:

Realistic expectations: Even with the best testing and surgeons, perfect prescriptions are not asssured, and glasses or contact lenses may still be needed.

Prescription: Good candidates should have stable prescriptions that haven't changed much in several years. Even so, there are no guarantees that your prescription won't change years after surgery. I've also found that myopia (nearsightedness) comes out better than farsightedness and moderate to high amounts of astigmatism. Patients with very high prescriptions have a higher risk of side effects, and there's more tendency for the prescription to change over time.

Type of visual system: I find that some patients have very "precise" vision, and small changes and variances affect them greatly. These patients are more likely to be disappointed by Lasik. Patients who can tolerate a range of prescriptions have a higher chance of being pleased with the results, even if not perfect.

Anatomical considerations: patients with dry eye and/or large pupils are much more likely to experience post-surgical symptoms.

Dependence on precise vision for work: A micro-surgeon who needs precise depth perception to perform his duties would have more trouble than a singer should the results be less than perfect.

Age: Although Lasik is approved for anyone over age 18, many younger patients' prescriptions continue to change in their twenties. I think that mid to late 20's should be the earliest age to consider surgery.

Separate prescription: If you need a separate prescription for close-up work than for distance, as becomes common after age 40, Lasik can correct only one of these. Unless one has even more risky monovision surgery, one pair of glasses will still be needed.

When I'm sure the patient is a good candidate for Lasik and has realistic expectations, I recommend they have it performed by an experienced surgeon, preferably with credentials as a corneal or anterior segment specialist.