Are You Interested in LASIK Eye Surgery?

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LASIK

What is LASIK?

LASIK stands for Laser-Assisted In Situ Keratomileusis. It is a form of laser vision surgery that can correct nearsightedness, farsightedness, and astigmatism. During LASIK, a small flap is made in the outer layer of the eye’s cornea to allow access to the underlying tissue. Then, the surgeon reshapes the inner corneal tissue with a special laser. The flap is laid back into place where it heals on its own.

Who is a LASIK candidate?

The best candidates for LASIK are people who strongly desire to rid themselves of glasses or contacts. Any patient who is seriously considering LASIK should be comfortable with all aspects of the procedure, especially the permanence of the results.

The LASIK surgeon conducts a thorough examination to determine if the patient is physically qualified for LASIK. Among the most important factors are the patient’s refractive error as well as the size and shape of the cornea. The LASIK specialist should perform a corneal topography to make sure that the patient’s cornea is of substantial thickness for LASIK. In addition, patients should make sure that the refractive surgeon performs a test to measure how much their pupils dilate in the dark. Pupils that expand to greater than 7-8 mm are susceptible to permanent haloes or glare after LASIK.

The following is a list of risk factors that may render a prospective patient unsuitable for LASIK:

Youth (the eyes may not be completely developed)
Recent pregnancy or anticipated pregnancy
Use of certain medications
Unstable vision
Severe dry eye
Chronic ocular infections
Amblyopia (“lazy eye”)
Keratoconus (“conical cornea”)
Glaucoma
Connective tissue disorders
A history of excessive scarring
Immune system problems

How is LASIK surgery performed?

Before going to have LASIK performed, the patient meets with the LASIK specialist for an initial evaluation. It is important that the patient avoid wearing his or her contacts for a few weeks in advance of the evaluation; this helps the eye surgeon accurately measure the eyes. The surgeon will explain the procedure and may recommend preparatory steps to the patient. These may include discontinuing the use of facial products and regularly scrubbing the eyelashes. Any foreign objects on the lashes or around the eyes can cause infection to the surgically-exposed regions of the eye.

To begin the procedure, the patient is asked to lie in a reclining chair. The LASIK surgeon cleans the eyes and places anesthetic eye drops in them. The drops ensure that the patient feels almost nothing during LASIK surgery, but particularly anxious patients may require a sedative as well. A device called a lid speculum is placed over the eyes to hold open the lids. The surgeon then marks the cornea with water-soluble ink as a guide during surgery. The surgeon checks the pressure in the eye, and then applies a suction ring to the cornea to stabilize the eye’s position. The patient usually senses a small increase in pressure due to the suction; however, any discomfort from the suction device is usually mild and short-lived.

Next, the LASIK surgeon connects a cutting tool called a microkeratome to the suction device. The microkeratome slices a thin layer of the cornea into a flap, which is folded over to the side. The suction ring and microkeratome are removed and the corneal tissue underneath is dried. The patient can see, but vision may blur intermittently.

Finally, the excimer laser is positioned over the eye. The surgeon turns on a small light and asks the patient to focus on it. Focusing on this light steadies the patient’s eye during ablation. Once the surgeon is convinced that the patient is ready to begin, the excimer laser is turned on. The laser is programmed ahead of time to remove tissue according to the patient’s specifications. Tissue is usually removed from either the center or the periphery of the cornea depending on whether the patient is myopic or hyperopic. During this portion of the procedure, the patient may smell the burning tissue and hear the sound of the laser ticking. The entire reshaping of the cornea takes about 60 seconds. Once it is complete, the flap is pushed back over into its original position. The doctor monitors the patient for about five minutes. Eye tissue bonds quickly, so sutures are rarely necessary. A plastic shield is placed over the eye to keep the flap in place.

What is recovery like?

There may be some uncomfortable effects from LASIK surgery. Most of them are ordinary, and should subside relatively quickly. Some examples are:

Mild pain
Burning
Itching
The sensation that the eye has something in it
Bloodshot eyes
Hazy or blurry vision
Sensitivity to light
Increased glare
Rainbow-colored “haloes” or starbursts from light

The LASIK surgeon typically asks the patient to return 24-48 hours after the procedure. The eye shield is removed at this time, and the patient may be given eye drops. The surgeon typically tells the patient not to wear makeup or apply anything to the skin around the eyes for the next few weeks. Strenuous activities should be avoided for at least four weeks.

The LASIK patient’s vision may take three to six months to stabilize. During this time, the patient may still experience effects such as diminished night vision, haloes, and starbursts. These effects eventually subside in most patients, although in some cases they are permanent.

Possible Risks and Complications from LASIK

Complications from LASIK surgery are rare, but they do occur. These may include under- or overcorrection of the eyes, temporary problems that become permanent, corneal flap problems, or decentered ablations.

Depending on how the eyes heal, the patient’s vision may end up being undercorrected or overcorrected. A second procedure may be necessary to readjust the cornea.

Problems that are usually temporary can sometimes manifest themselves on a permanent basis. These include decreased night vision, decreased contrast sensitivity, haloes, and starbursts. In addition, dry eyes can persist for extended lengths of time.

Occasionally, the surgeon may have trouble creating the corneal flap. A flap that is too thin or not large enough in diameter can make ablation with the laser impossible. Typically, the surgery is stopped, the patient is given time to heal, and the surgery is rescheduled with no further complications.

After surgery, the flap in the cornea can develop striae, or wrinkles. If the wrinkles are in the center of the flap, they may cause discomfort or blurry vision. If this is the case, the LASIK surgeon can reseat the flap into a more comfortable position. The flap is lifted, cleaned of any debris, and carefully laid back into place. If the LASIK surgeon feels it is necessary, sutures may be used to hold the flap in place.

The cornea underneath the flap can suffer from inflammation, called keratitis. This is usually treated using eyedrops or antibiotics. Patients are advised to report any irritation early, however, as serious cases can cause permanent damage to the eye.

A decentered ablation from the excimer laser can also occur during surgery. This is very rare but also quite serious. It can induce astigmatism, which is sometimes difficult to treat.

If you are interested in LASIK surgery, you may want to contact a LASIK surgeon for more information.

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