Want to improve your golf game? Project a smoother image to clients? Rev up your love life? Or just get rid of the hassle of glasses? Such are the promises of vision-correction surgery — usually an elective procedure that is gaining in popularity in Virginia.

With a few seconds of treatment from a laser beam, adults are trading contact lenses and glasses for a world in complete focus. In 1999, an estimated 950,000 people nationwide had laser correction surgery — twice as many as in 1998. Within a few years, the number is predicted to rise to 2 million surgical procedures annually to correct nearsightedness, farsightedness and astigmatism.

For years, the procedure was considered controversial and was restricted in the United States. An early form of it was developed by a Soviet ophthalmologist who made strategically placed incisions in the cornea. As they healed, the eyeball’s shape was changed to correct nearsightedness. Another form of the corrective surgery was allowed in Canada before it gradually gained acceptance in the states.

One patient, David McRae of Virginia Beach, is happy with what the procedure did for him. McRae, a former teacher, always saw himself as a kid with thick glasses. It didn’t matter that he’d been wearing contact lenses for decades or that he was 57 years old. In his mind he could still envision himself as a second-grader saddled with Coke-bottle lenses. Today, thanks to laser surgery, McRae has 20/25 vision and a new outlook on life. "Having the surgery was one of the best things I’ve ever done," says McRae, who had the surgery in 1998. Until then his 20/400 vision made the world murky. "I even had to shower with my glasses."

Although McRae had the surgery late in life, most patients are between 30 and 50, says Garth Stevens Jr. of Richmond, president of the Virginia Society of Ophthalmologists. The surgery works for younger patients, but it’s the older ones who are most able to afford it. It typically costs from $1,000 to $3,000 and almost always is an elective procedure not covered by HMOs or usual medical insurance.

Since upper-income, middle-aged people are the most likely patients, they are also the age group being bombarded with marketing. Radio stations flood adult listeners with spots promising better vision while newspaper ads hammer home the same message. In Hampton Roads, Eagle 97 news director Jennifer Lewis talks up her better vision, as does Bill Mann, vice president of the Nighthawks arena football team. Both are featured in ads for the rival practices that did their surgery. Ophthalmologists sponsor free seminars that treat the curious to a ham sandwich, a multimedia presentation and a chance to watch a live laser procedure.

McRae got his surgery through Beach Eye Care in Virginia Beach. The practice’s two surgeons started performing laser surgery in 1997, two years after the Food and Drug Administration approved lasers for vision correction. Since then, laser surgery has grown from a sideline for many ophthalmologists to a mainstay. At Beach Eye Care it is more than half the practice; this year the center is expected to do 4,000 laser procedures.

Most will be Lasik surgery, an acronym for Laser In-Situ Keratomileusis, the most common way to correct visual defects. The outpatient procedure involves creating a small flap in the outer layer of the eye that is lifted so laser beams can instantly reshape the cornea to fix refraction errors. The physician then replaces the flap, which reattaches itself to the cornea. Within minutes most patients are reading clocks across the room and preparing to go home. By the next day most are back at work with 20/40 vision, which continues to improve over the next few days. "It’s amazing how quick it was," McRae says. "I had no more than 30 seconds of the laser on each eye."

After his surgery McRae experienced one of its main side effects — the "wow factor" that comes from suddenly having crisp vision. "I couldn’t sleep the first night," McRae recalls. "I stayed awake because I had never been able to read my alarm clock before, and I couldn’t stop looking at it."

Since McRae had his surgery nearly three years ago, the cost has dropped as competition surges. It cost about $2,500 per eye a year ago, but now the surgery averages $2,000 per eye. Some volume practices in Northern Virginia advertise the procedure for $999 per eye. "That price usually is not for a total package," warns ophthalmologist Stevens, who also is medical director of the Lasik Center of Virginia in Richmond. He recommends that patients make sure the fees include all pre-operative work, the surgery and follow-up care for a year. That includes going back for "enhancements," which use the laser to fine-tune vision that may not be as accurate as the patient wanted. This is sometimes needed for patients who start out with severe myopia or astigmatism.

Stevens predicts prices will stabilize around $3,000 for both eyes. Lasers cost from $300,000 to $500,000 and frequently need upgrading to keep up with new techniques. Fees are controlled in part by manufacturers, as surgeons are required to pay patent fees each time they use the lasers.

Because vision correction is elective surgery, most insurance plans don’t pay for it. Those that do are getting out of it as the procedure gets more popular, says Scott Strelow of Roanoke, a corneal specialist. Some patients cut costs by using health-care reimbursement accounts to pay for the surgery with pre-tax dollars. They also look for discounts that sometimes come from attending seminars or agreeing to let other people watch them in the chair.

The best candidates for the surgery are people whose vision has been stable for at least 18 months. Some people wonder what will happen with corrected eyes over time as vision changes, which is why candidates for surgery must have stable vision. Patients also are opting for Intacs, which are implanted corneal rings that can be removed or changed. But they only work for people with slight vision loss.

Although Strelow thinks Lasik "is a fantastic procedure with a 98 percent patient happiness rate," he spends a lot of time talking about risks. Problems with glare, irritation and dry eyes usually are temporary, yet there is a slight risk of infection or impaired vision. Most importantly, "this is a surgical procedure and it can’t be undone," Strelow says. Because of heavy consumer marketing and the ease of recovery, "people have a tendency to treat this like an appointment with their hairdresser. I almost have to accentuate the risks to get them to pay attention."

Lynne Rauschenberger, a 48-year-old sales representative, had the surgery nearly three years ago. While the Virginia Beach resident is glad she had her vision corrected, she’s not 100 percent satisfied. For the first six months, she saw halos around lights at night, and her eyes are still sensitive to bright light. Having her numbed eyes clamped open during surgery left her with a slightly hooded eyelid she corrected with plastic surgery. Despite the side effects, Rauschenberger says the surgery has made her lifestyle more care-free.

The barrage of advertising for laser vision doesn’t usually mention that people nearing age 40 may still need glasses after surgery. Lasers can’t fix presbyopia, and as they age people will need reading glasses unless they have their eyes corrected for monovision. This option uses the laser to make one eye do distance viewing while the other handles reading. "I only do this for people who have tried monovision with contacts," Strelow says. "Only 25 percent of people can adapt to monovision."

Once patients have committed to the surgery, they shouldn’t expect to get it done immediately if they wear contact lenses. Soft lenses must be removed for several days before doctors can take an accurate measurement of the corneas. Hard or gas-permeable lenses have to be out of the eyes for several weeks before the pre-operative workup. Decades of wearing such lenses tends to flatten the corneas. Until the natural shape returns, patients must wear glasses or switch to soft lenses. A rule of thumb is one week out of hard lenses for every two years of having worn them.