What is a Thoracic Surgeon?

A thoracic surgeon is a medical doctor who performs operations on the heart, lungs, esophagus, and other organs in the chest. This also includes surgeons who can be called cardiothoracic surgeons, cardiovascular surgeons, general thoracic surgeons, and congenital heart surgeons.

What kind of training is required to become a Thoracic Surgeon?
Thoracic surgeons have to graduate from medical school and most commonly will go on to complete a five-year general surgery residency. After this they must successfully matriculate through an approved cardiothoracic surgery residency program for either two or three years. Some thoracic surgeons choose to do additional training in a sub-specialized area but this training is largely optional, except for congenital heart surgery.

What does it mean to be a board certified Thoracic Surgeon?
The American Board of Thoracic Surgery (ABTS) maintains standards for the practice of thoracic surgery in the public interest. Thoracic surgeons who have completed approved residency training, hold a full and unrestricted license to practice medicine in the United States, and maintain an ethical standing in the profession are eligible for board certification. Candidates must then pass both a written examination that is designed to test a broad range of knowledge in all areas of thoracic surgery. Upon successful completion of the written examination, candidates are eligible for and must pass an oral examination that tests knowledge, judgment and the integration of these skills in clinical practice. Once successful in these pursuits, a thoracic surgeon is “board certified”. In order to keep this certification, the maintenance of certification process is required to demonstrate lifelong learning throughout the thoracic surgeons’ career. There is a separate subspecialty certificate for congenital heart surgery.

Are there different kinds of Thoracic Surgeons?  What is the difference between a Thoracic and Cardiothoracic Surgeon?
All thoracic surgeons have the same general training and are certified by the same specialty board, except for congenital heart surgeons who have a sub-specialty certificate in addition to the ABTS certification. Some surgeons choose to focus their clinical practice in certain areas of thoracic surgery and can be referred to differently. A cardiac or cardiovascular surgeon will focus on the heart and great vessels. General thoracic surgeons treat diseases of the lungs, esophagus, chest wall, and mediastinum. Congenital heart surgeons operate on infants and children with heart disease. Cardiothoracic surgeon is the most inclusive term used to describe the specialty, irrespective of a particular surgeon’s area of focus and expertise, and can be used interchangeably with the term thoracic surgeon.

What diseases does a Thoracic Surgeon treat?
Thoracic surgeons operate on diseases that occur in the organs inside the chest, and in the bony structures and tissues that form the chest cavity. Coronary artery disease is one of the most common diseases treated by cardiac and cardiovascular surgeons. General thoracic surgeons treat a lot of lung cancer and diseases of the esophagus. Congenital heart surgeons care for babies and children with holes between the heart chambers or abnormal connections within the heart. Listed below are some examples of diseases treated by thoracic surgeons.

A cardiac or cardiovascular surgeon could treat:
- Coronary artery disease or blockages of the arteries in the heart
- Blockages in one of the heart valve(s)
- Leaking heart valve(s)
- Abnormal enlargement or aneurysms of the large arteries in the chest
- Heart failure
- Atrial fibrillation

A general thoracic surgeon could treat:
- Lung cancer
- Severe emphysema
- Cancer of the esophagus
- Gastroesophageal reflux disease
- Hiatal hernias
- Swallowing disorders such as achalasia
- Excess sweating, usually of the upper extremity called hyperhydrosis

A congenital heart surgeon could treat:
- Atrial septal defects
- Ventricular septal defects
- Coarctation of the aorta
- Hypoplastic left or right heart syndrome
- Transposition of the great arteries

What kind of operations does a Thoracic Surgeon do?

• A cardiac or cardiovascular surgeon could perform:
  - Coronary artery bypass surgery
  - Valve repair or replacement
  - Repair of thoracic aneurysms
  - Minimal access cardiac surgery
  - Ventricular remodeling
  - Heart transplant
  - Maze procedure
• A general thoracic surgeon could perform:
  - Removal of portion(s) of the lung containing cancer, eg, lobectomy, pneumonectomy
  - Thoracoscopy or VATS
  - Removal of a portion of the esophagus containing cancer and reconstruction of the gastrointestinal tract or esophagogastrectomy
  - Laparoscopic Nissen fundoplication
  - Laparoscopic Heller myotomy
  - Thoracoscopic sympathectomy
  - Lung transplant
• A congenital heart surgeon could perform:
  - Atrial septal defect repair
  - Ventricular septal defect repair
  - Repair of coartcation of the aorta
  - Arterial switch operation
  - Norwood operation
  - Creation of shunt to the pulmonary artery, e.g., modified Blalock-Taussig shunt, bidirectional Glenn shunt

Do Thoracic Surgeons do procedures other than open operations?
Yes. Some cardiac surgeons also perform percutaneous (through punctures in the groin) interventions to treat aneurysms of the large vessels in the chest. Most general thoracic surgeons also perform bronchoscopy and/or esophagoscopy, drain fluid from the chest with needles, or place catheters or tubes into the chest to drain fluid or air.

How is a Thoracic Surgeon different from a cardiologist or pulmonologist?
A cardiologist will primarily diagnose disorders of the heart and treat them with medication.  Cardiologists also perform interventions on the arteries in the heart working through puncture wounds in the groin, but they do not do open surgery.
A pulmonologist will diagnose disorders of the lung and treat them with medication.  Some pulmonologists will perform interventions through the airway such as bronchoscopy to diagnose some disorders but again, they do not perform open surgery.

When should I see a Thoracic Surgeon?
Your primary care physician, cardiologist, pulmonologist, or gastroenterologist may send you to a thoracic surgeon if he/she feels that you could benefit from an operation to treat a condition involving the heart, lungs, esophagus, mediastinum, or chest wall.

How can I find a Thoracic Surgeon?
The physician sending you to a thoracic surgeon may recommend a particular surgeon. You can also search for a thoracic surgeon by clicking here.

What can I expect on my first visit? 
You will be interviewed and examined by the thoracic surgeon, and if you have had any tests, echocardiograms, X-rays or CT scans done, your thoracic surgeon will review the images and reports. Then, he/she will make a recommendation for the next step in your evaluation and treatment. This includes possible surgery, additional testing, or observing your condition over time.

What is The Society of Thoracic Surgeons?
The Society of Thoracic Surgeons is a not-for-profit organization representing more than 6,700 surgeons, researchers, and allied health professionals worldwide who are dedicated to ensuring the best possible heart, lung, esophageal, and other surgical procedures for the chest. Founded in 1964, the mission of STS is to enhance the ability of cardiothoracic surgeons to provide the highest quality patient care through education, research, and advocacy.

Dry Eyes and LASIK: You may still be a candidate

Dry eyes after LASIK are so common that they occur in about half of all LASIK patients. While the condition usually is temporary and mild, significant numbers of people continue to have dry eyes for months or even years after a procedure.*

But to keep the problem in perspective, many people who seek LASIK already have dry eyes. As an example, contact lens wearers who find their lenses uncomfortable because of dry eyes may investigate LASIK as an alternative because they do not want to wear eyeglasses.

Fortunately, screening for LASIK has led to advances in dry eye detection and treatment. Many people wanting laser vision correction now have the chance of actually solving their pre-existing dry eye problem if it is addressed in the LASIK consultation.

How Does LASIK Cause Dry Eyes?

In certain cases, LASIK and other vision correction procedures can cause dry eyes after they penetrate the eye's surface and reduce corneal nerve sensitivity. When your eye then fails to sense the need for lubrication, inadequate tear production results.

Dry eyes after LASIK can cause both discomfort and less than optimal visual outcomes. For this reason, many eye surgeons now recommend that you use lubricating eye drops or other therapies to help maintain eye moisture. As a precaution, you also may be given treatments to increase eye lubrication in advance of a LASIK procedure even if you don't have any sign of dry eyes.
In some cases where dry eyes are of extra concern, corrective vision procedures that do not involve creating a thin flap on the eye's surface — such as PRK — may be recommended instead of LASIK.

Dry Eye Screening for LASIK Patients

Both the quality and the quantity of tears you produce are factors in the development of dry eyes, which also can affect healing after eye surgery.
Because eye surgeons now increasingly recognize that the best LASIK outcomes may depend on controlling dry eyes, you probably will undergo screening in advance of a procedure.
Various tests for detecting dry eyes include:

• Schirmer test: a thin strip of paper placed under the lower eyelid to measure tear production.
• Tear breakup time: placement of a small amount of dye on the eye's surface to monitor how tears are distributed and when they "break up" on the eye's surface.
• Imaging: keratometers or other instruments that provide a view of the tear film without touching the eye's surface.

While assessing you as a possible candidate for a LASIK procedure, your eye surgeon also may need to determine if you have an underlying condition that might be causing dry eyes.

Who Is Most at Risk of Having Dry Eyes After LASIK?

One Baylor College of Medicine study in Houston noted a significant risk of having dry eyes after LASIK particularly in people with higher degrees of myopia who required deeper removal of corneal tissue to reshape the eye.**
Researchers also found that LASIK generally carries significant risk for dry eyes in people who did not have the problem previously, and that dry eye symptoms persisted in about 25 percent of LASIK patients six months after surgery.
"Dry eye occurs commonly after laser-assisted in situ keratomileusis (LASIK) surgery in patients with no history of dry eye," the Houston investigators said. "The risk of developing dry eye is correlated with the degree of preoperative myopia and the depth of laser treatment. Patients should be counseled about the risk of developing dry eye after LASIK, particularly those with high myopia."
Other causes of dry eye syndrome before or after LASIK include:

• Older age, particularly if you are female and have undergone menopause.
• Allergy medications (antihistamines), certain blood pressure medications and anti-depressants that can decrease eye moisture.
• Autoimmune diseases such as Sjogren's syndrome.
• Unusually dry climates or environments, such as a room that is highly heated or air-conditioned.

Again, having dry eyes prior to a LASIK procedure will not automatically eliminate you as a candidate. But your eye surgeon will need to consider the severity of your condition and the possibility of effective treatment before recommending a procedure.

Treatment of Dry Eyes Before and After LASIK

Even if you do have a pre-existing dry eye condition, LASIK surgeons may consider treating you prior to LASIK or other procedures rather than eliminating you as a candidate.

Your eye surgeon also may treat you for dry eyes prior to a LASIK procedure as a precaution, even if your tear production ordinarily is normal.

You may be advised to take flaxseed oil or fish oil orally for several weeks before your vision correction surgery to improve your tear film. You also may need to use lubricating eye drops before and after a LASIK procedure.

Your eye surgeon may recommend prescription eye drops such as cyclosporine (Restasis) that help your body formulate tears. Cyclosporine actually has been found to quicken the recovery of corneal sensitivity after LASIK and thus return the eye to normal moisture.

Other common dry eye remedies include punctal plugs, which block tear drainage channels to increase moisture on the eye, and anti-inflammatory medications such as corticosteroids administered as eye drops.

Preventing Dry Eyes After LASIK

When meeting with your LASIK surgeon during your assessment as a candidate, make sure you mention any eye symptoms that could indicate a dry eye problem, such as a foreign body sensation or eye irritation. Even excessive tearing can indicate that you have dry eyes.

Studies indicate that taking omega-3 fatty acid supplements and eating food containing these "good fats," such as salmon, can help maintain a healthy tear film. Drinking plenty of water also can help keep your body — and your eyes — properly hydrated.

Also, make sure you have a frank discussion with your LASIK surgeon about the possibility of developing dry eyes following a procedure. Ask what specific steps can be taken in case of dry eyes to restore the eye's tear film and comfort until healing is complete.

Dry Eye Syndrome

Dry eye syndrome is caused by a chronic lack of sufficient lubrication and moisture on the surface of the eye.

Its consequences range from subtle but constant irritation to inflammation of the anterior (front) tissues of the eye.

Dry eyes also are described by the medical term, keratitis sicca, which generally means decreased quality or quantity of tears. Keratoconjunctivitis sicca refers to eye dryness affecting both the cornea and the conjunctiva.

Dry Eye Symptoms

Persistent dryness, scratchiness, red eyes and a burning sensation are common symptoms of dry eyes. These symptoms alone may prompt your eye doctor to diagnose dry eye syndrome.

Dry eyes can become red and irritated, causing a feeling of scratchiness.

But sometimes your eye doctor may want to measure the amount of tears in your eyes. A thin strip of filter paper placed under the lower eyelid, called a Schirmer test, is one way to measure tear production.

Another symptom of dry eyes is a "foreign body sensation," which is a feeling that something is in your eye.

And it may seem odd, but dry eye syndrome also can cause watery eyes. This is because dryness on the eye's surface sometimes will overstimulate production of the watery component of your tears as a protective mechanism.

What Causes Dry Eyes?

Tears bathe the eye, washing out dust and debris and keeping the eye moist. They also contain enzymes that neutralize microorganisms that colonize the eye. Tears are essential for good eye health.

Tears are complex, containing many different essential elements, including oils produced by special glands in the eyelids called meibomian glands. These oils prevent evaporation of the tears.

Dry Eye News

Smartphone Use Linked to Dry Eye in Schoolchildren

April 2014 — There might be another cost associated with children using smartphones besides a large monthly bill from the phone company: It could be causing kids to develop dry eye disease at an early age. That's the finding of a new study published in this month's issue of Journal of Pediatric Ophthalmology and Strabismus.

Researchers in Korea evaluated risk factors for dry eye disease among schoolchildren who used a variety of video devices, including smartphones. They examined 288 children and classified them as either having dry eyes or having a normal, moist eye surface (control group). Each child completed a questionnaire concerning the types of video devices they commonly used (computer, smartphone and television) and the amount of time they spent using each device.

Among the participants, 28 children (9.7 percent) were diagnosed as having dry eyes, and 260 children (90.3 percent) comprised the control group. Smartphone use was more common in the dry eyes group than the control group (71 percent vs. 50 percent), and increased daily duration of smartphone use was associated with increased risk of dry eye disease, as was the total hours per day spent using all video devices combined.

One interesting finding is that increased duration of computer use and television viewing measured separately did not increase the risk of dry eye disease.
The study authors concluded that smartphone use is an important dry eye disease risk factor in children, and that parents should monitor the amount of time their children spend using video displays, especially smartphones, on a daily basis. — G.H.

In dry eye syndrome, the lacrimal gland or associated glands near the eye don't produce enough tears, or dysfunction of the meibomian glands reduces oil output, leading to excessive evaporation of the tears. This is called evaporative dry eye and is now considered to be the primary cause or a contributing factor of most cases of dry eye.

Dry eye syndrome has many causes. It occurs as a part of the natural aging process (especially during menopause in women); as a side effect of many medications, such as antihistamines, antidepressants, certain blood pressure medicines, Parkinson's medications and birth control pills; or because you live in a dry, dusty or windy climate.

If your home or office has air conditioning or a dry heating system, that too can dry out your eyes. Another cause is insufficient blinking, such as when you're staring at a computer screen all day.

Dry eyes also are a symptom of systemic diseases such as lupus, rheumatoid arthritis, ocular rosacea or Sjogren's syndrome (a triad of dry eyes, dry mouth and rheumatoid arthritis or lupus).
Long-term contact lens wear is another cause; in fact, dry eyes are the most common complaint among contact lens wearers.

Recent research indicates that contact lens wear and dry eyes can be a vicious cycle. Dry eye syndrome makes contact lenses feel uncomfortable, and evaporation of moisture from contact lenses worsens dry eye symptoms. Newer contact lens materials and lens care products can help reduce contact lens dryness.

Incomplete closure of the eyelids, eyelid disease and a deficiency of the tear-producing glands are other causes.
Tears consist of three essential components:

• The outer, oily lipid component
• The middle, watery, lacrimal component
• The innermost component, consisting of mucous or mucin

Each component of the tear film serves a critical purpose. For example, tear lipids prevent evaporation and increase lubrication, while mucins help anchor the tears to the ocular surface.
Each tear component is produced by a different gland:

• The outer oily component is produced by meibomian glands in the eyelids.
• The watery component is produced by lacrimal glands located above the outer corner of the eyes.
• The inner mucoid component is produced by goblet cells in the conjunctiva.

A problem with any of those sources can result in tear instability and dry eyes.
Dry eye syndrome is more common among women, possibly due to hormonal fluctuations. A recent study also indicates that the risk of dry eyes among men increases with age.
Recent research suggests that smoking, too, can increase your risk of dry eyes.
With increased popularity of cosmetic eyelid surgery (blepharoplasty) for improved appearance, dry eye complaints now occasionally are associated with incomplete closure of eyelids following such a procedure.

Dry Eye News

Cities cited in the study included Chicago, New York, Los Angeles and Miami. Study subjects in and around Chicago and New York City were three to four times more likely to be diagnosed with dry eye syndrome than those in less urban areas with relatively little air pollution.

Dry Eye Syndrome More Prevalent in Larger Cities

November 2013 — Residents of some of the largest U.S. metro areas now have another item to add to their list of concerns, apart from traffic. Research shows that cities with high levels of air pollution have an increased risk of dry eye syndrome.

Using data from the National Veterans Administrative database, the National Climatic Data Center and National Aeronautics and Space Administration, researchers examined the health records of 606,708 U.S. veterans who had received dry eye syndrome treatment in one of 394 VA eye clinics from July 2006 through July 2011.

Those living in areas with high levels of air pollution had the highest magnitude of increased risk for dry eye syndrome, at an incidence rate ratio of 1.4. Most metropolitan areas showed relatively high prevalence of dry eye syndrome (17-21 percent) and high levels of air pollution.
In addition, the risk of dry eye syndrome was 13 percent higher in zip codes in high altitude areas. — T.M.

Dry Eye Disease High Among Office Computer Users

August 2013 — More than 75 percent of women who routinely use a computer at work may suffer from dry eye disease (DED), according to a new study.

Researchers in Japan investigated the tear function and prevalence of dry eye signs and symptoms among office workers who routinely use a computer on the job. Findings for 561 office workers (average age 43.3 years) were included in the study results. Participants completed questionnaires and underwent dry eye testing.

The percentage of female computer users with "definite or probable" DED was 76.5 percent; among male workers, it was 60.2 percent. Risk factors for dry eye included being over 30 and using a computer more than eight hours per day.
The study authors concluded dry eye disease is prevalent among young to middle-aged Japanese VDT users and that measures to reduce the adverse effects of computer use on the eye's surface may improve public health and quality of life for office workers.
A report of the study appeared on the website of the American Journal of Ophthalmology in July.

Reading More Slowly? Maybe It's Due to Your Dry Eyes

February 2013 — Discomfort and redness aren't the only symptoms of dry eyes. Reading speed can slow down, too.
This is according to a study that measured reading speed and contrast sensitivity among 52 adult dry eye sufferers and a 20-member control group.

The study showed that contrast sensitivity was not significantly different across the groups, but reading speed was. And reading rates decreased as the severity of the dry eye disease increased.
Researchers concluded that reading speed could be a measure of treatment benefit for dry eye sufferers. A report of the study appeared in Optometry & Vision Science in January.

How Common Are Dry Eyes?

Dry eyes and dry eye symptoms are very common, particularly among older adults. And a recent consumer survey commissioned by Allergan suggests dry eyes are even more prevalent than previously believed.
The survey found:

• 48 percent of adult Americans regularly experience dry eye symptoms.
• 42 percent of women age 45 to 54 who have dry eye symptoms report blurred vision associated with the condition.
• Women more frequently than men report having difficulty using a computer due to dry eye symptoms (62 vs. 44 percent).
• 43 percent of adults with dry eye symptoms say they experience difficulty reading due to their symptoms.
• Among adults age 55 and older, 30 percent of men and 19 percent of women say they have experienced dry eye symptoms for more than 10 years.
• 19 percent of adults say they use over-the-counter eye drops at least five times per week to treat dry eye symptoms.
• 63 percent of adults who use non-prescription eye drops to treat dry eyes say the drops are not effective or only somewhat effective in managing their symptoms.

The survey also found that though dry eyes cause problems for nearly half of adult Americans, many people fail to seek professional help for dry eye symptoms: 69 percent of respondents who experienced symptoms said they had not visited an eye care professional for dry eye treatment.
The Allergan Dry Eye Survey was conducted online in March 2011 by Harris Interactive, with 2,411 adults (age 18 and older) responding.

Treatment for Dry Eyes

Dry eye syndrome is a chronic and typically progressive condition that may not be completely curable (depending on the cause). But the accompanying dryness, scratchiness and burning can be managed. Because dry eyes can be caused by many different things, a variety of treatment approaches are used.
Eye drops and other lubricants. Your eye care practitioner may prescribe artificial tears, which are lubricating eye drops that may alleviate the dry, scratchy feeling. Some artificial tears address specific tear deficiencies, such as lack of sufficient lipids.

Left: Artificial tears help dry eyes feel better; don't confuse them with formulas that just reduce redness. Salmon is a good source of omega-3 fatty acids, which may reduce your risk for dry eyes. Sardine, herring and cod liver oils are even better, or try a supplement.

Prescription eye drops called Restasis (Allergan) go one step further: they help your body produce more tears by reducing inflammation associated with dry eye syndrome.

Another option for dry eye treatment is called Lacrisert, a tiny insert filled with a lubricating ingredient (hydroxypropyl cellulose). The insert is placed just inside the lower eyelid, where it continuously releases lubrication for the eye throughout the day.

Sometimes people use eye drops that are advertised to "get the red out" to treat their dry eyes. While these drops can reduce or eliminate eye redness temporarily, they may or may not be effective at lubricating your eyes, depending on the formulation.

Also, your eyes can develop a tolerance to the eye-whitening agents (vasoconstrictors) in these drops, which can cause even more redness over time. Redness-relieving eye drops can cause other adverse effects as well, especially if you use them too often.

If you wear contact lenses, be aware that many eye drops, especially artificial tears, cannot be used while your contacts are in your eyes. You'll need to remove them before using the drops and wait 15 minutes or even longer (check the label) before reinserting your contact lenses.

If your eye dryness is mild, then contact lens rewetting drops may be sufficient to make your eyes feel better, but the effect usually is only temporary.
Check the label on any eye drops you use, or better yet, check with your optometrist or ophthalmologist before buying any over-the-counter eye drops. It will probably save you a lot of money, because he or she will know which formulas are most effective and long-lasting and which ones are not, as well as which eye drops will work with your contact lenses.

Blocked meibomian glands. Meibomian gland dysfunction (MGD) is now recognized as a primary cause of or contributor to most cases of dry eye. LipiFlow treatment (TearScience) is an in-office procedure that clears blocked meibomian glands and restores normal function.
Some practitioners may recommend warm compresses applied to the eyes, followed by manual expression of the meibomian glands to treat MGD and evaporative dry eye.

Your environment. If the problem is environmental, wear sunglasses when outdoors to reduce exposure to sun, wind and dust. You may want to try the kind that has a foam or other seal at the sides and/or a close-fitting, wrap-style frame to keep wind and dust from getting behind the lenses and in your eyes.
Recent research suggests that cold temperatures may be another environmental cause of dry eyes. If it gets cold and windy where you live, try wearing goggles when you're outside in winter.
Indoors, an air cleaner can filter out dust and other particles from the air, while a humidifier adds moisture to air that's too dry because of air conditioning or heating.

Punctal occlusion. Temporary or permanent silicone plugs can be inserted in the lacrimal (tear) drainage ducts in your eyelids to keep tears on your eye from draining away as quickly. Called lacrimal plugs or punctal plugs, they can be inserted painlessly while you're in the eye doctor's office and normally are not felt once inserted.
A new type of punctal plug made of acrylic is a small rod that becomes a soft gel when exposed to your body heat after insertion. These plugs are designed to swell and conform to the size of your tear drainage canal. Advantages of this type of plug are that one size fits all, so measurement is unnecessary, and nothing protrudes from the tear duct that could potentially cause irritation.
Another new kind of punctal plug is made of a hydrogel material that expands into a soft, pliable gel in the tear drainage canal. It has no cap, and should it need to be removed, the eye care practitioner can simply flush it out with saline solution.
With some people, however, punctal plugs aren't effective enough, so their tear ducts need to be closed surgically (punctal cautery).

Nutrition and hydration. Doctors sometimes recommend special nutritional supplements for dry eyes. Studies have found that supplements containing omega-3 fatty acids can decrease dry eye symptoms.
Good sources of omega-3s include cold-water fish, such as sardines, cod, herring and salmon. Some eye doctors also recommend flaxseed oil to relieve dry eye.

Drinking more water can help, too. Mild dehydration often makes dry eye problems worse. This is especially true during hot, dry and windy weather. Simply drinking more water sometimes reduces the symptoms of dry eye syndrome.

The Institute of Medicine says that each day, women need 91 ounces of water and men need about 125 ounces to stay hydrated. Experts agree that about 20 percent of the water your body needs comes from the food you eat, while the rest originates from the fluids you drink.
The best choices for beverages are water, 100 percent fruit and vegetable juices and milk.

Texas Cities Dominate Top Dry Eye Hot Spots

The National Women's Health Resource Center has named the top 100 dry eye hot spots in the United States based on information compiled from the National Oceanic and Atmospheric Administration's Climatic Data Center and the Environmental Protection Agency.
Factors used in the selection process included temperatures, humidity, wind, altitude, pollutants and ocular allergens.
The top 20 U.S. cities named as dry eye hot spots are:

1. Las Vegas, Nev. 2. Lubbock, Texas* 2. El Paso, Texas* 4. Midland/Odessa, Texas 5. Dallas/Fort Worth, Texas 6. Atlanta, Ga. 7. Salt Lake City, Utah

8. Phoenix, Ariz. 9. Amarillo, Texas 10. Honolulu, Hawaii 11. Oklahoma City, Okla. 12. Albuquerque, N.M. 13. Tucson, Ariz. 14. Norfolk, Va.

15. Newark, N.J. 16. Boston, Mass. 17. Denver, Colo. 18. Pittsburgh, Pa. 19. Bakersfield, Calif.* 19. Wichita, Kan.*

*Cities were tied for these spots.

Medications. If medications are the cause of dry eyes, discontinuing the drug generally resolves the problem. But in this case, the benefits of the drug must be weighed against the side effect of dry eyes. Sometimes switching to a different type of medication alleviates the dry eye symptoms while keeping the needed treatment. In any case, never switch or discontinue your medications without consulting with your doctor first!

Eyelid diseases. Treating any underlying eyelid disease, such as blepharitis, helps as well. This may call for antibiotic or steroid eye drops plus frequent eyelid scrubs with an antibacterial shampoo.

Contact lenses. If contact lens discomfort is the cause of your dry eyes, your eye care practitioner may want to switch you to a different lens or have you wear your lenses for fewer hours each day. In some cases, it is recommended that contact lens wear be discontinued altogether until the dry eye problem clears up.

Vision correction surgery. Dry eyes and LASIK usually are not a good combination. If you are considering LASIK, be aware that dry eyes may disqualify you for the surgery, at least until the problem is resolved.

LASIK Surgery Risks and Complications and how to avoid them

LASIK Surgery Risks and Complications

LASIK and other types of laser eye surgery, such as PRK and LASEK, have an excellent safety profile and a very high success rate. They are designed to treat myopia (nearsightedness), hyperopia (farsightedness) and astigmatism, and can allow you to live without glasses or contacts.

Sight-threatening complications such as complete or partial loss of vision from LASIK surgery are extremely rare, and many side effects and laser eye surgery complications can be resolved with additional surgery or medical treatment.

Like any other surgery, however, there are potential risks, side effects and limitations you should be fully aware of before electing to undergo the procedure (or any type of procedure, for that matter). Choosing a skilled and experienced LASIK eye surgeon can help reduce these risks and enable you to achieve the best possible results from laser eye surgery.

The first step is to determine if you are a good candidate for vision correction surgery. Your eye doctor will perform an advanced diagnostic eye exam to determine your suitability for LASIK surgery. He or she will evaluate: the shape and thickness of your cornea; pupil size; refractive errors; the moistness of your eyes (to check for dry eye syndrome); general health and medical history; and any medications you are taking.

Even if you are not a good candidate for LASIK, don't worry — you might still be able to have your vision fixed with other vision correction surgery such as PRK, LASEK or implantable lenses.

LASIK Eye Surgery Risk Factors and Limitations

Not everyone is a suitable candidate for LASIK eye surgery. Certain conditions and anatomical factors can increase your risk of an undesirable outcome or limit optimal LASIK results. These include:

• Too thin or irregular corneas
• Large pupils
• High refractive error
• Unstable vision
• Dry eyes
• Your age
• If you are pregnant
• If you have certain degenerative or active autoimmune disorders

For a full checklist on LASIK risk factors and whether or not you are an appropriate candidate, read our LASIK Criteria for Success.

LASIK Side Effects and Complications

Millions of Americans have had LASIK eye surgery to correct their vision since it was introduced in the United States more than 20 years ago, and experienced LASIK surgeons report that serious complication rates can be held below 1 percent.

Common LASIK complications and side effects are listed below. Most of these problems can be resolved with medical treatment or additional "enhancement" surgery.

Temporary discomfort and vision disturbances. Discomfort during the first few days following LASIK surgery, such as mild irritation and light sensitivity, is normal and to be expected. During the first few weeks or months you also may experience: halos; glare and starbursts in low-light environments, especially at night; dry eye symptoms; hazy vision; and reduced sharpness of vision. In the vast majority of cases, these problems are temporary and disappear completely within three to six months.

Flap complications. The LASIK procedure involves the creation of a thin hinged flap on the front surface of the cornea. This is lifted during surgery for laser reshaping of the eye. The flap is then replaced to form a natural bandage.
If the LASIK flap is not made correctly, it may fail to adhere properly to the eye's surface or cause microscopic wrinkles in the flap called corneal striae (STRIE-ee). These flap complications can lead to an irregularly shaped eye surface and distorted vision.
Studies indicate that flap complications occur in from 0.3 to 5.7 percent of LASIK procedures, according to the April 2006 issue of American Journal of Ophthalmology. In a study of 3,009 consecutive LASIK surgeries performed August 2002 through July 2009 using a femtosecond laser for flap creation, flap complications occurred in fewer than one-half of 1 percent (0.37 percent) of these procedures, and all complications were successfully managed within the same surgical session.
Again, remember that you can reduce your risk of LASIK complications by choosing a reputable, experienced eye surgeon.
Some problems associated with LASIK flap complications include:

• Irregular astigmatism. This is caused by an unequally curved corneal surface. Irregular astigmatism also can occur from laser correction that is not centered properly on the eye or from irregular healing. Resulting symptoms may include double vision (diplopia) or "ghost images." In these cases, the eye may need re-treatment or enhancement surgery.
• Epithelial ingrowth. This is when cells from the outer layer of the cornea (epithelium) grow under the flap after LASIK surgery. In most cases, epithelial ingrowth is self-limiting and causes no problems. But in some cases (reported to be 1 to 2 percent of LASIK procedures), symptoms of discomfort and/or blurred vision can occur, and additional surgery is needed to lift the flap and remove the epithelial cells.
• Diffuse lamellar keratitis (DLK). Nicknamed "Sands of the Sahara," this is inflammation under the LASIK flap that may have several causes. Some inflammation of the cornea after LASIK surgery is normal. But if it is uncontrolled, as in DLK, it can interfere with healing and cause vision loss. If DLK occurs, it usually responds to therapies such as antibiotics and topical steroids. Also, the flap might need to be lifted and cleaned for removal of inflammatory cells and to prevent tissue damage.
• Keratectasia or keratoconus. This is a very uncommon bulging of the eye's surface that can occur if too much tissue is removed from the cornea during LASIK or if the cornea prior to LASIK is weak as evidenced from corneal topography mapping. Rarely does keratoconus develop after LASIK with no known risk factors.
  
  Enhancement laser surgery is usually not suitable, and gas permeable contact lenses or corneal implants (Intacs) may be prescribed to hold the cornea in place, or a treatment called corneal collagen crosslinking may be performed to strengthen the cornea. 

Dry eyes after LASIK. 

Some people who have LASIK surgery experience a decrease in tear production that can cause eye discomfort and blurred vision. Almost half of all LASIK patients experience some degree of temporary dry eye syndrome, according to the April 2006 issue of American Journal of Ophthalmology.
Dry eye syndrome after LASIK surgery usually is temporary and can be effectively treated with lubricating eye drops or other measures.
Dry eye problems usually disappear when healing of the eye is complete, which can take up to six months. People who already have severe dry eye usually are eliminated as LASIK candidates.
Significant undercorrection, overcorrection or regression. Not everyone will achieve 20/20 vision after LASIK eye surgery, and contacts or eyeglasses for some or all activities may still be required in rare cases. If the laser removes too much or too little corneal tissue, or your eye's healing response is not typical, your visual outcome will be less than optimal.
In many cases, the cause of a less-than-perfect outcome is that your eyes did not respond to laser eye surgery in a predictable manner. Another possible cause is that your eyesight may be optimal at first but regress over time due to "over-healing."
In most cases, a significant undercorrection or regression can be treated with additional laser vision correction or other refractive surgery methods such as conductive keratoplasty, once it is certain that the refractive error is stable.
Eye infection. While rare, LASIK surgeons report that infections occur more frequently with surface ablations such as PRK. At the 2008 annual meeting of the American Society of Cataract and Refractive Surgery (ASCRS), researchers reported that the LASIK flap, which is lifted during surgery and then replaced to serve as a type of natural "bandage," seemed to create a more sterile surgical environment than PRK and other surface ablation procedures, thereby reducing the risk of infection.
Eye infections after LASIK surgery typically are temporary, and can be treated with antibiotic eye drops or anti-inflammatory medication such as steroids.

LASIK Complications: How They Affect You, How They're Treated

Complications	Symptoms	Treatments
Incomplete corrections (undercorrection, overcorrection, residual astigmatism) or regression of effect	Blurry, less-than-perfect vision	Glasses or contact lenses; eye drops; re-treatment with laser
Decentered ablations	Visual aberrations*	Eye drops; re-treatment with laser
Oversize pupils	Visual aberrations*	Eye drops; re-treatment with laser
Haze	Visual aberrations*	Eye drops; re-treatment with laser
Irregular flap (folds, wrinkles, striae)	Visual aberrations*	Surgical correction; second laser procedure
Dry eye	Dry, itchy or scratchy eyes, often with redness and sense of foreign object in eye, and sometimes pain	Prescription dry eye medication; artificial tears; punctal occlusion (blockage of tear ducts in order to retain tear film on eye), oral flaxseed oil
Diffuse lamellar keratitis (eye inflammation)	Visual aberrations*	Eye drops; surgical rinsing of cells if severe
Epithelial ingrowth	Visual aberrations*	Surgical removal of epithelium
Infection	Redness, oozing of eyes, sometimes pain	Eye drops; oral medications
*Visual aberrations include symptoms such as glare, double vision, ghosting, halos, starbursts, loss of contrast sensitivity, and problems with low-light or night vision. Most patients do not experience these symptoms, and some patients with these complications experience no symptoms and require no treatment. [See also: Higher-Order Aberrations.] Chart created by Keith Croes and reviewed by Brian Boxer Wachler, MD.

How To Compare Laser Eye Surgery Prices with 8 questions to ask your surgeon.

How to Compare Laser Eye Surgery Prices

If you're looking into LASIK or other laser eye surgery, cost is going to be one of your main concerns. It's a significant investment, and you want to do your homework to be sure the price you're quoted is reasonable for your vision correction needs.

We provide average LASIK prices in a separate article, but prices can vary a lot from one surgery center to another, and it depends greatly on surgeon skill, the technology used, your vision prescription and more.

Newer Technology Can Increase LASIK Cost

There are different types of LASIK. You may expect higher costs when you choose newer options such as these over traditional LASIK:

• Custom LASIK (or wavefront LASIK), which uses wavefront analysis to measure and map the eye's aberrations to help provide a more precise correction.
• Femtosecond laser technology (often called all-laser LASIK or bladeless LASIK), which uses a laser instead of a blade to cut the corneal flap. Those surgeons who perform all-laser LASIK cite studies that show patients have fewer flap complications, need fewer retreatments and have a greater likelihood of achieving 20/20 visual acuity or better.
  
  But not all eye surgeons agree that laser-made flaps are superior, and the merits of blade versus bladeless LASIK continue to be debated.

But keep in mind that many surgeons don't charge a separate fee for new technologies used in LASIK, and instead quote their price as a single fee. In a survey of U.S. eye surgeons, about half said they quote their price as a single fee.

U.S. refractive surgeons are evenly divided between those who charge a single price for all their laser procedures and those who charge various prices according to the technology used or the severity/type of vision correction required by the patient. (Pricing information provided to AllAboutVision.com by a leading industry analyst.)

Other Contributors to LASIK Cost

One reason fees vary is that different providers perform varying levels of preoperative testing. Since proper screening can avoid problems, it's important to determine if appropriate testing is included in a quoted price.
Wide variation exists also in the cost of equipment used for testing and surgery. Technologies for eye tracking, tear film analysis and measurements of corneal thickness, corneal topography and pupil size, as well as the laser itself, are available at various price points and can be reflected in the procedure fee.
Refractive surgery fees cover a variety of costs, including:

• Purchase or lease and maintenance of the excimer laser, microkeratome, femtosecond laser and/or other devices used in the procedure.
• A $100 to $150 per eye royalty fee to the excimer laser manufacturer, who must recoup the cost to develop the machine.
• A $145 to $250 per eye royalty fee if it is a custom procedure, depending on the laser manufacturer.
• Microkeratome blades, surgical solutions and medications used during the surgery.
• For a femtosecond laser, disposable equipment that includes a metal cone and glass lens connecting the laser to the treated eye.
• Gowns, masks, gloves and other items for keeping the operation sterile.
• Overhead for the surgery center, which includes office and surgical staff salaries and benefits, rent, office equipment and office administration.
• Patient acquisition costs, which include advertising, seminars and fees paid to other eye care practitioners for comanagement.
• Insurance.
• And, especially, "the surgeon," who is the single most important part of any surgical procedure.

Also included in most fees are the pre-op evaluation meeting, comprehensive eye examination (including technician time and equipment costs), follow-up office visits and tests, plus any standard medications.
Many surgeons also offer free enhancement surgery if it is warranted. Often a team of doctors reviews your case to determine this, and their time is included in the fee.

8 Important Questions to Ask Your Surgeon About Procedure Prices

When discussing fees with your surgeon, ask:

1. What is included?
2. What is not?
3. May I have a written quote with everything itemized?
4. Is the price quoted for one eye or both eyes? (Technically, one procedure equals one eye, even if both eyes will be corrected on the same day.)
5. What will I have to pay for if complications occur or enhancement surgery becomes necessary?
6. What will be the cost of prescription medications (such as anti-inflammatories and painkillers)?
7. If I require temporary contact lenses or glasses after the procedure, how much will they cost?
8. How many follow-up visits will I need to make, and at what cost?

What Else You Need to Know About Laser Eye Surgery Prices

Before making a final decision, ask yourself:

• Does the quote fall within typical ranges? (See the yellow-highlighted areas of our laser eye surgery price chart.)
• If the quote is significantly higher than usual, does your eye surgeon have exceptional credentials that help justify the extra price?
• If the quote is significantly lower than usual, is your eye surgeon relatively inexperienced? Are you sure you are being quoted the full price?

When a surgical center quotes a single price for all procedures regardless of technology or your presciption, ask these questions:

• Will I receive a laser-created flap?
• Will my procedure be wavefront-guided?

LASIK Eye Surgery Results: Are you likely to see 20/20 after LASIK?

LASIK Results: What to Expect

By Keith Croes, with updates by Diane Donofrio Angelucci;
contributions and review by Vance Thompson, MD

LASIK eye surgery results have continued to improve, along with supporting technology and surgeon skill, which should offer some reassurance to candidates who are unsure about what to expect.

Thanks to LASIK, millions of people throughout the world are less dependent on glasses or contact lenses. Still, the decision to have LASIK should be approached with caution. Because surgery is involved, some serious potential risks — though rare — are associated.

Because LASIK is an elective procedure, you will be contemplating surgery on an otherwise healthy eye. For that reason, always consider that you have the option of safe and effective nonsurgical alternatives, such as glasses and contact lenses.

When considering LASIK, do some homework and consult with your eye doctor to learn more about the procedure. Ask about potential LASIK complications as well as visual outcomes.


Inquire about the technology your LASIK surgeon uses for the procedure. In LASIK, an ultra-thin, hinged flap is lifted from the surface of your eye. After laser energy is applied to reshape the cornea, the flap is replaced to serve as a type of natural bandage.

Does your surgeon prefer a blade-created flap or a laser-created flap associated with the recent innovation of bladeless LASIK? 

Consider also that newly developed eye-tracking technology in an excimer laser helps make inadvertent eye movement less of a problem during a procedure.
Also, custom or wavefront-guided LASIK reduces the chance of nighttime visual problems such as glare and halos.

After you go through the education process to understand your best treatment options and the available technology, it is important to understand your surgeon's level of experience. After a balanced discussion about all these issues, you will be more prepared to make an educated decision, which will improve your chance of a good LASIK outcome.

Possible LASIK Complications

LASIK carries a slight risk of short- and long-term complications. Most people respond well to treatment, but some cases are more difficult. Very rarely, permanent problems can result.

According to guidelines from the Eye Surgery Education Council (ESEC) founded by members of the American Society of Cataract and Refractive Surgery, fewer than 1 percent of LASIK patients experience serious, vision-threatening problems.
LASIK complications can include:

• More serious problems such as eye infection, chronic dry eye and LASIK flap problems.
• Less serious complications that generally clear up on their own as the eye heals, including halos, haze and glare.

The ESEC says most LASIK complications can be treated and usually clear up within several months.

Studies consistently show that LASIK complications decline as surgeon experience increases. So you can increase your chance of a good outcome by choosing an experienced surgeon.

It's also important to remember that your general health and eye health both influence the risk of certain complications. For example, you may be at greater risk of LASIK complications if you have a disease such as diabetes that can interfere with your body's normal healing responses. Of course, you will need to discuss your general health with your eye doctor.

Also consider that, even under the most ideal circumstances with a technically flawless surgical procedure, each patient responds and heals differently after eye surgery.

LASIK Studies and Safety Standards

The eye care community sets high standards for LASIK success. For a LASIK laser to receive FDA approval, manufacturers are expected to have adverse event rates of less than 1 percent during clinical trials.

The FDA definition of adverse event includes a list of specific problems such as corneal swelling, flap problems, uncontrolled intraocular pressure and a detached retina.
At this time, no central database of LASIK outcomes exists. Most of what is known about visual acuity outcomes after LASIK is based on various clinical studies, especially trials the FDA requires laser manufacturers to perform to obtain approval.
Most clinical studies of LASIK vision outcomes have a few elements in common. These include:

• An assessment of how many people achieve 20/20 vision or better (so-called "perfect" vision) and how many achieve 20/40 vision or better (the minimum visual acuity required to obtain a driver's license in most states).
• A discussion of how many people get to within one diopter or a half diopter of zero refractive error. (Myopia, hyperopia and astigmatism are all refractive errors. Zero refractive error is called emmetropia.)
• Details about possible adverse events associated with LASIK.

To monitor vision changes during the LASIK recovery period, many studies measure visual outcomes immediately after surgery, several days later and at one, three and six months after the procedure.

Apples to Oranges: Comparing FDA Data on LASIK Lasers

The FDA has approved lasers for use in LASIK to treat myopia and hyperopia, with or without astigmatism. Best results generally have occurred in people with low to moderate myopia.
When considering FDA studies, however, it is impossible to compare study results head-to-head. This is because people who enrolled in one study originally may have had different characteristics than those who had LASIK in a study for another company's laser.
Results from the same laser also can vary, depending on how people were selected for the study. Some studies may eliminate those with higher amounts of refractive error, for example, while others may need to assess results specifically for these types of vision problems.
Furthermore, later results with these lasers are probably better, as surgeons gain experience and many of the lasers are improved. In short, FDA results serve best to provide a general perspective of trends.
Our article on LASIK lasers provides more information about FDA-approved lasers for LASIK, including their approved treatment levels. For example, you can learn about the amount of myopia, hyperopia and/or astigmatism the lasers are approved to treat.
Just remember that, no matter the approved treatment level of the laser, you and your surgeon can choose to do whatever you think is appropriate and reasonable in your particular case.

Best-Corrected Vision After LASIK

The target values that the eye care community have established for LASIK vision outcomes say a lot about what you can expect from the procedure.
The most feared outcome of LASIK is a decrease in best possible vision, something doctors call best corrected visual acuity (BCVA), or sometimes best spectacle-corrected visual acuity (BSCVA).
In other words, if you can be corrected to 20/20 with glasses or contact lenses before undergoing LASIK, you'd like to be correctable to at least 20/20 after LASIK (if LASIK falls short of giving you 20/20 uncorrected vision).
For example, if you have 20/200 uncorrected vision before LASIK and see 20/20 with contact lenses or glasses, then see 20/40 uncorrected after LASIK but are correctable to only 20/25 with contacts or glasses, you have lost one line of BCVA (from 20/20 to 20/25) on a standard eye chart.
But even though you lost one line of best corrected visual acuity, you gained more than six lines of uncorrected vision (from 20/200 to 20/40).
The FDA expects laser manufacturers to show that no more than 5 percent of patients in clinical trials lose more than two lines of BCVA and that less than 1 percent of patients have BCVA worse than 20/40.

How Well Can You Expect To See After LASIK?

In a major report discussed on the American Academy of Ophthalmology website, 64 LASIK studies published since 2000 were reviewed with these results reported:

• In a detailed analysis of all 64 studies, a median of 92 percent of eyes with myopia or myopic astigmatism achieved a correction within 2.0 diopters of target. Results were better for eyes with low or moderate myopia, compared with high myopia.
• In 22 studies of outcomes involving people with low to high levels of myopia, a median of 94 percent of eyes achieved 20/40 or better vision after surgery and did not require correction with glasses or contact lenses (uncorrected visual acuity or UCVA). A median of 99 percent of people with low to moderate levels of myopia had 20/40 or better UCVA, and a median of 89 percent of people with high myopia had the same result.
• In these same studies, outcomes for people with hyperopia also were examined. Results showed that a median of 88 percent of eyes with hyperopia and hyperopic astigmatism achieved correction within 1.0 diopter of target, resulting in at least 20/40 UCVA.

According to a major analysis of scientific literature by the American Society of Cataract and Refractive Surgery reported in 2008, worldwide satisfaction rates among LASIK patients is 95.4 percent.
Some studies, such as one reported in the October 2008 issue of Journal of Cataract and Refractive Surgery, continue to show a slight trend toward better LASIK outcomes if you don't require a high degree of correction — for example, if you are moderately nearsighted as opposed to extremely nearsighted.
More details about LASIK outcomes will be known after the FDA completes an ongoing Quality of Life study that involves detailed examination of the types of vision improvement people have, along with possible side effects that might not ordinarily be reported in clinical trials. In late March 2011, the FDA began selecting sites throughout the United States where people who have undergone LASIK will be surveyed to assess their satisfaction with their LASIK outcome and to document adverse visual symptoms or complications.
Most LASIK surgeons should be able to provide you with benchmarks, such as figures showing what percentage of their patients have achieved UCVA of 20/20 or better after LASIK.

LASIK Results and Your Eye Surgeon

LASIK is like many other surgical procedures. Where you start is an important predictor of where you end up. Results are affected by the health of your body in general, your eyes in particular and the status of your current vision.
And, as with all other surgical procedures, surgeon skill and experience are major factors that cannot be overlooked.