R U Ready To Dump Your Glasses?

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Another big advance in the works could provide nearly all patients with better than 20/20 vision. Today's lasers, and the computer programs that run them, assume all corneas are more or less spherical. Scientists are developing instruments that will map the entire surface of the cornea and make point-by-point alterations to smooth out individual aberrations. Such carefully customized reshaping of the cornea could make astounding improvements in vision more of a sure thing.

But perhaps you don't want to wait five to 10 years longer for such improvements. If so, there are several things you can do to maximize your chances of success with today's LASIK procedure:

--DON'T GET CAUGHT UP IN THE HYPE. If you expect never to need glasses or contacts again, you may be disappointed. And since LASIK can't correct presbyopia, most patients over 35 will need glasses to read and for close work. You're also likely to need glasses at night or in movie theaters.

--TAKE YOUR TIME TO FIND THE RIGHT PHYSICIAN. Do you feel comfortable with the doctor's explanations? Or are you getting pressured by a sales pitch? Insist on an ophthalmologist who will meet with you before the operation--and not just 15 minutes before--to examine your eyes as well as take your medical history and answer your questions. Be sure to tell the doctor if you or anyone in your family has ever had a corneal disorder, diabetes or an autoimmune disease. Such conditions may increase the chances that laser surgery will severely damage your eyesight. If you have particularly dry eyes or an ocular herpes infection, you aren't a good candidate either. If the first surgeon turns you down, don't go shopping for another.

--FIND OUT HOW MUCH LASIK TRAINING YOUR DOCTOR HAS. Some ophthalmologists apparently start zapping corneas after little more than a weekend seminar. That might be enough preparation for a surgeon who is already skilled, but you may decide to select a more experienced doctor, such as a cornea specialist who has completed a year or two of additional training. Early studies also showed that the complication rates for individual surgeons underwent two significant drops, after 300 and 600 procedures. Proponents will tell you that LASIK training and technology are much better now and that today's doctors are perfectly proficient after just 25 to 50 operations.

If the doctor won't tell you what his or her complication rate is, find another one. Ask how many of the doctor's patients have worse vision--even with contacts or glasses--than they did before the surgery. For top doctors the figure is under 3 in 1,000.

--THINK LONG AND HARD ABOUT WHY YOU WANT TO HAVE YOUR EYES LASERED. "This is surgery on the only pair of eyes you have," says Dr. George Waring, founder of the Emory Vision Correction Center in Atlanta. Only you can decide whether the benefits are worth the small but very real risk of irreversible damage to your eyesight. If you're satisfied with your glasses or contacts, then you're better off leaving well enough alone. You can always change your mind later, when you've had a chance to weigh the improvements that future technology will bring.

--Reported by Dan Cray/Los Angeles and Alice Park/New York