LASIK or laser-assisted in situ keratomileusis is a refractive surgery that is used to correct myopia (nearsightedness), hyperopia (farsightedness), and astigmatism as an alternative to eyeglasses or contact lenses. LASIK is currently the most common of the refractive eye surgeries, largely because of the relatively low risk and the quick recovery and improvement in eyesight.
Also known as laser eye surgery or laser vision correction, LASIK uses a laser to reshape the cornea which is responsible for clear vision. The procedure is quick and relatively painless and eyesight is usually improved to 20/20 vision within one day of the surgery.
HOW DOES LASIK WORK?
LASIK is an outpatient procedure, which takes about 15 minutes for the actual surgery on both eyes and an hour total with recovery. A topical anesthetic drop is used and there is no need for bandaging or stitches following the procedure. The doctor will start by stabilizing the eye and then making a small flap in the outer layer of the cornea. Then with access to the underlying tissue, he uses a laser to reshape the corneal tissue and re-closes the flap, which will heal on its own. The nature of the corneal reshaping depends on the type of refractive error.
WAVEFRONT LASIK
Wavefront LASIK uses computer mapping technology to guide the laser treatment based on the precise shape of the cornea. This can correct very precise issues, provide much sharper vision than non-wavefront LASIK, and can reduce complications such as halos, glare, and problems seeing at night.
WHAT TO EXPECT DURING AND AFTER LASIK
During the procedure, you may feel some pressure on your eye while the laser is working. Immediately following you will likely experience some blurriness and may feel burning or itching (be sure not to rub your eyes!). For your journey home you will be given protective shields to guard your eyes and will need someone to drive you. You will also be prescribed medicated eye drops for a week or so to aid in healing and prevent infection. Your doctor may also recommend artificial tears to moisten the eyes and keep them comfortable in the days following the procedure.
The day after the surgery you will be asked to visit your eye doctor (or the surgeon) for a checkup and to evaluate whether you are able to drive. Most people experience an improvement in vision by then, although for some it can take a few days or even a week. Your eyes may be sensitive to light for a day or two as well. You will likely be advised to rest for a day or two and to refrain from strenuous physical activity for about a week until further healing has taken place.
Most people achieve at least 20/20 vision following the surgery, although this can vary and there are cases where 20/40 vision is obtained or where people continue to wear glasses or contacts with a much lesser prescription. Some patients have light sensitivity, particularly when driving at night, also suffering from seeing halos around lights or glare. There are glasses and lenses available to reduce this glare and assist with night driving.
For some, it can take weeks or even months until the vision completely stabilizes. Occasionally, after a few months, patients who do not experience perfect results will schedule an enhancement or touch-up surgery to correct the vision even further.
AM I A CANDIDATE FOR LASIK?
The ideal LASIK candidate is a patient over 18 with generally healthy eyes. Since the procedure involves shaping the cornea by removing some of the tissue, it is not ideal for individuals with a thin cornea or any sort of corneal condition or disease. Patients with chronic dry eyes might also be disqualified as LASIK can often exacerbate these symptoms.
During a comprehensive eye exam, your eye doctor will assess your eligibility by looking at the general health of your eye including your cornea, your pupil, the moisture in your eye, the type of refractive error you have, and whether you have any other eye conditions of concern.
For the right candidate, LASIK can offer a lifestyle improvement in giving clear vision without the need for glasses or contact lenses, however, the results are not guaranteed. You and your eye doctor need to weigh the benefits and the potential risks based on your personal needs.
LASIK RISKS AND COMPLICATIONS
LASIK is the most common refractive eye surgery, partially due to the fact that the risks and complications are low. The majority of patients don’t experience any long-term complications as a result of the surgery. Nevertheless, as with any surgical procedure, there are some risks, however rare they are and it is important to know them and to discuss them with your eye doctor or surgeon prior to undergoing the surgery.
SIDE EFFECTS OF LASIK
There are a number of side effects that are somewhat common immediately post-op and in some instances can last longer – sometimes indefinitely. Those include:
Dry Eyes: About half of LASIK patients experience dry eyes, which are usually a temporary side effect that resolves within 3-6 months after the surgery. Your doctor will likely prescribe artificial tears in the days and weeks following the surgery which should be continued as long as the symptoms persist. Because of this, it is usually recommended that patients with a history of chronic dry eyes opt for another type of refractive surgery such as PRK, another style of laser refractive surgery with reduced risk.
Eye Infection or Irritation: While not common due to the eye drops and checkups prescribed post surgery, there is a chance of developing an eye infection. If this does occur, it can be treated with antibiotic eye drops, anti-inflammatories, or sometimes may require other treatment such as oral antibiotics. If you are experiencing symptoms of an eye infection such as redness, pain, discomfort, discharge, or any change in vision, see your eye doctor immediately. As a precaution, it is imperative to follow your surgeon’s instructions for your post-operative care including prescription medications and doctor’s visits.
Vision Issues: Following surgery, you may experience certain vision issues such as poor night vision, double vision, halos around lights, or glare. These side effects are common and can last up to a few weeks, but typically go away. Some patients report a lasting reduction in vision in low light conditions and may require vision aids for seeing better at night.
OTHER RISKS OF LASIK INCLUDE SURGICAL ERRORS, MANY OF WHICH CAN BE CORRECTED BY A FOLLOW-UP SURGERY. THESE INCLUDE:
Overcorrection or Undercorrection: The key to vision improvement in LASIK is the accurate reshaping of the corneal tissue. If too much is removed or not enough is removed, your vision will remain imperfect and when possible may require a follow-up procedure to obtain the clear vision being sought.
Flap Complications: Perhaps the greatest risk involved in LASIK is the accurate creation and healing of the flap of the cornea that is lifted to reshape the underlying tissue and replaced after. If the flap in the cornea is not made accurately, cut too thick or too thin and not carefully replaced back on the eye, it can cause complications in the shape of the eye surface and therefore clear vision. Studies indicate that these complications occur usually in under 6% of cases and the experience and skill of the surgeon play a large role.
There can also be complications in the healing process of the flap which include infection or excessive eye tearing.
Vision Loss: There is a chance, albeit small that the surgery can result in a loss of vision or reduction in visual clarity due to complications with the surgery.
It is quite rare for any permanent damage or vision loss to occur as a result of LASIK and usually any vision problems can be corrected by a follow-up procedure. However, as with any surgical procedure, there are risks, so it is important to reduce your risks by finding an experienced surgeon and carefully considering your suitability for the surgery in the first place.
LASIK: HOW TO MEASURE SUCCESS OR APPLICABILITY
Is laser eye surgery for everyone?
BELOW ARE SOME GUIDELINES TO HELP YOU DECIDE IF LASIK IS A GOOD CHOICE FOR YOU:
Vision stability: Young adults often experience annual changes in their prescription for eyeglasses or contact lenses. A 12-month period of maintaining the same prescription is highly recommended prior to LASIK. Otherwise, there is a considerable risk of requiring repeated LASIK surgery in the future.
Healthy Eyes: Problems, diseases or conditions related to your eyes could cause increased risks to both the actual surgery and the healing process. If you have a condition that can be treated such as dry eyes, pink eye (conjunctivitis) or any eye injury speak to your doctor. It is probably best to wait until the condition is resolved to schedule your LASIK surgery. Conditions like cataracts, glaucoma, and other more serious conditions may disqualify you from LASIK altogether.
Age: 18 is the minimum age of consent for LASIK. Younger patients may be able to get special exemptions based on certain circumstances.
Vision prescription range: A very high degree of myopia may require the removal of too much corneal tissue. This may exclude your candidacy for LASIK or make another refractive surgery a better option. For example, many surgeons conclude that a phakic IOL procedure provides better results and possesses less risk than LASIK for nearsighted prescriptions higher than -9.00 diopters.
Pregnancy: Normal hormonal changes of pregnancy may cause swelling of the cornea which can alter vision. Dry eye is also common during pregnancy. Additionally, medications (antibiotics or steroids) that are administered for LASIK could cause risk to the embryo or nursing infant. It is recommended to delay LASIK for several months after childbirth until the eyes stabilize and risks are reduced.
Systemic and autoimmune diseases such as rheumatoid arthritis, type 1 diabetes, HIV, or AIDS may disqualify or delay candidacy for LASIK. If your body has trouble healing, your cornea may not heal properly after LASIK surgery. Opinions vary among professionals as far as which diseases automatically disqualify and which ones pose acceptable risks. Discuss this in-depth with your doctor if applicable.
