Why Not Wait Until Later For LASIK

Intelligent consumers are always in the position of weighing their best options today against a potentially improved one tomorrow.  Look at the case of computer memory, the price drops in half while the amount of storage doubles almost every two years.  On the other hand, if you need some RAM memory today, it matters little what it will cost tomorrow.  Medical procedures and services have not traditionally been considered consumer items.  For one, if you really need your gall bladder removed, you will take the best technology you can get today, even if someday it will be possible to remove it through your mouth in fifteen minutes. Many elective procedures are in the same situation where a face lift in five years will definitely not be less expensive than one today.  Cosmetic surgeons have been able to maintain the aura of individual craftsmanship, whether deserved or not.   Laser vision correction has somehow fallen into the realm of being  much a consumer driven purchase.   While laser eye surgery is much different than say selecting a new washing machine, there are some consumer sentiments which are evaluated similarly to "features" on a consumer product purchase.  We pick  products based on considerations including obsolescence whereas we choose professionals based on esteem.  Because of all of the marketing around LASIK and its reliance on high technology,  it is driven by both factors.

All areas of medicine have had amazing improvements both in devices like cardiac pacemakers and staples instead of sutures as well as medications to treat a myriad of disorders.  For one thing, there is no compelling reason to have LASIK today, since contacts can be worn until the decision to make a switch.  Some people are motivated by a career or recreational desire to have better vision now.  Such as the police officer who wants to be free of glasses while in perilous situation, or the snow boarder who does not want his goggles and glasses fogged up or a contact falling out at the wrong moment.  But many others are timing vision correction with flexible spending accounts, work schedules, or a vague notion of when it the right time to have it based on technology advances.

There is no doubt that LASIK has changed considerably although it is surprisingly similar in many ways to how it was 15 years ago, after all, it is still LASIK.  Today we have honed many aspects of the procedure which I would like to briefly discuss to help potential patients decide when is the best time to move ahead with this decision.

There have been two important changes in LASIK since it was first performed.  The first has to do with flaps, originally created and often today by a microkeratome, which is a bladed device that "shaves" the cornea.  Now we have femtosecond lasers, and in their current generations can safely and effectively create precise flaps or openings.  This technology has developed over the last decade and is mature at this time.  What this means is that it is well understood and will not change significantly in the near future.  Will there be subtle refinements?  Probably.  Will it change in a way that will make a difference in LASIK outcomes?  Unlikely.

The second part of LASIK involves using an excimer laser to reshape the eye.  Previous posts on this site and other sources have described how this technology has changed and evolved.  Currently there are eye trackers, very fast lasers, and very good algorithms to determine the exact amount and shape of the correction.  In fact things are so good that most patients obtain an excellent clinical result.  Again, there are no fundamental new changes in how this technology is delivered, and we do not expect to see nor are there required to be major advances in excimer treatments over the next decade.  In fact, there are no active FDA studies enrolling new patients into LASIK technologies beyond what exists today.

Let me say that again.  There are no new studies enrolling patients for LASIK technologies beyond what exists today.  Yes, this is part because it is so expensive, and difficult to get approvals for additional improvements, but also it speaks to the fact that very little additional change is required.  The clinical studies predate the acceptance of a new technology by 5-10 years, so no new testing today, means no new technology until the next decade.

Let us look at a different high technology product, the modern jet aircraft.  While there are some new planes being built, for the forseeable future we can expect to fly on the same planes that have been in the air for the last 20 years on average.  There is not a strong demand for newer planes and the ones we have seem to work fine, (at least until they wear out which is hard to predict).

The lasers that we have at Dishler LASIK are the newest generation available.  They are the most recently approved and provide a high tech solution for vision correction.  While it is true that some centers are using lasers that were developed almost 20 years ago in order to offer low pricing, our center and many others offer much more state of the art solutions for vision correction.  We have gone through many generations and types of lasers over the last 15 years, but I do not expect to see a significant change in this technology in the near future.  This means that LASIK today will be the same as it was a year ago, and the same as it will be a year or so from now.  While no one can completely predict the future, LASIK is a mature technology and is not likely to change much more.  The same can be said of PRK or surface ablation.

There are two other area where the have been and could continue to be some changes.  One area is that of diagnostic instrumentation.  That is, the devices we use to measure the eyes and determine what and how we do laser vision correction.  While these also are very developed technology, there continues to be small but important advances and this is why we have the latest of this type of technology as detailed elsewhere on our site.

Alternative technologies to LASIK are also a consideration. ICL's and other implants or intraocular devices continue to be developed and perfected, and are not yet mature technologies.  The problem with some of these is that they are in my opinion too imperfect to compete with LASIK unless absolutely necessary due to circumstances.  Other technologies show much promise such as the all laser femtosecond which may be able to perform procedures beyond those of simply making flaps.

Based on all of the above, there has never been a better time than now to have LASIK.  And there probably will not be much of an advantage to having LASIK a year or so from now than having it today.  It probably will not even be significantly different 5 years from now.  Instead of viewing this as a consumer purchase, more and more patients are returning to the more traditional medical approach where they value the reputation of the provider and their staff in making recommendations and their experience and skill in delivering today's technology in a friendly, caring, and competent manner.  While the plane is important, the airline and the pilot are probably the best considerations in travel.  In medical services this is even more the case, where the doctor, dentist, or other health care providers are individuals and your relationship with them is paramount to any future small changes in technology.