All about LASIK Eye Surgery

Here is a really good summary about the entire LASIK process. I got this from my doctor. It really puts it all together...

Your Eyes

The cornea is the outer layer of your eye. It acts like a lens, focusing light and controlling how clearly you see. If your cornea is too flat, too curved, or uneven in places, what you see may be out of focus.

The length of your eye from front to back also affects how clearly you see. The shape of the cornea and the length of your eye determines whether you're nearsighted, farsighted, or have astigmatism.

Light passes through the cornea and hits the back of your eye (called the retina). Your retina is made up of a bunch of nerve cells that gather information about what you see, and then sends that information to your brain for processing.

In an eye with good vision, light enters the cornea and is focused on a single point on the retina. This allows what you see to be clear. But when light isn't focused on a single point, you'll have blurry vision.

Your Vision

How does LASIK work?

You can’t change the length of your eye, but you can change the shape of your cornea. And that’s what LASIK does. LASIK reshapes the cornea to help correct vision.

There are 3 types of vision problems that can benefit from LASIK.

• In a nearsighted eye: LASIK flattens the cornea so light can focus to a sharp point on the retina.
• In a farsighted eye: LASIK can curve the cornea so images can be focused onto the retina by bringing them forward.
• If you have astigmatism: Multiple images are brought together into focus on the retina.

After LASIK, will I have 20/20 vision?

20/20 vision means you can see very clearly (both near and far) without glasses or contact lenses (until around age 45 when you may need reading glasses). And after LASIK you will most likely have vision in the 20/20 range. But the goal of LASIK is to reduce your dependence on glasses and contacts lenses.

Before Your Surgery

You may have 1 or 2 appointments before your procedure so your surgeon can check:

• Your cornea for thickness and shape
• The size of your pupils
• The general health of your eyes

For your safety, make sure your doctor knows:

• If you have any health conditions or any allergies
• What you take, including eye drops, aspirin, medications, herbal supplements, and vitamins
• If you use eye drops or take any eye medication. And ask your doctor if you should stop using these before surgery.

This is very important because any of these may change the risks of this procedure.

If you wear contact lenses, you'll need to switch to glasses BEFORE surgery. Contact lenses can change the shape of your cornea and can even have an affect on healing. So follow your doctor's instructions and take them out. How long you need to wear glasses depends on whether your contacts are soft, hard, or toric. So check with your doctor.

Do NOT wear any eye makeup or eye cream the morning of your procedure and for about 5 days afterward. You don't want to risk an infection.

After surgery, you will NOT be able to drive yourself home. Plan to have someone take you home or use public transportation. And if you take care of children, have someone at home to help you out for rest of the day. You’ll need to rest and heal.

The LASIK Procedure

Your surgeon may do things a little differently, but this will give you a general sense of how your procedure will go.

The procedure takes about 15 to 30 minutes. And you may be offered a mild sedative to help you relax. It's really up to you if you want to take it.

1. They'll clean your eye and numb it with drops. So you should not feel pain during the operation.
2. Next, your surgeon uses an instrument to gently hold your eye open. This may feel strange, but it won't be too uncomfortable.
3. A little suction ring is placed on your eye. This helps hold your eye still and lifts the cornea up a bit. Things will get dark and fuzzy for a moment as the pressure is raised in the eye. You might feel a slight squeeze.
4. Once the pressure is right, he makes a thin flap in the cornea. And he can do this one of 2 ways. He can use a precision tool called a "microkeratome." Or he can use a special laser. You may have heard this called "no-blade" or "all-laser" LASIK.
5. The suction ring is removed and the doctor carefully exposes the inside layer of the cornea. He'll also take a close look at the flap to make sure it's safe to continue.
6. Then he uses the laser to carefully reshape your cornea. You may be asked to stare at a blinking light. Try your best to do this. It helps steady your eye. But you should know that most lasers have a tracking system. So if your eye wanders a bit, the laser will follow the movement. You won't feel or see the laser, but you might hear it. It makes a light clicking sound.
7. Then your doctor folds the flap back into position.
8. He'll spend a few minutes to make sure that the cornea is lined up and everything looks right.

Most of the time, the laser reshapes the cornea just as your doctor planned. But, in some people, the cornea may react differently to the laser for many different reasons. This could mean that too much or too little cornea was removed or that the surface of the cornea is uneven. This can often be corrected with an enhancement surgery. Ask your doctor about this.

After Your Surgery

After your procedure, your doctor may ask you to stay in the office for a while for observation.

While you wait, do NOT touch or rub your eyes. This can move the corneal flap out of place and increase the risk of infection or other problems. So don't touch them.

The first few hours after surgery:

• Your eyes may feel sore
• You may have fuzzy vision and may feel like you’re wearing dirty contact lenses
• Your eyes may water or feel dry
• You may have a mild sensitivity to light
• Your eyes may itch or feel irritated

For most people, these feelings are temporary. But let your doctor know if any of these feelings last more than a few days.

At home

The best thing to do is to get some rest so your eyes have a chance to recover and heal.

• You may get protective goggles or eye shields to wear while you sleep for the first several days.
• You may be told to use eye drops. This can help reduce any swelling or dryness that naturally occurs after LASIK.
• You’ll get antibiotic drops to prevent eye infections. It's important to use these drops as instructed.
• If you have any unusual pain or a significant change in your vision, call your doctor.

In the first 12 to 24 hours:

• Your eyes should adjust to the new shape of your cornea
• Most people experience a significant improvement in vision.
• Be gentle with your eyes. They’re still healing.
• In most cases, you can work and travel the day after your surgery. But talk to your doctor before you start exercising again or playing sports.

Do NOT use eye makeup for about a week. Again, this helps prevent infections.

Can I rub, scratch, or blink the corneal flap out of place? In the very beginning, YES you can. But after a week or so, the flap should be healed and be very difficult to move.

How soon will my vision improve?

Although many people have good vision in the first few days, it may take up to 3 months for your vision to stabilize. During this time:

• Your eyes may feel drier than usual
• You may have some trouble seeing at night
• You may see glare or halos around lights

In most cases, these side effects are temporary. Your eyes are still adjusting to their new corneal shape, so it’s important that you keep in touch with your doctor during this period.

Risks and Benefits

Benefits

• For most people, the benefit of LASIK surgery is that you will be able to see well without your glasses or contacts lenses.
• After surgery, most people will have vision in the 20/20 range.

But LASIK CANNOT stop the natural aging process of your eyes. As we get older, the lenses in our eyes become stiffer and can't focus and adjust as well as they used to. So as we get into our 40s, most of us start to use reading glasses. So if you're in your 20s or 30s now and you have LASIK, you may still need reading glasses later in life. Or if you use reading glasses now, you will still need them after LASIK. If you have questions about this, ask your doctor about options that are available.

Your doctor thinks you are a good candidate for LASIK. But you are NOT a good candidate for LASIK if:

• You are under 18
• Your eyeglass prescription changed in the last year
• You have progressive cataracts, an unusual cornea shape, certain corneal diseases or thin corneas
• You are pregnant or nursing, or have given birth in the last 3 months
• You have an illness like diabetes or other general medical conditions that can affect your eyes
• You take medication that may interfere with LASIK.

Make sure your doctor knows if any of these apply to you.

Risks

This goes over some of the general risks, but this isn't meant to scare you. Understanding what’s involved is an important part of any procedure. So if you have any questions about how these risks relate to you, ask your doctor. There are also some very unusual risks that will not be covered here. So please do not consider this list complete.

• The equipment can malfunction: This can result in some visual loss that will require further medical treatment. This is a rare occurrence. If the equipment malfunctions, the doctor may have to stop the procedure early and you may have to come back for surgery on another day. It is possible that you could suffer visual loss that cannot be repaired with glasses, contact lenses, or additional surgeries.
• The corneal flap may not be perfect: In rare cases, this could require more surgery. It is possible that the cornea can be cut all the way through instead of making a shallow flap. In most situations, the doctor is able to correct this and, in some cases, complete the procedure. In rare circumstances, if the flap is damaged, it may require a second corneal surgery to correct.
• Irregular healing of the cornea, which could make your vision worse than it was before surgery: This is not common, but if the cornea does not heal properly you may need glasses or contact lenses again, and your vision may be worse than it was before surgery. In some cases you may need a partial or complete corneal transplant.
• Vision may not be fully corrected or that it becomes worse than it was before surgery: For a variety of reasons, it is possible that your vision may not be as clear as you want. This might be corrected by a second LASIK surgery. In other cases you may still need glasses or contact lenses some (or all) of the time. In rare cases, your vision after surgery may be worse than it was before surgery. And it will not be possible to correct your vision, or to restore the vision to the level it was before surgery.
• Poor night vision, which in rare cases, may be permanent: At night, you may see glare, star-shaped lights, or halos around lights. If this happens you may have trouble driving at night. These side effects are often temporary and go away as your eyes heal. Sometimes a second surgery is needed to correct this problem, but in a small number of patients, this condition is permanent. There are certain patients who are at a higher risk for having nighttime difficulties after surgery. You should discuss this with your doctor.
• Infection or inflammation of the cornea that can result in loss of vision: Just as with any surgery, there is a chance of infection. If you follow your doctor’s instructions and use good hygiene, you can reduce this risk. Your doctor may give you antibiotic eye drops to prevent an infection. If an infection occurs it can often be treated with more antibiotics. If a severe infection occurs, you could have permanent scarring or lose part or all of your vision in that eye. You may require a second surgery or a corneal transplant. A more general type of corneal inflammation can occur. This is called "diffuse lamellar keratitis" or DLK. There are multiple causes of DLK. If DLK occurs, in most cases, it happens in the first few days after surgery. You may not have any symptoms, but your doctor will see signs of DLK when your eye is examined. DLK is easy to treat and in most cases it will clear up in a few days without any loss of vision. In unusual cases, DLK can occur weeks after surgery. The best way to protect yourself is to make sure you see your doctor after surgery for all scheduled follow-up appointments.
• Other complications that can impair your vision or cause blindness: Although extremely rare, you may suffer from corneal swelling, progressive corneal thinning, poor circulation to the optic nerve of the eye, cataract formation, or total blindness. You should discuss any concerns about these rare risks with your doctor.

Alternatives

One alternative is to not have surgery and continue wearing your glasses or contact lenses.

PRK and LASEK

There are other kinds of laser eye procedures that work a little differently. The 2 most common alternatives are PRK and LASEK. People with thin or irregular corneas or large pupils may be good candidates for these procedures. As with LASIK, these procedures work by changing the shape of the cornea. But unlike LASIK, it’s done on the outside of the cornea.

Custom LASIK (Wavefront)

You may have heard about something called "wavefront" or "custom LASIK." Custom LASIK is a way to measure your eye so the procedure is custom fit for your unique vision.

With this, your surgeon collects information from your eye to create a map. He then uses this map to guide the laser during the LASIK procedure.

Some people aren't candidates for wavefront. But if you'd like to learn more about it, ask your surgeon if this might be right for you.

New vision therapies and technologies are always being developed. So if you hear about a new technique or procedure that you'd like to know more about, ask your doctor.

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