ll of these surgeries continue to elicit controversy despite successful application of the techniques and the results. Some of the cautious statements that were made in the beginning were valid then but not today. However, some problems previously envisioned, have resulted from inappropriate application or execution of these procedures. None of these techniques are simple despite their appearance to the contrary and are on a par with open heart surgery. No general surgeon would dream of performing open heart surgery, leaving that to specialists. So too refractive surgery. There are a myriad of small details that must be constantly considered and concentration on the case at hand is essential to success. Such necessity does not fit in well with the general practice of ophthalmology. There is a tendency to take short cuts and because of lack of experience overlook data as insignificant. The proper performance of this surgery is best left to specialists who have dedicated and are prepared to continue to dedicate themselves to it. Teaching of these techniques should not be done as a matter of course in a residency program but afterwards in a program devoted to refractive surgery alone.

Some would tell you to have LASIK because it's “better" than RK — it isn't. It might be quicker — in some cases — but it hasn't proven to be better yet. Increasing reports of serious night-time glare are being seen. The Canadian government is said to be considering re-testing of all such patients for their driver's licenses. It is highly likely that both it and RK will be used together to deal with most cases of myopia.

Many PRK advocates have essentially abandoned the procedure for LASIK. In high myopia, it's the method of choice — in the right hands. It is much better than ALK; the incidence of irregular astigmatism is much less but still greater than that seen with RK. That's important because many physicians are pushing LASIK for low to moderate myopia. Not good! There's an old saying: “If all you have is a hammer, everything looks like a nail.” It is a fact to ponder that many of the self-same individuals who touted PRK in the past are now pushing LASIK instead because of the very problems I and others were warning about in the recent past.

As for hyperopia — nothing has yet surfaced which is an unequivocal success for far-sightedness. The excimer has been a disappointment thus far. Thermokeratoplasty — of any stripe — has been abandoned for the most part, though some still say the laser procedure has merit; I shall demur here. Hexagonal keratotomy was never a viable option as history has proven.