Is Lasik Surgery Right for You?

All of the maintenance and hassle of wearing glasses or contacts over the years may have finally gotten on your nerves and left you looking for a better solution. One type of procedure your optometrist may have informed you of is called LASIK. How do you know if LASIK is the right answer for you?

Vision Issues

LASIK works best on eye care patients who are nearsighted or have blurry vision due to an astigmatism, which is an irregular curvature of your eye’s cornea. During the LASIK procedure a small slit is made in the flap that covers the eye, then the cornea is reshaped and the flap repositioned. Nearsighted people see immense improvement because of the way their cornea is shaped due to the nearsightedness. Farsighted patients will experience some improvement but usually not to such an exceptional degree.

Health Status

LASIK is recommended for people who are in average to good health. If you have an existing eye disease, or know that you have a history of poor wound healing or problems with Diabetes, LASIK may not be a fitting solution for you.

Continuous Vision Changes

For most patients, the yearly optometrist exam results in less prescription changes as they get older. When you’ve gone for a few visits without a significant change, that may be the right time for LASIK. If you are still experiencing rapid fluctuations in your vision, you should wait. An optometrist typically will not perform LASIK on someone under 18 as they are still experiencing significant changes.

Expense

Though contacts and glasses are a routine expense that you expect if you have vision issues, they are expenses that occur on a monthly, quarterly, or yearly basis rather than all at once. LASIK can be costly but is not the type of procedure that you’d want done at a bargain basement doctor. Many reputable LASIK doctors will offer financing options, and that is the direction you should investigate rather than deals that seem “cheap.”

Specific Occupations

For a handful of careers, refractive procedures are restricted. For those in a field such as aviation or the military, be very sure that you would be permitted to continue working after a LASIK procedure.

LASIK makes it possible for many patients to wake up with crystal clear vision, without contacts or glasses. If you think LASIK may be a solution for you, talk to your Phoenix optometrist today.

Corneal Inlays and Onlays

Corneal inlays and onlays are small lenses or optical devices that can be inserted into the cornea to alter its shape and correct vision problems.

Though these devices and the surgical procedures associated with them are not yet FDA-approved for use in the United States, they are currently in clinical trials and may soon represent a new form of vision correction surgery.

In LASIK and PRK, vision correction is achieved by removing corneal tissue with a laser to reshape the eye. But with corneal inlays or onlays inserted just beneath the surface of the cornea, laser energy some day could be used to sculpt this artificial material instead of the eye itself, and corneal thickness can be preserved.

Corneal inlays and onlays will work much like contact lenses, but with the advantage of never needing removal or ongoing care. And they differ from currently available intraocular lenses, or IOLs, because they are less invasive and aren’t placed in the interior of the eye (behind the cornea or iris).

And because corneal inlays and onlays don’t require tissue to be removed from the cornea, there may be less risk of ectasia (bulging of the cornea), dry eye and other potential complications of laser vision correction procedures like LASIK and PRK.

The corneal inlay procedure

With corneal inlays, a thin flap is created on the eye’s surface with a laser or a microkeratome. In this regard, the procedure is very similar to the first step of LASIK. The inlay is then positioned in the center of the cornea, and the flap is replaced to hold it in place.

The procedure takes less than 15 minutes and can be performed in the eye surgeon’s office. Sutures are not required, and only topical anesthesia in the form of eye drops is used.

The corneal onlay procedure

Unlike corneal inlays, where a flap is created to place the inlay within the body of the cornea (called the stroma), corneal onlays are positioned under the cornea’s thin outer layer of cells called the epithelium. An instrument is used to create a pocket between the epithelium and the stroma, and the onlay is inserted in this space. The onlay is secure nearly immediately, and within 48 hours, new epithelial cells grow over the surgical wound to seal it completely.

When will these procedures be available in the U.S.?

It’s impossible to predict when corneal inlays and onlays will gain FDA approval for use in the United States. Clinical trials have begun for two corneal inlays designed to correct presbyopia, the age-related condition that results in near vision focusing problems.

For more information on corneal inlays and onlays or presbyopia, visit All About Vision®.

LASIK Risks and Complications

If you are considering LASIK and worried that something could go wrong, you might take comfort in knowing that it’s very rare for complications from this procedure to cause permanent, significant vision loss. Also, many complications can be resolved through laser re-treatment.

Selecting the right eye surgeon probably is the single most important step you can take to decrease any risks associated with LASIK. An experienced, reputable surgeon will make sure you are a good candidate for LASIK before a procedure is recommended. And if problems develop during or after the procedure, the surgeon should work closely with you to resolve them.

How common are LASIK complications?

Public confidence in the LASIK procedure has grown in recent years because of a solid success rate involving millions of successful procedures in the United States. With increasingly sophisticated technology used for the procedure, most LASIK outcomes these days are very favorable.

The U.S. military also has adopted the use of refractive surgery including LASIK to decrease reliance of troops on prescription eyewear. In a study of more than 16,000 U.S. Army personnel who underwent refractive surgery from 2000 through 2003, 86 percent achieved 20/20 or better uncorrected vision and 98 percent achieved 20/40 or better (the legal requirement for driving without glasses in most states).

“Reports of night vision difficulties, LASIK flap dislocation, and dry eye are infrequent, and do not seem to have a significant negative impact on military operations or individual readiness,” researchers who studied these outcomes concluded in the February 2005 issue of Ophthalmology.

LASIK complication rates

Experienced LASIK surgeons report that serious complication rates can be held well below 1 percent if surgical candidates are screened and carefully selected. You may be eliminated as a candidate, for example, if you are pregnant or have certain conditions such as diabetes that may affect how well your eyes heal after LASIK. Discuss any health conditions you have with your eye doctor during your LASIK consultation or pre-operative exam.

Large pupil sizes also might be risk factors for LASIK complications, because pupils in dark conditions could expand beyond the area of the eye that was treated. Again, make sure you discuss any concerns about these or other matters with your eye surgeon.

Other considerations about LASIK risks

While the great majority of LASIK outcomes are favorable, there is still that fraction of less than 1 percent of people who experience sometimes serious and ongoing vision problems following LASIK. No surgical procedure is ever risk-free.

Some LASIK patients with excellent vision based on eye chart testing still can have bothersome side effects. For example, it’s possible a patient may see 20/20 or better with uncorrected vision after LASIK but still experience glare or halos around lights at night.

When you sign the LASIK consent form prior to surgery, you should do so with a full understanding that, even in the best of circumstances, there is a slight chance something unintended could occur. Even so, most – but not all – problems eventually can be resolved.

Common LASIK complications

When LASIK complications occur, they are sometimes associated with the hinged flap that’s created in the cornea (the clear front covering of the eye) in the first step of the LASIK procedure. This flap lifted prior to re-shaping the underlying cornea with a laser, and is then replaced to form a natural bandage.

If the LASIK flap is not made correctly, it may fail to adhere correctly to the eye’s surface. The flap also might be cut too thinly or thickly. After the flap is placed back on the eye’s surface, it might begin to wrinkle. These types of flap complications can lead to an irregularly-shaped eye surface.

Studies indicate that flap complications occur in from 0.3 percent to 5.7 percent of LASIK procedures, according to the April 2006 issue of American Journal of Ophthalmology. But inexperienced surgeons definitely contribute to the higher rates of flap complications. Again, remember that you can improve your odds of avoiding LASIK risks by selecting a reputable, experienced eye surgeon.

Some problems associated with LASIK flap complications include:

Irregular astigmatism can result from a less than smooth corneal surface. Irregular astigmatism also can occur from laser correction that is not centered properly on the eye. Resulting symptoms may include double vision or “ghost images.” In these cases, the eye may need re-treatment (also called an “enhancement”).

Diffuse Lamellar Keratitis (DLK), also nicknamed “Sands of the Sahara,” is inflammation that can occur under the LASIK flap after surgery. In rare cases, DLK leads to corneal scarring. Potentially permanent vision loss can occur without prompt treatment with therapies such as antibiotics and topical steroids. The flap also might need to be lifted and rinsed to remove inflammatory cells and prevent tissue damage.

Ectasia (or keratectasia) is bulging of the cornea that can occur from a flap being cut too deeply, when too much tissue is removed from the cornea during LASIK, or when the cornea was initially weakened as evidenced from cornea topography mapping prior to LASIK. Resulting distorted vision likely cannot be corrected with laser enhancement, and rigid contact lenses or corneal implants (Intacs) may be prescribed to hold the cornea in place.

Other, more commonly reported LASIK complications include:

  • Dry Eye: Almost half of all patients report problems with dry eye in the first six months following LASIK, according to the April 2006 issue of American Journal of Ophthalmology. These complaints appear related to reduced sensitivity of the eye’s surface immediately following the procedure. If you have this problem, temporary remedies such as artificial tears or prescription dry eye medication may be needed along with oral flaxseed oil capsules. After about six months to a year, however, most of these types of complaints disappear when healing of the eye is complete. People who already have severe dry eye usually are eliminated as LASIK candidates.
  • Significant Undercorrection, Overcorrection, or Regression: An overcorrection or undercorrection of your vision problem means your vision may remain slightly blurred from residual nearsightedness, farsightedness or astigmatism. Regression is when your eyesight is optimal at first after LASIK, but then begins to deteriorate over time (due to a return of some nearsightedness, for example). These problems can usually be corrected with an enhancement LASIK procedure.
  • Eye Infection or Irritation: In some rare cases, you may develop an eye infection, inflammation, or irritation that requires treatment with eye drops containing antibiotics or anti-inflammatory medication such as steroids.

Vision changes unrelated to LASIK

If you have LASIK in your 20s or 30s, be aware that your reading vision will change as you get older. This has nothing to do with your LASIK surgery – it’s caused by a normal age-related loss of focusing ability called presbyopia. Because of presbyopia, most LASIK patients (like anyone else who sees well without glasses in younger years) will need reading glasses after age 40.

 

 

What is LASIK Surgery?

LASIK

LASIK, short for laser-assisted in situ keratomileusis, is the most popular refractive surgery available today. Each year, more than one million LASIK procedures are performed in the United States.

LASIK has become the premier surgery for vision correction because it’s quick and painless, there is little or no discomfort after the procedure and vision recovery is rapid – some patients already see 20/20 the following day.

LASIK can correct nearsightedness, farsightedness and astigmatism. With a special technique called monovision, it can also reduce the need for reading glasses among patients over age 40 who wear bifocals.

Am I a good candidate for LASIK?

To be a good candidate for LASIK, you should be at least 18 years old, have healthy eyes, and have adequate corneal thickness since LASIK corrects your vision by removing tissue from your cornea to reshape your eye.

Chronic dry eye problems, corneal diseases and other abnormalities may disqualify you from having LASIK surgery. In order to know for sure if you are a good candidate, a comprehensive eye exam is required. For your convenience, we are happy to provide LASIK pre-operative exams and consultations at our office. Call us for details.

Important considerations when deciding whether or not to have LASIK are your expectations and your ability to accept a less-than-perfect outcome. LASIK can reduce your dependence on glasses and almost always gives you the ability to function well without the need for glasses or contact lenses. But there are no guarantees, and LASIK doesn’t always create perfect vision. In some cases, your vision after LASIK may be permanently less clear than it was with glasses before the procedure. You have to ask yourself if you’re willing to accept the risk of such an outcome before you decide to have LASIK surgery.

Remember: LASIK is an elective procedure, not a required one.

The LASIK procedure

LASIK is an ambulatory procedure. You walk in the surgery center, have the procedure and walk out again. The actual surgery usually takes less than 15 minutes for both eyes, but expect to be at the surgery center for an hour or more.

LASIK is a two-step procedure. In the first step, the surgeon creates a thin, hinged flap of tissue on your cornea with an instrument called a microkeratome or with a laser. This flap is folded back and the second step – the laser reshaping of your eye – begins. After the laser treatment, which usually takes less than a minute, the flap is repositioned and the surgeon moves on to your other eye.

After LASIK surgery

After the procedure, your surgeon or an assistant will apply medicated eye drops and clear protective shields over your eyes. You can open your eyes and see well enough to walk without glasses, but you must have someone drive you home.

You will be expected to use medicated eye drops several times a day for a week or so to protect your eyes from infection and help them heal properly. You will also be told to use artificial tears frequently to keep your eyes moist and comfortable.

You should rest and not use your eyes much when you get home from surgery that day. You may also be more comfortable if the lights in your house are dimmed.

The following day, you should be seeing well enough to drive and can resume most activities. Be careful, however, not to rub your eyes until your eye doctor tells you it is safe to do so.

Usually, you will be asked to return to the surgery center the following day so your surgeon or another eye doctor at the center can check your vision and make sure your eyes appear as they should. At this visit, you typically will be given additional instructions about using eye drops and artificial tears, and you will be able to ask the doctor any questions you have.

From this point forward (and sometimes for this “day one” visit as well), your post-operative care may be performed by an eye doctor other than your LASIK surgeon. When your post-operative care is provided by a doctor other than your surgeon or another doctor at the surgery center, it’s called co-management. We are happy to provide post-operative care for you at our office through a co-management agreement with your surgeon. Call our office for details.

What if my vision is still blurry after LASIK?

Though most patients see quite clearly in a matter of days after LASIK, it can take several months before your eyes are completely stable. Until then, improvements in your vision can still occur. But if several months pass and your vision is still blurred, see your LASIK surgeon. Usually a second LASIK surgery (called an enhancement) can sharpen your eyesight further.