Looking good or looking troubled?

Since 1993 it has been the most effective and efficient cure for myopia (nearsightedness). But last month the safety of LASIK (laser-assisted in situ keratomileusis) laser eye surgery was suddenly thrown into doubt.

Cai Ruifang, a professor of ophthalmology at Taipei Medical University and the surgeon who first introduced this surgery in Taiwan, announced that he would no longer perform this surgery because of the side effects he had observed in patients, including dry eye syndrome and a loss of general visual acuity in the long run. This shock announcement was followed a few days later when he reversed his decision and stated that the surgery was comparatively safe as long as the correct preoperative checks and the surgery were conducted properly.

In a country with the world's largest number of myopia sufferers - 430 million - the demand for laser eye surgery has been soaring over the past few years. But the professor's statements and reservations have shattered a lot of trust in the treatment. An online survey by the Global Times revealed that 49 percent of the 935 polled said that they would not now take the risk given the possibility of side effects while 26 percent said that they would still give it a go. The rest remained uncertain for the present.

Last year in Shanghai about 30,000 people had laser eye surgery in the city's 23 approved institutions with no infections reported. Specialists say that laser eye surgery technology has been tested and the key issues were that patients had to have a rigorous physical examination beforehand and there had to be strict supervision of the equipment and the medical staff involved.

Safe and effective

LASIK is refractive surgery for correcting myopia, hyperopia and astigmatism. Ophthalmologists perform LASIK using a laser to reshape the cornea to sharpen the vision.

Animal experiments using this technology started in 1983 and it began clinical trials in the US in 1988. The technique was first introduced into China in 1993.

The Eye, Ear, Nose & Throat Hospital affiliated with Fudan University was one of the first to start using LASIK surgery that year. Thousands of laser eye operations have been performed at the hospital since then. Ophthalmologist Zhou Xingtao with the Eye, Ear, Nose & Throat Hospital said that he had not seen a single case of a serious complication resulting from the surgery.

"Objectively speaking, this surgery is very safe and effective if the proper equipment and techniques are used. International statistics indicate that there is less than a 0.50 percent occurrence of complications affecting visual acuity," said Zhou.

But the surgery is not for everyone. According to Lian Jingcai, another ophthalmologist at Ruijin Hospital, more than 70,000 people have received LASIK surgery at the hospital, but many more had inquired about getting their myopia treated this way.

"For every 10 people who want to have the surgery, only six are suitable," Lian said. He said the surgery was not suitable for people who had suffered serious keratitis (corneal inflammation) after wearing contact lenses or for people whose corneas were too thin. Other restriction included patients who suffered serious myopia (where the degree of myopia is more than 1,200, or hyperopia (farsightedness) or astigmatism (where the degree of hyperopia or astigmatism surpasses 600); patients under the age of 18; and those with unstable myopic conditions or suffering immune diseases. "If these are ruled out usually nothing will go wrong in the surgery," Lian said.

Although the risks of the surgery are extraordinarily small mathematically, one ophthalmologist in the city, who insisted on anonymity, said that she does not encourage people to choose this. "The probability theory becomes meaningless if something happens to you. Even if these is just a 0.50 percent chance of suffering a side effect, once you are a victim you are just one of the extreme minority. You cannot argue with figures," said the doctor. She felt the controversy would put some people off the treatment for the meantime and it would have a negative effect for a while.

She added many of the people choosing laser eye surgery are in their 20s and 30s and some continue playing sport after the surgery. "After this surgery, the cornea is thinner and any knocks to the head or eyes must be avoided. But physical contact is inevitable and unpredictable in sport," she said.

A step forward

While the reasons why Professor Cai Ruifang has changed his attitude are unclear, it is indisputable that the market for laser eye surgery is huge. The Economic Information Daily (run by the Xinhua News Agency) reported that the whole laser eye surgery market is worth more than 100 billion yuan ($15.87 billion).

In Shanghai and most other first-tier cities, a standard LASIK operation costs 7,000 to 8,000 yuan, while the cost in second-tier cities is about 1,000 yuan less. But some hospitals in town have been advertising the service for as little as 3,700 yuan, a price that experts say is so low it would be difficult to cover the costs.

"Modern LASIK equipment costs 6 million yuan. Based on the predicted length of service, it should cost 500 yuan per operation. Taking into account other materials involved and the hospital's operating costs, the price of an operation on each eye cannot be under 2,000 yuan," said Zhou Yuehua, an ophthalmologist with the Beijing Tongren Hospital.

China's Ministry of Health introduced new regulations for LASIK surgery last month. This means that LASIK equipment can only be used for 10 years at the most. The regulations also detailed side effects and the qualifications needed by ophthalmologists to operate.

Chu Renyuan, the director of the myopia laboratory under the Ministry of Health and the director of the Shanghai Optical Treatment Quality Control Center, said fifth-generation LASIK equipment is now available, but in some remote areas of the country, first-generation equipment that has been used for nearly two decades is still in use.

"The management of this sector is a major issue. It is compulsory to have automobiles checked every year and vehicles have to be scrapped when they pass their use-by date. But there are no regulations for laser eye surgery equipment. Authorities need to improve their oversight of this sector as it directly relates to safety," Chu said.

Insiders say that to maximize their economic returns some hospitals recycle disposable materials, like scalpels, that are supposed to be used only once. Other dodgy practices include doctors operating on patients with dry eye syndrome (xerophthalmia) or operating on patients suffering inflammation. It has also been reported that some inexperienced doctors have operated neglecting to take into account the three dimensional effect for their subjects.

Hoping for a good view

Reports from people who have experienced laser eye surgery offer a range of reactions. Judy Liang, who had severe myopia in both eyes, had laser surgery in 1997 when she was 24-year-old.

"I didn't want to wear heavy glasses and contact lenses were troublesome since they were not allowed when I had a cold or was menstruating. I thought the operation was a one-off effort," Liang said.

The 39-year-old recalled that for the first month after the surgery, she had to use hormonal eye drops which helped speed the recovery of the corneas. "My sight has been good since then, but I was very worried when I decided to have a baby five years ago. I was concerned that I might not be able to have the child naturally because some people said that after laser eye surgery, a woman giving birth could go blind," she said.

Because she didn't dare to ignore the potential dangers and as she was in her mid-30s, Liang chose to have her baby via cesarean section. "It's been 15 years. Generally things have been good. Some of the side effects I've experienced include that I'm allergic to strong light. When exposed to bright sunshine, my eyes water. And I cannot watch television or look at computer screens for too long because my eyes get very dry," Liang said.

Tong was in her late 20s when she had laser eye surgery. It was a case of vanity then but she has not felt comfortable since.

"It is difficult for me to see things in the dark and I suffer from blurred vision (astigmatism). When I had the surgery I just suffered from nearsightedness. Now I cannot drive at night because it's hard for me to make out the traffic lights - red, yellow and green are jumbled for me," Tong said.

She has also lost some sharpness of vision. Tong has asked ophthalmologists what the problem is and was told that perhaps her body has not adapted to the changes in her eyes.

For 31-year-old sports enthusiast Yu, the most difficult period was immediately after the operation when he completely lost his sight for 24 hours. "I was very frightened at the thought I would never be able to see again. But things came into focus quickly and for the past eight years everything has been fine," said Yu.

Bank worker Sun had laser treatment two months ago and found it rather traumatic because the patient before her was kept on the operating table more than half an hour for a procedure, which she had been told would only take a few minutes.

"There was something wrong with the equipment and she was kept waiting there with her eyelids locked open while staff adjusted the machinery. I don't know what she was feeling but if it were me I might have fled. Especially since I had just watched the movie Final Destination 4 where a woman dies horrifically in a laser eye operation," Sun said.After the operationThe first week after the operation is crucial. Patients must not rub their eyes and must avoid splashing water on them. Doctors usually advise that they do not shower or shampoo in this period.

It is important to use the eye drops prescribed - they will help recovery.

See your doctor soon after surgery and whenever it is suggested. Make sure the intraocular pressure is checked regularly.

It takes time to recover from the operation so rest properly in the first week and avoid using your eyes where possible. After a week most patients will be able to return to work. Viewing computer screens will not affect the surgery but patients should not overwork their eyes for some time.

Do not drive at night for a month after the operation.

Do not play sport in the first week after surgery and do not swim for 40 days after surgery. Do not exercise where there is a chance of a knock to the head or eyes.

Do not use make-up for three days after surgery and for two weeks do not use eye liner or mascara.

Avoid sour or spicy foods. Fruit will help your recovery, especially citrus fruit. Green vegetables, fish and eggs are also helpful.

Drink plenty of water to avoid dehydration.