Anyone contemplating laser eye surgery should carefully consider both physical and psychological factors beforehand, eye surgeons and consumer advocates agree.
While there are no reported cases of blindness from Lasik, a minority of patients have been left with serious and sometimes uncorrectable problems such as glare, haze, double vision, ghosting or irregular astigmatism, a permanent warping of the cornea.
Here are suggestions for prospective patients:
* In addition to a complete eye exam to ensure that corneas are healthy and thick enough to undergo surgery, be certain to have the size of your pupils measured. Patients whose pupils expand to more than about 7 millimeters in dim light are more likely to experience glare, halos and ghosting that may not go away, even if they can see 20/20. Patients with large pupils and high levels of myopia or astigmatism are especially prone to such problems.
* Ask surgeons about their experience, outcomes and complication rates. Doctors learn to perform Lasik in weekend courses in which they practice first on pigs' eyes, then graduate to people. Many ophthalmologists believe it takes several hundred procedures before a surgeon has the requisite skill and can recognize and manage complications. Ask surgeons how many of their patients needed a second procedure, known as an enhancement. Question a rate above 20 percent, which might indicate a lack of surgical acumen.
* Consider doing only one eye at a time, not both simultaneously, an increasingly common practice. If something goes wrong or you don't like the result, at least you'll have one unaffected eye.
* Read the consent form carefully, preferably before the day of surgery. Do not assume that complications happen only to other people.
* Make sure your surgeon uses an FDA-approved laser. Several years ago the federal government cracked down on illegal "black box" devices, lasers imported or built for individual use that had not been FDA-approved.
* Think about how you will feel if your vision turns out to be less than crisp--or worse than it was with glasses. Some people, particularly those who are very nearsighted, may be delighted seeing 20/40 without glasses, while those who are only slightly nearsighted and those who are extremely precise may be unhappy with less than crystalline vision. A minority of patients experience complications that cannot be corrected with glasses or contact lenses.
* Do not expect Lasik to eliminate the need for reading glasses. Nearly everyone needs them sometime after age 40 because eyes lose their ability to focus.
* Avoid a surgeon who promises good results or who seems to be trying to sell the procedure. Lasik is surgery and there are no guarantees. Results depend in part on how the eye heals, an unpredictable variable.
Sources: American Academy of Ophthalmology; Food and Drug Administration; Washington Eye Physicians and Surgeons; Washington Laser Eye Center; James Salz; Surgical Eyes; Emory University
CAPTION: These photos simulate the pronounced halos, left, and star bursts, right, that some patients see around lights after Lasik surgery.