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In SNEC, we first started laser refractive
surgery to correct short-sightedness in1992 with the earlier PRK
technique, and we later switched to performing the more successful
LASIK procedure which we started in 1998. A total of 5953 PRK and
18,288 LASIK (total 24241 cases) have been performed so far with
a very good track record of safety and success rates.
As in any surgical procedure, there are certain
risks involved in refractive surgery. In the SNEC, patients are
first of all carefully evaluated for suitability of the procedure.
Patients with high degrees of myopia falling outside the treatment
range, or with too thin corneas or not meeting other treatment criteria,
will not be accepted for treatment. Around 10% of patients are screened
out after careful evaluation and advised not to proceed with the
procedure. Performing LASIK on only those who are suitable for the
procedure allows for a high safety profile and avoiding unnecessary
risks complications.
An important aspect of refractive surgery is
detailed counseling concerning expectations of success, the quality
of vision after surgery, and very importantly, the potential side-effects
and complications which may arise. In SNEC, full informed consent
is obtained for all refractive procedures and this process is especially
thorough and detailed as compared to other eye operations, as we
adopt a checklist and FAQs comparable to that recommended by the
US Federal and Drug Administration (FDA).
On top of this, SNEC conducts a 100% audit
on our LASIK surgeries to monitor results and maintain high standards
of outcomes and care. Our clinical audit data show a strong track
record of safety and efficacy. In almost 25,000 consecutive cases
of excimer laser refractive surgery performed in SNEC, we have not
encountered any
major complication which has resulted in severe visual loss or blindness.
Surgery can never be totally devoid of complications, however, and
we do have complications relating to lasik surgery, but these have
been relatively minor and fully treatable to date. The incidence
of complications in our LASIK series stands at 0.4% i.e. 4 per 1,000
cases, and examples of these include trauma to the LASIK flap following
surgery and other minor and treatable flap-related complications.
In addition, some of our patients also experience minor side-effects
of LASIK surgery, as in transient dry eye symptoms, and night vision
issues such as seeing haloes around bright lights and reduced visual
contrast in dim light. All these are carefully explained to patients
prior to surgery. It should be noted that many of our own lasik
surgeons, ophthalmologists, nurses and our family members have undergone
LASIK themselves, clearly establishing the level of confidence we
have in this procedure.
The potential complication of corneal ectasia
mentioned in the article is very uncommon, but may occur with excessively
thin corneas or weak corneas, as in certain conditions such as keratoconus.
The latter is a more common condition in Causasian eyes. If these
eyes are inadequately screened, and LASIK is performed inadvertently
in these cases, the cornea becomes weaker and becomes unstable in
shape, resulting in distorted vision or an unstable state of refractive
error. A very important aspect of the pre-LASIK examination is to
detect thin or weak corneas unsuitable for surgery, and this is
done in all cases in our centre. Corneal ectasia is therefore a
preventable complication if appropriate screening is performed in
all patients going for LASIK surgery. I am unaware of any other
form of long term complication associated with LASIK surgery.
Finally, it appears that the UK National Institute
for Clinical Excellence (Nice) report has been prepared to look
for evidence whether it justifies the widespread use of LASIK in
the National Health Service (NHS) which is for subsidized treatment.
Given myopia can be corrected effectively by glasses and contact
lenses in the majority of patients, there is no justification that
LASIK should be a subsidized procedure and hence would explain Nice’s
recommendation to “block” LASIK for widespread use in
NHS. In Singapore, LASIK is deemed a cosmetic procedure and is already
blocked from subsidy and medisave withdrawal except for a very few
cases which can justify the procedure on therapeutic grounds.
SNEC continues to advise patients to seek full
information on LASIK when considering undergoing the procedure.
Patients should carefully weigh the benefits and risks of LASIK,
discuss the procedure carefully with their surgeon, ensuring that
all their questions and queries are fully addressed (including queries
as to the individual surgeon’s experience and success with
LASIK), before embarking on this procedure. Having said that, with
the appropriate standard of ophthalmic assessment and care in place,
LASIK is, and can be one of today’s safest and most successful
forms of eye surgery.
For further information, please contact:
Ravi Chandran
Corporate Communications Executive
Singapore National Eye Centre
Tel: 6 322 8394
E-mail: ravi@snec.com.sg
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© 2004. Singapore National Eye Centre. All rights reserved.
