Simultaneous Bilateral LASIK
The editorial by a journal editor1 was overdue. I consider it particularly appropriate that simultaneous bilateral laser in situ keratomileusis (LASIK) is subjected to serious questioning. One can only marvel at the naive trust by patients in modern medicine and in their surgeons and the similarly naive convictions of surgeons that simultaneous bilateral LASIK is what the patients need.
It is not purely a safety issue; simultaneous bilateral surgery violates the principles of informed consent. Nobody can deny that experience with the first eye will render the patient better informed for consenting to the procedure being performed on the second eye. Simultaneous bilateral surgery deprives the patient of the possibility of gaining a better refractive outcome in the second eye2 and of judging the visual benefit of the surgery by comparing the operated eye ± residual spectacle or contact lens correction with the corrected unoperated eye. Finally, simultaneous bilateral LASIK pre-empts a possible decision by the patient to choose another type of refractive surgery for his/her second eye, such as photorefractive keratectomy, intracorneal ring segments, or a phakic intraocular lens, or to postpone surgery on the second eye until better procedures become available if the result of LASIK on the first eye proves unsatisfactory. He/she may not have to wait very long. 3
Klaus D. Teichmann MD
aJeddah, Saudi Arabia
1. Rosen ES. LASIK mania (editorial). J Cataract Refract Surg 2000; 26:303-304
2. Chiang PK, Hersh PS. Comparing predictability between eyes after bilateral laser in situ keratomileusis; a theoretical analysis of simultaneous versus sequential procedures. Ophthalmology 1999; 106:1684-1691
© 2000 by Lippincott Williams & Wilkins, Inc.
3. Mrochen M, Kaemmerer M, Seiler T. Wavefront-guided laser in situ keratomileusis; early results in three eyes. J Refract Surg 2000; 16:116-121