Where to start

Why consumers choose this surgery

Consumer Reports asked almost 800 U.S. adults who have had vision-correction surgery about their reasons for having the procedure. Being tired of needing to wear glasses or contact lenses was the No. 1 reason, given by 61 percent of them. Finding contact lenses too uncomfortable and difficult to put in and care for was a reason given by 38 percent of the respondents. Twenty-four percent said they found glasses too inconvenient for work. And 14 percent reported that they no longer wanted to wear thick, unattractive glasses.

Are you a good candidate for Lasik?

As with any type of surgery, a good candidate for laser vision-correction surgery is more than just someone who is expected to receive the maximum benefit from the procedure with minimum risk. "It's also very important that the patient's expectations of the results are consistent with what can actually be achieved," says Howard Kornstein, M.D., a laser eye surgeon and clinical instructor in ophthalmology at Mount Sinai School of Medicine in New York, who was a consultant for our survey. "If a patient has unrealistic expectations, then he or she is a poor candidate for elective surgery even if everything else is in order."

The initial examination is crucial, Kornstein says. It should include a detailed medical history and a thorough eye exam, including an evaluation of visual acuity, pupil size, and tests of corneal shape and thickness.

You may be a good candidate if:

• You are at least 18 years old (21 for some lasers). The Food and Drug Administration has not approved lasers for Lasik on people younger than age 18 since their vision usually is still changing.
• Your career plans permit it. Some employers, such as the military, may not allow people to perform specific jobs if they have had certain procedures, so be sure to check.
• You don't play contact sports. Since laser vision- correction surgery involves the creation of a flap in the cornea (the clear covering of the eye that sits over the iris), you may be vulnerable to eye injury after surgery both in the short- and long-term. Wear protective eyewear if you participate in contact sports or other activities in which you could get hit in the face.
• Your eyeglass or contact-lens prescription has been stable for at least the last 12 months. It should be within acceptable limits to undergo laser vision-correction surgery and unlikely to change.
• You don't have a disease or take medications that can impede healing. Certain conditions, such as lupus, rheumatoid arthritis, and diabetes, as well as drugs such as retinoic acid and steroids may prevent proper healing after laser vision surgery.
• You are not pregnant or breast-feeding, as that can affect vision measurements.
• You have no other risk factors: Your corneas are thick enough for reshaping with Lasik. Your pupils aren't too large under dim lighting conditions so that they increase your risk of postoperative night-vision symptoms such as glare, halos, and starbursts. (Ask your doctor whether you've been given a test for those problems.) You have no history of dry eyes, a condition that Lasik tends to aggravate. You show no evidence of blepharitis, inflammation of the eyelids with crusting of the eyelashes, a condition that increases the risk of corneal infection or inflammation after Lasik.

Common types of laser vision surgery

In the Consumer Reports survey, a majority of the respondents (65 percent) had Lasik as their most recent surgery. Only 5 percent reported having PRK, Lasek, or epi-Lasik. But it's important to note that nearly a third of the respondents (28 percent) were unsure about what type of surgery they had. Here's a rundown of the types of surgery commonly used to correct vision.

• Lasek (laser epithelial keratomileusis). A surgeon uses alcohol to loosen and then peel back the epithelium, or outer surface of the cornea. Next, a laser is used to reshape the surface of the cornea to correct nearsightedness, farsightedness, and astigmatism (which is blurred vision due to irregularities in the curvature of the cornea or lens). Then the epithelium flap is placed back into position and a contact lens is placed temporarily on the eye as a bandage. Recovery is rapid but there may be some initial discomfort. For more information on how Lasek surgery works, go to the Eye Surgery Education Council's Web site.
• PRK (photorefractive keratectomy). A surgeon removes microthin layers of tissue from the outermost layer of the cornea with a sterile brush and uses a laser to reshape the cornea to correct either nearsightedness, farsightedness, or astigmatism. Then a contact lens is placed over the eye as a temporary bandage. There may be some discomfort as the cornea heals during the next several days. For more information on how PRK surgery works, go to the American Academy of Ophthalmology's Web site.
• Lasik (laser assisted in situ keratomileusis). Surgeons use a surgical knife, called a microkeratome, to create a flap on the surface of the cornea. Then, using a laser, the surgeon reshapes the underlying cornea to correct vision and folds the flap back into place. In wavefront, or custom Lasik, the surgeon uses a device to map the irregularities of the eye, which permits correction of subtle focusing imperfections. Lasik typically has rapid visual recovery with less discomfort. For a step-by-step animation of how Lasik surgery works, go to the Food and Drug Administration's Web site.