Sorry, doc, but I have to take serious exceptions to your comments. The
primary one being: that is not acceptable to present medical advice to
patients without a clear knowledge of their medical history unless that
caveat is so included.  You are simply wrong that medical history is not
an issue for refractive surgery.  Most of what follows is from the US
FDA printed patient information on LASIK.

Like I said, spin it any way you want, but you have no idea if he/she is
or is not "an ideal candidate."

How rare it is is not the issue. The consequences of operating on such
an individual can be devestating. See below.

So completely wrong here that I will quote from the US FDA LASIK
guidelines. It is quite specific:

----begin copy/paste text----
General risk factors and contraindications for LASIK refractive surgery;

       * In their early 20s or younger,
       * Whose hormones are fluctuating due to disease such as diabetes,
       * Who are pregnant or breastfeeding, or
       * Who are taking medications that may cause fluctuations in
vision,
       * You have a disease or are on medications that may affect wound
healing. Certain conditions, such as autoimmune diseases (e.g., lupus,
rheumatoid arthritis), immunodeficiency states (e.g., HIV) and diabetes,
and some medications (e.g., retinoic acid and steroids) may prevent
proper healing after a refractive procedure

-----end text----

Following that bit of information, the FDA goes on to point out various
OCULAR DISEASE contraindications to LASIK.

---begin copy/paste text---

Precautions
The safety and effectiveness of refractive procedures has not been
determined in patients with some diseases. Discuss with your doctor if
you have a history of any of the following:

   * Herpes simplex or Herpes zoster (shingles) involving the eye area.

   * Glaucoma, glaucoma suspect, or ocular hypertension.

   * Eye diseases, such as uveitis/iritis (inflammations of the eye)

   * Eye injuries or previous eye surgeries.

   * Keratoconus

Other Risk Factors
Your doctor should screen you for the following conditions or indicators
of risk:

   * Blepharitis. Inflammation of the eyelids with crusting of the
eyelashes, that may increase the risk of infection or inflammation of
the cornea after LASIK.
     
   * Large pupils. Make sure this evaluation is done in a dark room.
Younger patients and patients on certain medications may be prone to
having large pupils under dim lighting conditions. This can cause
symptoms such as glare, halos, starbursts, and ghost images (double
vision) after surgery. In some patients these symptoms may be
debilitating. For example, a patient may no longer be able to drive a
car at night or in certain weather conditions, such as fog.

   * Thin Corneas. The cornea is the thin clear covering of the eye
that is over the iris, the colored part of the eye. Most refractive
procedures change the eyes focusing power by reshaping the cornea (for
example, by removing tissue).  Performing a refractive procedure on a
cornea that is too thin may result in blinding complications.

   * Previous refractive surgery (e.g., RK, PRK, LASIK).  Additional
refractive surgery may not be recommended.  The decision to have
additional refractive surgery must be made in consultation with your
doctor after careful consideration of your unique situation.

   * Dry Eyes. LASIK surgery tends to aggravate this condition.

----end text---

And remember this comes from the FDA, the people who brought you
thalidomide and VIOXX.  So you might think about what is not said.

Or, of course, we could just take it as it is, which is IMHO, a pretty
reasonable disclosure.  But I digress.

And I'm all in favor of improvement!

Continuous wear silicon hydrogel contact lenses.  Or wait for technology
to give us replaceable/removable imbedded contact lenses or cornea
molding/keratoplasty. Or even ICLs. Something that does not permanently
alter human tissue by removing it.

Although I am not an active promoter of LASIK as you appear to be, I am
very much demanding of full and clear disclosure (with information that
relates specifically to their issues) to patients considering medical
treatment for anything.

I apologize if it seems I'm being hard on you about this. But we must
remain aware that lay people read this stuff on the internet and some of
them look only for what they want to hear, not necessarily getting the
big picture. It's OK to promote your own view point as long as it is
clear that is what it is.  When it comes to medical advice, we have to
extra vigilant not to persuade but to inform without bias.

Regards,

Larry