LASIK surgery can clear the fog.

Being severely myopic or out of focus for distant vision puts a runner at a significant disadvantage compared to his 20/20 fellow runners. Leaving your glasses at home isn't an option--it's imperative to be able to see your feet, a car coming, bicycles, pot holes, dogs, strollers, or a low branch. Running into any of these things can really wreck your whole day. Having glasses bouncing around on your face or steaming up and defeating their purpose is hardly an improvement over a myopic fog for the serious runner. Contact lenses may be an alternative for some, but they too come complete with annoying problems, like getting dry, irritated eyes, or popping out and getting lost.

Over the last 25 years there has been an unending succession of advances from research ophthalmologists in the treatment of eye disorders. None, however, is likely to affect more people than recent breakthroughs in laser-assisted in-situ keratomileusis, or LASIK surgery. At long last we have entered an era in which a quick, safe, and highly successful surgical procedure can free patients from glasses and contact lenses.

LASIK is sometimes referred to as "Flap and Zap" surgery. A very delicate instrument called a microkeratome is applied with suction over the apex of the cornea to raise a thin flap of cornea. The eximer laser is then used to ablate or reshape the interior of the cornea to correct myopia, astigmatism, or farsightedness. The flap is then put back in place and adheres without stitches. LASIK is usually painless and takes just a few minutes. Many surgeons do both eyes at the same visit. Refractive surgery is most often done on a Friday with full recovery over the weekend. You can work on Monday without glasses. Restrictions on returning to running vary from one surgeon to another, but are usually no longer than two weeks. Swimming may be curtailed longer.

In some cases, surgery results in either under- or over-corrected vision problems. In these cases, additional LASIK surgery can help. But with a skilled and experienced surgeon, 95% to 98% of the time LASIK produces corrected distant vision of 20/40 or better. This is good enough to drive without glasses. 20/20 vision occurs in 80% to 90% of LASIK cases. Some people with less than perfect vision after surgery may opt to wear glasses for special situations such as night driving or movies.

While it won't interfere with running, one shortcoming for many aging runners is that LASIK does not correct presbyopia or the loss of the ability to read or see near objects caused by the aging process. Correcting this aging process and maintaining both good distance and reading vision over our lifetimes is the next challenge for researchers.

As is always true for any surgical procedure, LASIK can have complications. One possibility is lingering halos around light in darkened areas, like headlights and streetlights at night. Individuals with unusually large pupils are at risk for this complication for which there is no correction. The most important concept for anyone considering LASIK is that no surgeon, no matter how skillful, can guarantee perfect vision or that there will be no complications. Serious complications with LASIK occur less than 5% of the time, and usually involve damage to the corneal flap or failure for it to seat properly.

Both the costs and risks of LASIK are probably less than a lifetime of wearing contact lenses, especially extended-wear contacts that are worn during sleep. The cost of LASIK surgery is about $1,800 to $2,500 per eye and is not usually covered by health insurance. Financing or time payments are generally available. An important consideration when inquiring about costs is the possible need to repeat surgery in the future. Many surgeons offer a "lifetime warranty." In the event that additional LASIK surgery is necessary because of residual refractive errors or the development of more myopia or astigmatism, there is no extra charge.

Choosing a LASIK surgeon may be the most difficult part of the process. Because of the widespread success and acceptance of LASIK many ophthalmologists are doing the procedure, but there are significant differences in the skill, training and experience of LASIK surgeons. If you are considering LASIK surgery you should not hesitate to ask your prospective surgeon about his training, how long he has been performing the procedure, how many LASIK procedures he has done, his success rate, and the number of patients requiring second procedures. Testimonials and names of previous patients furnished by the doctor's office are likely to be the happiest of the happy but not necessarily the most representative. Seek out friends and acquaintances who have bad their LASIK surgery done by different surgeons and compare experiences and results. Ask your optometrist or ophthalmologist who'd she have operate on her own eyes or those of a family member if she were choosing a surgeon. And beware of kick-back schemes in which su rgeons pay referring doctors for sending patients for LASIK procedures.

If you are a myopic runner and wish to toss out your burdensome eyeglasses, doing so is a real option today thanks to the development of the LASIK procedure. Deciding to undergo any elective surgery should be given a lot of consideration, but LASIK has certainly made this decision easier, and changed the lives of many millions of grateful individuals.

(American Running Association Clinic Advisor John D. Hagan, M.D., is an ophthalmologist who wears glasses, runs, and treats patients in Kansas City, MO)

RELATED ARTICLE: Refractive Conditions--Eyes in which sight is blurry due to light rays not being brought to a clear focus on the retina. Glasses, contact lenses or refractive surgery such as LASIK can correct refractive conditions. Refractive conditions are not diseases and do not necessarily indicate damaged or diseased eyes.

Refractive Surgery--Procedures to correct myopia, hyperopia, astigmatism and presbyopia. Approved procedures include radial keratotomy (RK), photorefractive keratectomy (PRK), laser-assisted in-situ keratomileusis (LASIK) and more recently, intra-corneal rings. Experimental procedures include intraocular contact lenses and implants.

Myopia or nearsightedness--An eye that is longer than normal makes distance vision blurry. Reading vision is often good. Middle-aged myopics often have to remove their distance glasses to read.

Hyperopia or farsightedness--An eye that is shorter than normal makes near vision blurry. The strong focusing muscle of the young eye corrects farsightedness without difficulty. In extremely farsighted eyes or aging eyes, reading glasses and eventually bifocals are needed.

Astigmatism--A lop-sided or non-round eye usually caused by an aspherical cornea causes an astigmatism. Large or moderate amounts of astigmatism blur both distant and near vision and require optical correction.

Presbyopia--The loss of focusing power due to the aging process. Usually becomes evident in early 40's. Worsens with age. Older nearsighted people can read without glasses but distant vision is blurry.