Laser In-Situ Keratomileusis (LASIK)

LASIK is laser surgery to correct nearsightedness with or without astigmatism. The surgery is similar to PRK, but does not treat or alter the front surface of the cornea. The doctor uses an instrument called a microkeratome to create a circular flap of corneal tissue. The flap is then lifted from the cornea while the doctor uses the excimer laser to remove small amounts of underlying tissue from the exposed cornea. The corneal flap is then repositioned and the eye is covered with an eye patch.

AFTER THE LASIK PROCEDURE

As soon as the anaesthetic wears off your eyes will be sore, watery, and light sensitive. This phase of the healing lasts for 6 to 8 hours until the surface layer at the edge of the flap heals. During this time it is recommended that you take your eye drops and if possible, sleep wearing your shields.· The next day your eyes will still be blurry and light sensitive. It is typical to be able to return to most of your normal activities from 3 - 7 days. You may experience a fluctuation in your vision from morning to evening, and you can also expect to see halos around lights at night. This is caused by normal postoperative swelling (edema). This is a normal part of the healing process and may take several weeks to resolve. Some patients note that even though they see 20/20, it may not be as sharp or well defined as before. This is caused by a small loss of contrast and is regarded as a minor tradeoff for acceptable vision without glasses.

Ask your surgeon the following questions:

How long have you been doing Lasik surgery?

How much experience do you have with the Lasik procedure?

How do you define success?

What's your success rate?

What is the chance for me (with my correction) to achieve 20/20?

How many of your patients have achieved 20/20 or 20/40 vision?

How many patients return for enhancements?
In general 5-15% return.

What laser will you be using for my surgery?

Make sure your surgeon is using a laser approved by the U.S. Food and Drug Administration (FDA). As of this publication's printing, the FDA has approved five lasers for Lasik; they are manufactured by VISX, Summit, Bausch and Lomb, Nidek and ATC. Contact the FDA for updates.

What's involved in after-surgery care?

Who will handle after-surgery care? Who will be responsible?

What about risks and possible complications?

Risks and Possible Complications

Before the surgery, your surgeon should explain to you the risks and possible complications, and potential side effects, including the pros and cons of having one or both eyes done on the same day. This is the "informed consent" process. Some risks and possible complications include:

Over- or under-correction. These problems can often be improved with glasses, contact lenses and enhancements.

Corneal scarring, irregular astigmatism (permanent warping of the cornea), and an inability to wear contact lenses.

Corneal infection.

"Loss of best corrected visual acuity" - that is, you would not be able to see as well after surgery, even with glasses or contacts, as you did with glasses or contacts before surgery.

A decrease in contrast sensitivity, "crispness," or sharpness. That means that even though you may have 20/20 vision, objects may appear fuzzy or grayish.

Problems with night driving that may require glasses.

Flap problems, including: irregular flaps, incomplete flaps, flaps cut off entirely, and ingrowth of cells under the flap.
The following side effects are possible, but usually disappear over time. In rare situations, they may be permanent.
Discomfort or pain
Hazy or blurry vision
Scratchiness
Dryness
Glare
Haloes or starbursts around lights
Light sensitivity
Small pink or red patches on the white of the eye
Surgery: What to Expect Before, During and After
Before
You'll need a complete eye examination by your refractive 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 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.
The 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 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 surgery, your doctor may tell you to stop wearing your contact lenses for a while 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 treatment or increase the risk of infection after surgery.

During
Lasik is an outpatient surgical procedure. The only anesthetic is an eye drop that numbs the surface of the eye. The surgery takes 10 to15 minutes for each eye. Sometimes, both eyes are done during the same procedure; but sometimes, surgeons wait to see the result of the first eye before doing the second eye.

The Surgical Procedure: A special device cuts a hinged flap of thin corneal tissue off the outer layer of the eyeball (cornea) and the flap is lifted out of the way. 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 clear plastic or perforated metal - is placed over the eye to protect the flap.

After
Healing is relatively fast, but you may want to take a few days off after the surgery. Be aware that:

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.
Alternatives to Lasik
You may want to discuss some surgical alternatives to Lasik with your eye doctor:

Photorefractive keratectomy (PRK) is a laser procedure used to reduce myopia, hyperopia and astigmatism without creating a corneal flap.

Astigmatic keratotomy (AK) is an incisional procedure to reduce astigmatism.

Intrastromal corneal rings are clear, thin, polymer inlays placed on the eye to correct low myopia only.
For More Information
For more information about vision correction procedures, contact:

American Academy of Ophthalmology, P.O. Box 7424, San Francisco, CA 94120-7424.

The AAO works to advance the lifelong learning and professional interests of ophthalmologists to ensure that the public can obtain the best possible eye care.

American Society of Cataract and Refractive Surgery, 4000 Legato Road, Suite 850, Fairfax, VA 22033.

The ASCRS works to raise the standards and skills of anterior segment surgeons through clinical and practice management education. The Society also works with patients, government and the medical community to promote delivery of quality eye care.

International Society of Refractive Surgery, 1180 Springs Centre So. Blvd. #116, Altamonte Springs, FL.

The ISRS provides scientific research, knowledge and information to all individuals who are interested in refractive surgery.

National Eye Institute, 31 Center Drive MSC 2510, Bethesda, MD 20892-2510; 301-496-5248

The NEI conducts and supports research on eye diseases and vision disorders, and offers free publications for the general public and patients.

Food and Drug Administration, 5600 Fishers Lane (HFE-88), Rockville, MD 20852; 1-888-463-6332; (301) 827-4420.

The FDA oversees the safety of food, cosmetics, medicines, medical devices, and radiation-emitting products and provides information on contact lenses, intraocular lenses, refractive surgery, and corneal implants for myopia.

Federal Trade Commission, Consumer Response Center, 600 Pennsylvania Avenue, NW, Washington, DC 20580; 1-877-FTC-HELP (382-4357).

The FTC enforces federal antitrust and consumer protection laws and works to eliminate unfair or deceptive acts and practices in the marketplace. The FTC publishes brochures on your rights when you're buying eyeglasses and contact lenses and making decisions about vision correction procedures.