Fleming performs no more than one or two dozen LASIK surgeries a year and personally screens patients and does the follow-up care. As a result, his patients rarely have complications, he said.

"When you're high-volume and relinquish part of the care to nonphysicians," Fleming said, "you don't have time to be thorough. That can lead to problems."

Few complaints become lawsuits, said Bill Faison, a well-known medical malpractice lawyer in Durham, N.C., who has represented one LASIK patient in court in the past three years.

What foils most attempts to sue for damages, Faison said, are the costs to mount a legal challenge. Also, carefully worded patient consent forms spell out the risks of the surgery and often require patients to first try to work out their differences with the LASIK center.

"Short of the [LASIK surgeon] being stupid, if it's just a bad outcome, there's nothing to recover," Faison said.

The procedure is safe and effective for many, said Dr. Brad Randleman, a laser eye surgeon at Emory University in Atlanta who has done LASIK on about 1,000 patients over five years.

Post-surgical complications such as dry eyes and vision distortions often subside after a few weeks.

"I had nothing but a great experience," said Jim Branch, 55, a Raleigh real-estate developer who had LASIK at Duke about five years ago.

Medical research has found that cutting the cornea permanently weakens it. The severed nerves need years to recover and may misfire pain signals. But those findings have not been conclusively linked to lingering complications from LASIK, said Dr. William Bourne, an ophthalmology professor and LASIK surgeon at the Mayo Clinic in Rochester, Minn.

"I don't think we've proven what it is," Bourne said.

A better understanding of what causes the complications is essential to better screen patients before surgery and eliminate those at risk, he said.