About LASIK

If you’re tired of wearing glasses or contact lenses, you may want to consider Lasik eye surgery. Lasik is one of the newest procedures to correct vision problems. Before you opt for lasik surgery, discuss with us to get a clear picture of what you can expect.

What is LASIK?

LASIK is the most commonly performed refractive surgery procedure. You may hear people calling it “LASIX,” but the name is actually short for “laser-assisted in situ keratomileusis.”

LASIK has advantages over other procedures, including a relative lack of pain afterward and the fact that good vision is usually achieved by the very next day.

Both nearsighted and farsighted people can benefit from the LASIK procedure. With nearsighted people, the goal is to flatten the too-steep cornea; with farsighted people, a steeper cornea is desired. While this is not widely recognized by consumers, excimer lasers also can correct astigmatism by smoothing an irregular cornea into a more normal shape.

About The Eyes

To see clearly, the cornea and the lens must bend, or refract, light beams so they focus on the retina. The retina is a layer of light-sensing cells that line the back of the eye. The retina converts the light rays into impulses that are sent to the brain, where they are recognized as images.

If the light rays don’t focus on the retina, the image you see is blurry. This is called a “refractive error”. Glasses, contacts and refractive eye surgery attempt to reduce these errors by making light rays focus on the retina.
Refractive errors are caused by an imperfectly shaped eyeball, cornea or lens, and are of four basic types;

• Myopia – nearsightedness – only nearby objects are clear.
• Hyperopia – farsightedness – only objects far away are clear.
• Astigmatism – images are blurred at a distance and near.
• Presbyopia – also known as aging eye. This condition usually occurs between ages 40 and 50, and can be corrected with bifocals or reading glasses.

LASIK Is Not For Everyone

• You should be at least 18 years old (21 for some lasers), since the vision of people younger than 18 usually continues to change due to physical immaturity.
• You should not be pregnant or nursing as these conditions might change the measured refraction of the eye.
• You should not be taking certain prescription drugs, such as Accutane or oral prednisone.
• Your eyes must be healthy. If you’re myopic, you should postpone Lasik until your refraction has stabilized, as myopia may continue to increase in some
• Patients until their mid- to late 20s.
• You should be in good general health.

LASIK may not be recommended for patients with diabetes, rheumatoid arthritis, lupus, glaucoma, herpes infections of the eye, or cataracts. You should discuss this with your eye surgeon.

Weigh the risks and rewards

If you’re happy wearing contacts or glasses, you may want to forego the surgery.

Understand your expectations from the surgery. Ask your doctor if you’re a candidate for monovision, the correction of one eye for distance vision and the other eye for near vision. Lasik cannot correct presbyopia so that one eye can see at both distance and near. Lasik can be used to correct one eye for distance and the other for near. If you can adjust to this correction, it may eliminate or reduce your need for reading glasses. In some instances, surgery on only one eye is required. If your doctor thinks you’re a candidate, ask about the pros and cons.

LASIK Eye Surgery: What to Expect Before, During and After

Before Your LASIK Surgery

You will need a complete eye examination by your eye surgeon. A preliminary eye exam may be performed by a referring doctor (Eye MD or optometrist). Take your eye prescription records with you to the exams.

Your eye doctor should:

• Dilate your pupils to fine-tune your prescription.
• Examine your eyes to make sure they’re healthy. This includes a glaucoma test and a retina exam.
• Take the following measurements; The curvature of your cornea and your pupils. You may be rejected if your pupils are too large.
• Asertain topography of your eyes to make sure you don’t have an irregular astigmatism or a cone-shaped cornea – a condition called Keratoconus. The pachymetry, or thickness, of your cornea.

You need to have enough tissue left after your corneas have been cut and reshaped. Ask you to sign an informed consent form after a thorough discussion of the risks, benefits, alternative options and possible complications. Review the form carefully. Don’t sign it until you understand everything in the form.

If your doctor doesn’t think LASIK is right for you, you might consider getting a second opinion. However, if the opinion is the same, believe it. If you qualify for LASIK  eye surgery, your doctor may tell you to stop wearing your contact lenses for a period of time before the surgery is scheduled because contacts can temporarily change the shape of the cornea. Your cornea should be in its natural shape the day of surgery. Your doctor also may tell you to stop wearing makeup, lotions or perfume for a few days before surgery. These products can interfere with the laser eye treatment or increase the risk of infection after surgery.

During Surgery

LASIK is an outpatient surgical procedure. The only anesthetic usually needed is an eye drop that numbs the surface of the eye. The surgery takes 10 to 15 minutes for each eye. Sometimes, both eyes are done during the same procedure. Sometimes surgeons wait to see the result of the first eye before doing the second eye.

The Surgical Procedure

• An instrument called a microkeratome is used in LASIK eye surgery to create a thin, circular flap in the cornea.
• The surgeon folds the flap back out of the way, then removes some corneal tissue underneath using an excimer laser. The excimer laser uses a cool ultraviolet light beam to precisely remove (“ablate”) very tiny bits of tissue from the cornea to reshape it.
• When the cornea is reshaped in the right way, it works better to focus light into the eye and onto the retina, providing clearer vision than before. The flap is then laid back in place, covering the area where the corneal tissue was removed.
• The laser reshapes the underlying corneal tissue, and the surgeon replaces the flap, which quickly adheres to the eyeball. There are no stitches. A shield, either plastic or perforated metal, is placed over the eye to protect the flap. LASIK is an ambulatory procedure; you walk into the surgery center, have the procedure and walk out again. In fact, the actual surgery usually takes less than five minutes, and you’re awake the whole time.
• Occasionally, the surgeon will give a mild oral sedative beforehand.
  Even though the procedure is relatively quick, this does not minimize the importance of having it performed by a highly skilled surgeon with proper equipment because LASIK is a very delicate procedure. You also should have someone accompany you to drive you back home afterward.
• Most people don’t feel pain during LASIK surgery. Your eyes are first anesthetized with special drops.
• The doctor will have you lie down, then make sure your eye is positioned directly under the laser. (One eye is operated on at a time.) A kind of retainer is placed over your eye to keep your eyelids open – normally, this is not uncomfortable. It has a suction ring that keeps your eye pressurized, which is important in LASIK for allowing the surgeon to cut the corneal flap.
• The surgeon will use an ink marker to mark the cornea before the flap is created. The flap is then created with either a microkeratome or with a laser, depending on the surgeon’s preference. During the procedure you won’t actually see the creation of the flap, which is very thin.

Surgery Prices

• An ultra-thin flap is created on the eye’s surface during LASIK corrective eye surgery. After laser energy is applied to reshape the eye, the flap is replaced to serve as a type of natural bandage.
• The doctor uses a computer to adjust the laser for your particular prescription. You will be asked to look at a target light for a short time while he or she watches your eye through a microscope while the laser sends pulses of light to your cornea.
• The laser light pulses will then painlessly reshape the cornea. You’ll hear a steady clicking sound as the laser is operating. You’re also likely to smell a mildly acrid odor due to the tissue removal. The higher your prescription, the more time the surgery will take. The surgeon has full control of the laser and can turn it off at any time.
• After the procedure is finished, you will rest for a little while. If you’re having both eyes done the same day, the surgeon will probably do the other eye after a short period of time. Some people choose to have their second eye done a week later.
• The doctor may prescribe medication for any postoperative pain, but many people feel no more than mild discomfort after LASIK. That’s one advantage over PRK, which can be quite painful afterward. After Surgery

Healing

• Healing is relatively fast, but you may want to take a few days off after the surgery.
• Be aware You may experience a mild burning or sensation for a few hours after surgery.
• Do not rub your eye(s). . Your doctor can prescribe a painkiller, if necessary, to ease the discomfort.  Your vision probably will be blurry the day of surgery, but it will improve considerably by the next day when you return for a follow-up exam.
• If you experience aggravating or unusual side effects, report them to your doctor immediately. Do not drive until your vision has improved enough to safely do so. Avoid swimming, hot tubs and whirlpools for two weeks after surgery.

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After LASIK: Short-Term

As with any kind of surgery, it’s important that you follow your doctor’s instructions to the letter. Get proper rest, fill and use any necessary prescriptions and call your doctor immediately if you suspect a problem. What occurs after the surgery can affect your vision just as much as the surgery itself.

Immediately after LASIK, the doctor will have you rest for a bit, then you can go home (someone else must drive). At home, you should relax for at least a few hours.

You may be able to go to work the next day, but many doctors advise a couple of days of rest instead. They also recommend no strenuous exercise for up to a week, since this can traumatize the eye and affect healing.

Avoid rubbing your eye, as there is a chance (though slim) of dislodging the corneal flap.

After LASIK: Longer Term

• With LASIK surgery, most people’s vision improves right away, but some find that their vision gradually improves even more over the next few days or even weeks.
• Most people achieve 20/20 or better vision with LASIK. Some may achieve only 20/40 or not quite as good. In fact, 20/40 is fairly good vision. In most states, the law considers it good enough for driving.
• Some patients may still need glasses or contact lenses following laser vision correction, though their prescription level typically will be much lower than before.
• Postoperative complications can include infection or night glare (starbursts or halos that are most noticeable when you’re viewing lights at night, such as while you’re driving). Rarely, people will experience improvement, then notice a gradual worsening of vision (called “regression”). If this happens, discuss it with your surgeon to determine if more surgery (called an enhancement or “touch-up”) will be necessary.
• Even if you see perfectly after laser eye surgery, you may still need reading glasses or bifocal contact lenses once you hit your 40s. This is because of a condition called presbyopia, which begins to develop in most people when they’re between the ages of 38 and 42. Your distance vision will probably remain crisp, but seeing up close will be more difficult. However, researchers are studying ways to correct presbyopia surgically. So it’s possible that you could have one of those procedures later, once they are FDA-approved.

All of these are important topics to discuss with your surgeon before deciding on the surgery.

REMEMBER

If you are considering LASIK eye surgery, your first step is to choose a good surgeon. In order to decide whether you’re a good candidate for LASIK, your eye doctor will examine your eyes to determine their health, what kind of vision correction you need, and how much laser ablation is required.

Your doctor will also look for signs of dry eye disease, which must be treated and cleared up before LASIK can be performed.

Finally, the doctor will find out from you any health problems you have or medications you take. Some health conditions will disqualify you altogether for LASIK, but others may just postpone the procedure until a later date.

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