Last word on Lasik is caution

NEW DELHI: The final word on the commonly used surgery for removal of spectacles -- Lasik -- is out from no less than a team of medical scientists: the lifestyle surgery is associated with several potentially sight-threatening complications.
The safety of Lasik had snowballed into a major controversy following a series of reports in The Times of India on its complications.It was being marketed as a very safe procedure till then.
The Indian Journal of Ophthalmology, while doing a complete assessment of its possible risks, also notes in a hard-hitting editorial: "There is a tendency amongst our colleagues to trivialise Lasik as an easy, completely machine dependent, ''anyone can do it’ procedure. These doctors do a great disservice to our
profession and belittle
themselves and their colleagues." It also lauds the media’s efforts in creating awareness of the pre-operative assessment.
While the surgery itself is safe, its practice may not be, indicates the editorial. " Lasik in India is industry driven and not patient or physician driven," indicating that the strict parameters required for patient selection are not being applied.
Applying a strict screening criterion is necessary for avoiding some of the possible complications. The journal also lists a series of complications associated with
the surgery.
The six researchers of the paper are medical scientists from the best eye institutions -- L V Prasad Eye Institute, Hyderabad, Sankara Nethra-laya, Chennai, Dr Rajendra Prasad Centre for Ophtha-lmic Sciences, All India Institute of Medical Sciences, Cornea Service, Wills Eye Hospital, Philadelphia, US.
From complications associated with the corneal cap removal to its perforation, the researchers list several things that may go wrong. For instance, the head of the microkeratome, or the instrument used for performing the surgery, may not complete its full excursion across the cornea resulting in an incomplete cut. Or it may cut the flap off completely, resulting in a free cap.
While no Indian studies are available, a study of 1,019 eyes reported in the American Journal of Ophthalmology, had shown such complications in 109 eyes or a high 8.6 per cent of the patients.
A corneal perforation during the creation of a flap is a devastating intra-operative complication, it says.
Among the other complications, an inflammatory reaction, known commonly as Shifting Sands Syndrome, can occur through seemingly innocous substances such as talc from gloves, oil, wax, metallic fragments, and even particles from eye drapes, among others. A progressive thinning of the cornea could be a potential, serious
late complication following Lasik, perhaps due to altered biomechanics of this layer
of the eye.
In most cases, there is a decrease in tear secretion following the surgery. Night vision problems and other optical aberrations may occur in some cases. Under correction and overcorrection after myopic Lasik is not uncommon, says the journal. Though rare, infection following Lasik is a potentially vision-threatening complication. The incidence is expected to be one in 5,000.