LASIK Surgery:

Just had LASIK surgery this morning at the Maloney Vision Institute; the full results won't be evident for months, but so far, so good. My right eye, which used to be nearsighted and astigmatic, now seems to see perfectly. My left eye, which has been wildly nearsighted as long as I remember it, and was 20/800 yesterday, now seems very good, though I'm not sure that it's quite 20/20 (the doctor had warned me that I might need a touch-up operation for that eye, which would be part of the total package I bought).

I hope that things continue uneventfully, but if they do, I'll consider it a sound (though expensive, $2800 per eye plus a $200 consultation) investment — no more vision trouble from my astigmatism lens swimming around in the eye, fewer infections than with lenses, less of the occasional discomfort that contact lenses tended to cause, less risk of trouble in emergency situations where my contacts might be lost or damaged, and the like. (I can't successfully wear glasses for the long term because my prescriptions were so different, so contacts or surgery was my main option.)

I promise I won't turn into the sort of person who talks incessantly about his ailments, surgeries, bowel movements, and the like — but I just thought that this is an interesting enough surgery, and one that could help enough people, that it was worth mentioning it. Likewise, I generally don't comment on the amount of money I spend for my various purchases, whether of good or services; but here the data point seemed especially relevant for those who might be considering the operation themselves. (I am told that Dr. Maloney's rate is on the high end, but it probably gives you some sense of the likely ballpark for well-regarded LASIK surgeons in expensive areas like L.A.)

James Ellis (mail):
I had been considering the same procedure for myself until I realized that the feeling of taking off my glasses and staring into space was one of life's simple pleasures. Here's hoping you don't miss it!
9.5.2006 9:06pm
I'm curious how you chose your doctor, since I've considered getting the same procedure.
9.5.2006 9:17pm
cirby (mail):
WWeell,, II hhooppee eevveerryytthhiinngg ccoommeess oouutt ookkaayy wwiitthh nnoo ccoommpplliiccaattiioonnss..
9.5.2006 9:23pm
arem (mail) (www):
sir, if i may say so with all due respect, this blog reminds me of something your average teen would post in their daily (correction, HOURLY) post.

"Fight the System, Love Your Neighbor"
9.5.2006 9:30pm
I saw an article recently (don't know where so I can't link to it) about how common such surgery was among students at our military academies. So much so, in fact, that the competition for the choicest training programs (I assume certain kinds of fighter aircraft training) had increased considerably because students who would have formerly not qualified for those slots because their vision was less than perfect could now have the surgery and qualify.

Good luck w/ yours.
9.5.2006 9:33pm
Man I thought I was bad at 20/400 in my left eye! I have asymetrical vision and use glasses to drive, etc,. I have had a doctor tell me never to have this surgery as I have built in bifocals as my left eye can see up close perfectly and my right can see in the distance almost perfectly. I can read without glasses and just use them to see in the distance, although seeing without them would be a pleasure. Contacts are a pain. Thanks for the info.
9.5.2006 9:36pm
PatHMV (mail) (www):
Eugene, please continue to post on your experience. I've been contemplating Lasik for awhile now, but the fear of complications has held me back so far. I am able to wear glasses, and so there's not a great urgency for it, but being able to see clearly while swimming, sweating, waking up with a beautiful woman in the morning, all those things would be very, very nice.
9.5.2006 9:37pm
Brett Bellmore:
Alas, I'm one of those poor souls whose corneas are considered too thin to be safe candidates for Lasik. Intaks (Plastic rings that are implanted just outside the cornea, and pull it flat.) would be an ideal solution for me, as they are safe, reversable, and also restore some accomidation by stretching out the attachment point for the lens' ciliary muscles.

Too bad any surgery that involves implants is insanely expensive due to tort considerations....
9.5.2006 9:57pm
Chris Bell (mail):

So much so, in fact, that the competition for the choicest training programs (I assume certain kinds of fighter aircraft training) had increased considerably

Although I can see how vision would be beneficial for almost every soldier, I've been told that LASIK will NOT allow you to be a fighter pilot. (Much to my dismay.) The extreme forces felt by fighter pilots can tear the scars open. You may, however, still be able to fly other airplanes.

So sorry Eugene, you days as a fighter pilot are gone.
9.5.2006 10:09pm
DrObviousSo (mail) (www):
Wait, you may have every reason in the world to wear a monocle, and you want to get that changed?
9.5.2006 10:20pm
blackdoggerel (mail):
$2800 PER EYE?? Wow. I looked into getting the procedure done in the greater Washington, DC, area, and the guy who has done Lasik on dozens of PGA golfers, including Tiger Woods -- who I'll thus assume is one of the best in the area -- only (or "only") charged about $1800 per eye. I realize DC isn't LA, but that's a significant difference in price.
9.5.2006 10:26pm
Sasha Volokh (mail) (www):
Just a small plug for myself: Check out my 1997 Reason article, "Software Pirates," on laser eye surgery and how it connects with the FDA's control over software.
9.5.2006 10:37pm
A. Zarkov (mail):
"I can't successfully wear glasses for the long term because my prescriptions were so different, so contacts or surgery was my main option."

I'm not sure what you mean by this statement.

If you vision is correctable with contacts, why not with conventional eyeglasses?

Another question. Did you consider doing one eye at a time? If you get major complications in the first eye then stop.

I am under the impression that the price of Lasik surgery has dropped drastically because of a super abundance of machines. I've seen prices of $500 and less per eye. That $1,800 is, well, eye popping!
9.5.2006 10:41pm
blackdoggerel: That's the guy who did my Lasik about 6 months ago. I'm pretty happy with the results. My vision has been 20/20 since the day of the surgery and I haven't had any complications.

Zarkov: I'm a little confused as to why you found $1800/eye so shocking after reading about EV's $2800/eye surgery.
9.5.2006 10:53pm
Zarkov, both contacts and glasses distort the image as well as correcting focus. Glasses distort more because they are farther from the eye. I have both glasses and contacts, and find the change in distortion levels disorienating when I switch between them. If you have radically different prescriptions in each eye, I would imagine the difference in distortion levels would be problematic.
9.5.2006 10:56pm
Ken Hirsch (mail):
Here's the article from the NY Times about corneal correction in the military: Perfect Vision Is Helping and Hurting Navy
9.5.2006 10:57pm
A. Zarkov (mail):

Sorry that was a typo. Make that $2800.
9.5.2006 11:09pm
bilfay (mail):
I had LASIK in both my eyes in 2004. I had really bad eyes like Prof. Volokh (both were -8.5 diopter). I knew that I may have to have the surgery again and had regression in both eyes and had to go in 9 months later for another round.

My eyes are now 20/20 in daytime and good light conditions, however I have some night myopia, which wasn't there previously, so I have a pair of glasses for driving and when I play sports at night.

Overall, I'm glad I did it and even though I wear glasses at night, it's better than my horrible vision before and the hassle and discomfort of contacts.

One other note, I did start to have some dry eyes and slight eye pain. My doctor recommended HydroEyes a supplement. I never take supplements, and figured I'd take one bottle and stop. I didn't even notice how much better my eyes felt until I stopped taking it. Just a thought to tuck away in case you have any issues w/ dry eyes. Good luck!
9.5.2006 11:14pm
Houston Lawyer:
I had Lasik 5 years ago. I see 20/15 in my left eye and 20/20 in my right. For a few months after surgery, at night I saw trails behind lights. I don't see that anymore. I spent $2,400 per eye. I used the same doctor that did Jeff Bagwell's eyes. I figured that anyone who did professional athletes would be satisfactory to me.

I suffered no complications. My only complaint is that my doctor died and I have to go find a new one.

I highly recommend it. Now that I've reached 46 years old, I am beginning to need reading glasses. That's not a side effect of surgury.
9.5.2006 11:45pm
Christopher S.:
I'm a Navy grad who had terrible vision (20/400) but got a Marine Corps slot. I have since undergone civilian LASIK surgery (my chain of command just had to give their approval). It was great (20/10 vision; none of the side effects they talk about). Anyway, currently LASIK makes one ineligible for military dive or flight status. The procedure the mids are doing now is called PRK (photorefractive keratotomy). My little brother, also a navy grad, had this done by the military and just got his wings as a naval aviator.
9.5.2006 11:51pm
My only complaint is that my doctor died and I have to go find a new one.
Isn't that so typical of those self-centered doctors, just dropping dead whenever they feel like it without a thought to the inconvenience it will cause important lawyers.

9.6.2006 12:02am
R Gould-Saltman (mail):

In addition to avoiding becoming a fighter pilot or navy wreck diver, my recollection is that you may also experience focus problems if you spend significant amounts of time outdoors above about 22,000 feet, and should therefore also think twice about that assault on K-2. . . .

I'm thinkin' about a LASIK myself; I became a lot less wary when I noted that my former opthalmologist now employs an opthalmological surgeon in his group to do refractive corrections, and that this younger doctor has been a LASIK PATIENT. . .

anyway, congrats on the eye work.
9.6.2006 12:21am
Comment of the day, Malvolio.
9.6.2006 12:57am
my recollection is that you may also experience focus problems if you spend significant amounts of time outdoors above about 22,000 feet, and should therefore also think twice about that assault on K-2

This was popularized by the Beck Weathers tale on Everest in 1996 (from Into Thin Air, among other places). However, Weathers had radial keratotomy (sp?), not Lasik.

As a climber who wears contacts, let me tell you, climbing in high altitude with contacts is no treat either. Here's an interesting article about a study (I guess you can call it) of a bunch of post-Lasik climbers who summited Everest.
9.6.2006 1:28am
Did you use the newer wavefront-guided version? It's very effective at reducing higher order aberrations that plague earlier versions of LASIK.
9.6.2006 2:57am
The River Temoc (mail):
Urijah: what is the "wavefront-guided version" of LASIK? Are there any other innovations in the procedure that a prospective customer should know about before getting it?

Eugene: I, too, would like to hear more about your experience with LASIK. Like one of the earlier posters, I've been considering it, but have held off because of the potential for complications.
9.6.2006 4:50am
cac (mail):
As an aside, does anyone have a theory as to why the price seems to be remaining reasonably stable? (I have an interest in this in that I keep thinking if I put it off for a bit the price will come down).

I'm sure I'm missing something here, but I gather that much of the cost is the high tech gizmoes involved (admittedly with a highly skilled and presumably commensurately remunerated operator) and surely these should be subject to the same principles that have seen computers and digital cameras halve in price every few years?
9.6.2006 5:20am
L Halbrook (mail):
I had the wavefront Lasik surgery 3 weeks ago, and have been thrilled with the results. My vision was almost too bad to be qualified, but thankfully I made the cut off. Within a day, my left eye was 20/20 and my right eye 20/30. I've been having trouble with my right eye - seeing a bit of blur - but apparently it is just extremely dry. I put drops in every 2 hrs. and that is helping a lot. I paid a little over $4000 for both eyes and it was worth every penny. It is a luxury to be able to see things when I first wake up in the mornings! And I feel like I can safely do water sports with my daughter without worrying about her splashing my contact lenses. There are just so many benefits. I'm so glad I had this surgery!
9.6.2006 9:43am
liberty (mail) (www):
"As an aside, does anyone have a theory as to why the price seems to be remaining reasonably stable?"

Could be to do with the FDA regulatory boondoggle that Sasha explains in that Reason piece, if that's all still true.
9.6.2006 12:49pm
SFO to PHX (mail):
LASIK is great. I had it done in 1999 - Turner Eye with locations in Oakland and San Jose. $2,000 per eye back then, but saved more by paying through my company's FLEX plan. I had halos around lights for a month or so and had a week where I noticed the time to adjust from dark to light or far to near. Its still wonderful to be without glasses/contacts.
9.6.2006 1:26pm
Anthony A (mail):
What's the NPV of the glasses or contacts you won't be buying compared to the cost of the surgery?
9.6.2006 1:32pm
Craig Oren (mail):
congrats to you on the successful outcome, Eugene. I have more than a six diopter difference between left and right eyes. But I am told that my right eye is so myopic (-13 or so) that the surgery is not feasible for me.
9.6.2006 3:23pm
Mikeyes (mail):
I've always thought that medical schools should offer a "Cash On The Barrel Head" (COTBH) residency that includes such things as LASIK, breast implants, orthodontics, various face lift procedures and psychoanalytic psychotherapy. Most of these procedures are not covered by medical insurance (although in some cases they are, of course) and are paid for, in full, by the patient. But they are in great demand by people with disposable income. (The sister law schools could offer electives in COTBH torts.)

Recently the FDA approved a hip resurfacing procedure that has been standard of practice in Europe for years and takes the place of hip replacement surgery in many cases. Don't be fooled into thinking that the FDA is not supposed to regulate the practice of medicine, they do, albeit indirectly. The insurance companies (they are mostly insurance managers in this age of self insurance) also have a great influence on how medicine is practiced by agreeing to "honor" these regulations in order to save money. The latest ploy is to only approve medications on the Medicare D list if they are used in "FDA approved doses" (which means the doses used in the original studies, they do not necessesarily correlate with the doses that help the patient) because it saves money to deny any dose that doesn't follow those guidelines. Next, they will be denying any off-label use of meds (which is 60% of all drug usage, I don't have the cite at hand.)

The FDA under this administration is especially intrusive, but only by about 10% or so over past administrations. It usually depends on the political bent of the FDA head as to how the rules are implemented.
9.6.2006 5:48pm
Silicon Valley Jim:
I promise I won't turn into the sort of person who talks incessantly about his ailments, surgeries, bowel movements, and the like — but I just thought that this is an interesting enough surgery, and one that could help enough people, that it was worth mentioning it.

Definitely worth mentioning - just look at the comments above. You, as you frequently do, stimulated some interesting and informative discussion.

Your catholicity of interests is one of the very best things about not only the Volokh Conspiracy, but the web as a whole. Here's one vote in favor of your posting on whatever happens to interest you.

I believe that LASIK doesn't do anything for presbyopia (the thing that has caused me to require reading glasses since I was forty-six or so). Anybody here know anything about that?
9.6.2006 7:28pm
I had LASIK surgery a little over a year and a half ago and have been quite happy with my altered-eyes.

My prescription was about -8 or so in both eyes. The astigmatism I had was bad enough that I couldn't wear contacts at all, even the weighted ones made for astigmatism wouldn't stay put in my eyes or correct my vision well enough.

Within a day of the surgery my eyes were at 20/20 and 20/25 and haven't moved from there since (despite warnings about possible regression). I did have some problems with halos for the first few months. My night vision still leaves a little to be desired but isn't too bad. I actually seem to have gotten a bonus in the daylight sensitivity department, unlike most people I seem to be less sensitive to daylight after my surgery.

The biggest problem I had was my computer. I was constantly squinting without realizing it while I worked on my computer and I think the refresh rate on my screen was also set lower than it should have been. I had constant headaches for a few months but managed to make changes to my computer usage patterns and my setup and haven't had a problem in a long time.

For the occasional bout of dry eye, my doctors recommended Refresh Liquigel Lubricant Eye Drops which have worked really well for me.

I didn't have the Wavefront LASIK, my doctor said that it usually removes a little more of the cornea than the machine he used on my eyes. The impression I got was the Wavefront was easier for everyone to use and didn't need as much manual programming for the surgery (this could be incorrect).

A coworker of mine got Wavefront done a few months after I got my surgery and his surgery turned out really well too.

I paid about $2k for both eyes; my insurance company had a discount program but I'm not sure what that saved me exactly. I've seen a lot of wavefront ads that make it seem like that's a much cheaper option but I get the impression that it's like car ads: You only get the deal if you don't really need it.
9.6.2006 9:21pm
torrentprime (mail):
To the best of my knowledge, the price remains stable but the technology changes. The reason the top doctors still charge more is that they use continually newer and newer lasers, each with a this-year's-model price tag. The doctors with the hand-me-down models charge less, less experienced doctors charge less, and brand-new doctors with old equipment get away with charging $500 an eye.
My surgeon actually had 2 different machines--one had better results with a higher price than the other.
Another data point: the places that advertise $500 or so an eye will not give you their best surgeon; you get the newer ones. The experienced doctors even at those cheap places charge more for their time, so the price tag really varies depending on the operator and the equipment.

I paid $4k total for mine, with a Bay Area surgeon who had worked on the Giants, the 49ers, the Raiders, etc. I came out with 20/15 the next morning, so no complaints from me.
9.6.2006 9:36pm
Alan K. Henderson (mail) (www):
Welcome to the LASIK club.
9.7.2006 3:48am
Houston Lawyer:
Silicon Valley Jim

You are correct, LASIK won't help with presbyopia. There are doctors out there offering new surgical techniques that are supposed to fix that problem. I remain skeptical about their effectiveness. They also sound far more invasive than LASIK.

With regard to the armed forces, they don't like LASIK. They prefer PRK. My nephew had PRK so he could become a Naval aviator. With LASIK, they cut a flap off the front of the cornea and adjust the tissue underneath. Then the flap is put back into place. This is attractive to most people because the healing is very fast.

PRK involves applying the laser directly to the surface of the eye. This process is apparently more stable, but recovery is substantially longer and the immediate side effects are more severe.
9.7.2006 11:55am
Those are outrageous prices. Up here in the Great White North, I paid $500 an eye. Granted, my eyes only needed a small correction and the whole thing was like an assembly line but I got plenty of pre and post operation exams and the senior doctor (owner) did the actual work. Plus the latest equipment.
9.7.2006 12:02pm
Chris B (mail):
I had LASIK several years ago, and have been pretty happy with the results. The only side effects have been slight irritation from dry eyes (not enough that I feel I need to use eye drops) and some difficult viewing very small print/details in situations that wouldn't have been a problem before I had the surgery.

One thing I noticed recently is that, after many years (30+) of wearing glasses, you tend to not realize that you don't have that barrier in front of your eyes anymore.
9.7.2006 1:11pm
Rich Rostrom (mail):
I had LASIK six years ago - I paid $1500/eye to one of the top shops in Chicago, Kraff Eye Institute. Due to presbyopia, I now need reading glasses (which I get for $1 at Dollar Tree) some of the time, but I have perfect distance vision. And I don't have to buy or taek care of prescription glasses.

I recommend the procedure, but I also urge going to a "top shop", even if it costs more, rather than taking a bargain. One only has one set of eyes, and they can be permanently damaged. (What sold me on Kraff Eye was that one of the companies selling the equipment featured them in its ad - like Michael Jordan and the shoes, it meant that they had a massive reputation in the field.)
9.7.2006 2:56pm
To all who have posted and to those who are considering LASIK, please be sure you are investigating the surgeon who will actually be performing the procedure and their credentials/qualifications as well as the generation of technology in use. There is a tremendous difference in Wavefront Guided IntralaseLasik and the original Micro Keraton. The fees for the former are obviously much higher than the latter but the results are proven to be so much better. The decision to have this procedure done should not be made on price. I have also seen a lot of negative posts/blogs about Lasik and it's my opinion that those who are not in favor of this elective surgery are those who have either not done their research and/or opted for a surgeon that was not skilled. The ultimate results will vary according to your degree of correction and the shape of your cornea and a good surgeon will tell you what the best expectations are before proceeding.
9.7.2006 5:37pm
forgot to add that Presbyopia is usually corrected with NearVision CK, a procedure which uses high frequency radio waves and not lasers. The waves are applied in eight symetrical spots around the perimter of the cornea to "tighten" it. This produces a steepening effect that eliminates the problems reading print.

It is a temporary solution as Presbyopia will/can worsen with age. The result should last 2-3 years and this procedure can only be done a few times.
9.7.2006 5:55pm
Amos (mail):
I'm sure Lasik is mostly safe, but there are some horror stories out there..
9.7.2006 11:40pm
kas (mail):
I had Dr. Maloney do my eyes in August 2000. I see perfectly - it was doubtless the best $5K I ever spent. My law partner did it too with him before I did and she's thrilled too. It was especially important for me because I'm a Guard officer who spent the Gulf War screwing with contacts. On my recent deployment, I had no hassles at all. Only those of us who lived nearsighted can truly appreciate perfect vision!
9.8.2006 12:31am