An expert in laser eye surgery for more than 15 years, Pflugfelder is increasingly falling back on an older, less invasive procedure known as photorefractive keratectomy, or PRK, which involves only the surface of the eye.

In the past three years, the number of LASIK procedures at Baylor has dropped from about 70 percent to about 50 percent of all laser eye surgeries.

At Duke, LASIK makes up about 80 percent of all laser eye surgeries. Dr. Alan Carlson, head of the Duke Eye Center, is comfortable with that.

"Dry eye hasn't been a big problem," Carlson said.

The university buys the most sophisticated lasers on the market, he said. Patients are screened for risk factors and informed of what they can and cannot expect from LASIK. A surgeon might even do LASIK on one eye at a time.

Those precautions did not prevent Lauranell Burch, a former Duke medical researcher, from suffering a serious complications after undergoing LASIK at the Duke Eye Center.

Burch, 47, said that since the surgery March 31, 2004, her eyes sting and burn all the time, eye tissue is wrinkled like a Ruffles potato chip and her night vision is distorted.

"(The damage) is noticeable and on the front of your mind all your waking hours," Burch said. "There's no escape."

In the winter, she takes an anti-anxiety pill about 15 minutes before she drives home in the dark from her job in Research Triangle Park. She compares the distortions she sees at night, also known as star bursts, to explosions of light without a bang.

Burch cut short her follow-up treatment at Duke, became an avid patients' advocate and started to take on LASIK surgeons on Internet Web sites.

Federal privacy laws prohibit Carlson from speaking about an individual patient's case. But the head of the Duke Eye Center acknowledged that LASIK can cause serious complications.

"It's imperfect surgery in an imperfect world," he said.