LASIK & Laser Eye Surgery

What is LASIK Laser Eye Surgery?

LASIK stands for Laser-Assisted In Situ Keratomileusis. LASIK surgery is not right for everyone and requires careful evaluation and consultation. Today, more people are electing to have LASIK to correct their vision as it reduces the need for eyeglasses and contact lenses to correct most common vision problems. LASIK is a quick eye surgery procedure that provides good vision with few postoperative complications for most people. LASIK eye surgery is a refractive surgery. Refractive surgeries can be categorized by technique, as flap or non-flap procedures. LASIK is a flap procedure, which means it involves lifting a corneal flap in order to remove the tissue beneath.

As of 2010, over 20 million people worldwide have undergone LASIK surgery, making it one of the more common surgeries performed today. But LASIK is not suitable for people with certain health problems, eye diseases, and other conditions, or for people who may be taking certain medications. As part of your consultation, your refraction, medication, and health histories are screened and reviewed to determine appropriateness for LASIK.

LASIK Eye Surgery Procedure

LASIK eye surgery requires that a series of detailed measurements be taken to ensure that you are a good candidate. This process should begin with a discussion about your expectations. Then a careful review of your health and eye history should be undertaken by the doctor’s office. Next, in order to determine the exact prescription that will need to be corrected, a refraction will be performed to measure the degree of nearsightedness, farsightedness, or astigmatism followed by a cycloplegic refraction and dilated fundus examination. Corneal topography, a painless, non-invasive technique for mapping the surface curvature of the cornea, will also be done to determine the health and status of the cornea. Corneal pachymetry (the thickness of the cornea) will also be measured to determine whether the anatomy of your cornea is appropriate for LASIK.

On the day of your surgery, a technician will put a series of drops into your eyes in order to prepare them for treatment, beginning with antibiotic drops to prevent infection. Anesthetic eye drops will be used to numb the cornea so that you are comfortable during your procedure. You may also be given some medication to help you relax. The technician will clean and disinfect the area around your eyes with a cleansing pad. After you recline on the bed-like chair under the laser, an eyelid holder (called a speculum) is gently placed between your eyelids to help keep your eyelids open.

Next the LASIK surgeon will use either a laser or an instrument called a microkeratome to create a very thin, circular flap on the front of the cornea. Since you have had numbing drops placed in your eyes, this will not be uncomfortable. You will feel a slight pressure around your eyes. The surgeon will instruct you to look at a small light during your procedure. Today’s laser technology uses a tracking system that follows your eye movements during your procedure, so if you move your eyes a little it isn’t a problem. If your eye moves too much, the laser stops. Then when you once again fixate on the light, the surgeon resumes the laser treatment.

To correct nearsightedness, farsightedness, or astigmatism, your surgeon will use one of many types of Excimer laser. The Excimer laser removes a small amount of corneal tissue — the amount depends on calculations based on the measurements taken during your consultation. There is a tracking system that monitors the position of your eye in order to make sure the laser is applied to the correct place. The procedure usually takes five to seven minutes per eye, depending on the complexity of the correction you need.  You may feel some pressure from the suction ring that is used to create the flap, but otherwise feel no pain. You may also hear a steady series of clicking sounds while the laser is operating.

Upon completion of the procedure, the flap is replaced in its original position. Its extraordinary bonding properties enable it to adhere to itself without the need for sutures. Additional eye drops are instilled when the procedure is finished, to maintain comfort and reduce post-operative inflammation. A clear plastic shield or goggles will be applied to prevent you from rubbing your eye and to protect you from injury. Your doctor will give you additional drops to use at home, and will let you know when you need to return for your first follow-up visit. Typically, follow-up visits take place one day after surgery,  then one week later, and then one month after surgery.

You will need someone to drive you home. When you get home, you should rest your eyes for five or six hours. When you wake up, you will notice several things. First, you will notice a dramatic improvement in your vision, which will continue to improve as your eyes heal. You should expect to feel some mild “grittiness” for a day or so, like a little sand or dust has gotten into your eyes. As your eyes heal, it also normal to be a little sensitive to bright light and to see glare or even halos around lights at night.

After the surgery, call your doctor immediately if:

  • You experience increased pain, redness, or drainage from the eye
  • You experience a decrease in visual acuity or a loss of vision, even if it is temporary
  • You develop an untreatable headache, dizziness, muscle aches, fever, or general ill feeling

LASIK Laser Eye Surgery Candidates

The best candidates for LASIK Eye Surgery are people with healthy eyes who have not had previous eye surgery and are looking to correct nearsightedness, farsightedness, or astigmatism. They must also have stable vision for at least a year. People with certain medical conditions and those taking certain medication may not be eligible for LASIK eye surgery. Some people with thin corneas may better be suited for other refractive procedures.

Drawbacks of LASIK Eye Surgery

According to the U.S. Food and Drug Administration (FDA), risks of LASIK eye surgery include:

  • Possibility of vision loss
  • Under-correction or over-correction
  • Glares, halos, or double vision may develop
  • Not a good procedure for those with severe refractive errors of any type
  • For some farsighted patients, results may diminish with age
  • LASIK is still relatively new, which limits the amount of long-term data available
  • Some people develop Dry Eye Syndrome as a side effect
  • Monovision may develop
  • LASIK becomes riskier when done on both eyes instead of one eye at a time

Surgical risks increase in people who have:

  • Vascular disease or autoimmune disease
  • Diabetes
  • Women who are pregnant, nursing, or planning to become pregnant within six months
  • Active or recurrent eye disease, especially glaucoma
  • Progressive myopia, hyperopia, or amblyopia (lazy eye)
  • Use of some prescription and non-prescription drugs; notify eye doctor of all medications or supplements you have taken in the last month

Wavefront technology in LASIK Eye Surgery

Wavefront technology is a major advance in LASIK laser eye surgery, especially for people who have complicated prescriptions. It may sound a bit funny, but your eyes are like your feet. Your shoe size is determined by the length of your feet. With conventional or standard LASIK surgery, vision correction is measured by the patient’s visual acuity: 20/20, 20/40, 20/100, etc. This method corrects how much a person can see, but doesn’t address all the details.

Imagine if shoes were made exactly for your feet by measuring width, length, comfort level, arch, and so on. The result would be a great pair of shoes that fit perfectly. Wavefront technology does this for the eyes by measuring the whole eye and providing a three-dimensional map of how light is altered as it travels through the eye.

All optical aberrations from front to back are visible on this map, which allows the eye surgeon to correct your vision to a perfect fit. This allows correction not only for nearsightedness, farsightedness, and astigmatism, but also for other aberrations that can affect contrast sensitivity, night vision, depth perception, and light sensitivity (photophobia). By correcting for the individual’s specific wavefront map, vision can be improved dramatically.

Photoablative Inlay (PAI) LASIK

PAI-LASIK is a recent breakthrough LASIK Surgery. Invented by Dr. Gholam A. Peyman, this process was invented to improve LASIK by enabling it to correct higher degrees of refractive errors. The procedure involves creating a flap in the cornea, placing a synthetic PAI on the stromal bed, and performing the excimer laser correction on the inlay. This process involves little if any removal of tissue from the cornea. The synthetic PAI can be removed and replaced for a different correction. It is a new process, and research is still being done on possible side-effects.

How Much Does LASIK Cost?

On average, LASIK eye surgery costs between $1,500 and $2,500 per eye. These numbers are based on factors such as:

  • The patient’s individual needs and requirements
  • The type of laser technology being used (all-laser or bladeless LASIK)
  • The eye doctor and his or her location
  • The patient’s vision insurance (most companies still consider this procedure elective or cosmetic, and do not cover the cost)

Talking to Your Eye Doctor

Here are some questions to ask your eye care professional about LASIK eye surgery:

  • Do you think LASIK surgery is the best option for me?
  • Which other refractive surgeries do you think would benefit me?
  • What are the possible risks and benefits involved?
  • How often do you perform LASIK eye surgery?
  • If I have the procedure, how long will it be before I can resume my normal daily activities?
  • Which type of technology will you be using?
  • What are the costs?
  • What steps will be taken if I am not satisfied with the results?
References:
  • J. Weizer, MD and J. Stein, MD, MS “Reader’s Digest Guide to Eye Care” (Quantum Publishing Ltd, 2009) 41-44
  • U.S. Food and Drug Administration LASIK FAQs http://www.fda.gov
  • J. Anshel, MD “Smart Medicine for Your Eyes” (SquareOne Publishers, 2011) 358
  • H. Griffith, MD, S. Moore, MD, K. Yoder, MD “Complete Guide to Symptoms, Illness & Surgery” (The Berkeley Publishing Group, 2006) 898-899
This article was last updated on 03/2014