BEFORE LASIK TREATMENT
What are the common problems and complications?
By far the most common issue is under-correction or over-correction. In this case, vision will be “good, but not perfect.” Further laser treatment, known as an “enhancement” or a “touch-up”, can improve the vision further by treating the remaining optical imperfection. About 20% of patients can experience optical consequences during the healing process, including glare, halos at night, or ghost images. In almost all cases, these conditions disappear within several weeks or months. Careful attention to detail in centration and calibration of the laser, as well as measurement of pupil size, substantially reduces the potential for these issues.
What if I have astigmatism?
Having astigmatism is quite common and does not discount you from being a candidate. In fact, our lasers are able to treat the astigmatism along with correcting the nearsightedness or farsightedness. It is all done in the same procedure.
DURING LASIK TREATMENT
What if I move during the LASIK procedure?
Many patients worry about this, and the concern is certainly understandable. Almost everyone moves a tiny bit during the procedure. Under the laser microscope, a person’s face and eyes can move (slightly) in concert with normal breathing. This is why we perform every surgery with “assisted stabilization” to ensure ideal rendering and centration of the laser treatment, and we use lasers with pupil-tracking systems. Also, the laser treatment can be paused if necessary, and then resumed whenever we want, and resume when it is safe, and stable, and proper to do so.
What if I blink when they’re doing the laser?
The eyelids are gently held apart during the laser treatment by a special instrument, which feels a little odd, but doesn’t typically hurt.
Are there limits to correction?
The maximum limit of correction obtainable with LASIK varies from one laser to another, but it’s typically about -12 diopters of myopia. Depending on the model of laser used, the limit for treating hyperopia is +4.00 to +6.00 diopters, and for astigmatism, -3.00 to -5.00 diopters. (Decipher your prescription)
Are there different types of LASIK procedures?
LASIK stands for Laser-Assisted in-situ Keratomileusis. There are 3 main varieties of LASIK surgery, only one of which is correctly called “LASIK surgery”, and it’s principally used for people who are very shortsighted or very longsighted. The other two types of treatment are:
PRK (Photorefractive Keratectomy), which was the original kind and is still sometimes used. It involves gently scraping some surface cells off the cornea and then using a laser beam to re-shape it.
E-LASIK, or Lasek (Laser Epithelial Keratomileusis), which is used for people with mild to moderate short-sightedness, whose corneas are too thin and delicate for regular LASIK surgery. A finer blade is used to create a tiny flap from the epithelium of the cornea, but before it is lifted, an alcohol solution loosens the edges. Then the LASIK surgery re-shapes the cornea and the flap is replaced
Epi-LASIK, (Epithelial Laser In-Situ Keratomileusis), which, like e-LASIK, is for those whose corneas are too too thin and delicate for regular LASIK surgery. Instead of creating the tiny flap and using alcohol to loosen it, the flap is gently separated by a specially designed instrument prior to the application of the laser, consistent with other methods
What is an excimer laser?
An excimer laser is a precise computerized instrument that uses invisible ultra-violet light to ablate the cornea during refractive surgery. This cool light laser produces virtually no damage to the surrounding tissue, increasing its safety. Each pulse of the laser removes only a small amount of corneal tissue — about 1/500th of the thickness of a human hair. First- and second-generation excimer lasers use a broad beam (about 6 mm in diameter) with an aperture that controls the amount of the beam that is exposed to the eye during any single pulse.
Manufacturers have refined this technology by splitting the single broad beam into several smaller beams that are rotated around the treatment area (similar to how a shower head splits the main water stream into smaller streams). Flying Spot Newer generation excimer lasers, such as Bausch & Lomb’s Technolas® 217A, utilize an innovative technology called a “flying spot laser.” A narrow beam (about 2 mm wide) contacts the eye at lightning speed in a pattern that allows the debris to clear in one place before contacting that area again. The laser beam covers a broad surface area, but does not penetrate as deeply as in RK procedures. Unlike the broad beam, the full width of the flying spot beam is exposed to the cornea during every pulse. This technology produces a smoother corneal shape and helps increase the accuracy and efficacy of the procedure.
What does PRK have to do with LASIK?
LASIK evolved from PRK and both procedures use lasers in a similar manner. LASIK provides the same visual-correction benefits. LASIK uses an excimer laser to ablate part of the corneal stroma. Since LASIK does not disturb the sensitive top layer of the cornea there is less discomfort with this procedure and there is faster recovery.
What is photorefractive keratectomy (PRK)?
Photorefractive Keratectomy (PRK) is a surgical procedure that uses an extremely precise laser to remove corneal tissue for the purpose of correcting refractive error. PRK takes place on the surface of the cornea. Since the central corneal epithelium (the outer layer of corneal cells) needs to be removed for PRK, and there are nerve fibers that run through it, there may be discomfort initially. This discomfort is equivalent to a badly scratched eye or a corneal abrasion and it can cause pain, irritation, watering of the eye, blurry vision, or the sensation of a particle in the eye. A bandage contact lens helps to reduce the irritation and encourage healing of the tissue. Following PRK, vision is blurry the first few days, but it generally improves once the corneal epithelium has healed and the bandage lens is removed. By one week, vision should be reasonably good and is often stabilized by six months.
What is radial keratotomy (RK)
Radial Keratotomy (RK) corrects myopia by flattening the central cornea using a series of peripheral cuts (incisions) radiating from the central cornea. A hand-held knife with a retractable diamond cutting tip is used to perform the operation. The optical zone (the central part of the cornea that’s responsible for our most critical vision) is marked off with a circular ring. Corneal thickness is measured and the diamond cutting tip is extended to the appropriate length. Incisions are made from the edge of the optical zone out to the edge of the cornea. By doing so, the central optical zone is not touched. RK can treat only low degrees of myopia and astigmatism, but LASIK can also treat hyperopia and higher degrees of myopia and astigmatism.
Can both eyes be done at the same time?
Yes. Surgery is commonly done on both eyes at the same time. Our simple price is the cost of a single eye treatment.
Can I lose vision as a result of this treatment?
This is one of the most important concerns that patients have. No patient in any of the extensive FDA studies of excimer laser treatment has suffered profound vision loss. In the entire world experience, we are aware of an extremely small number of cases (approximately one per million surgeries performed) that have caused serious eye or vision problems. That includes surgeries done by untrained or ill-trained surgeons, experimental and “off-brand” lasers. It is the general consensus among very experienced, and competent US and European surgeons that this should not happen in the hands of good surgeons doing good work with proper equipment.
Is this a “no-risk” procedure?
No medical procedure is without risk. We take risk every day when we get out of bed, walk across a street, drive a car, or fly in an airplane. We consider these “acceptable” risks and a part of modern life. There are certain risks involved in taking any action (such as having LASIK) and there are risks involved in not taking action. For example, there is a small risk of blindness associated with use of soft contact lenses (due to amebic corneal infection in perhaps 1 per million contact lens wearers), and risk of serious eye injury if glasses are worn and facial trauma occurs. This latter risk is also in the range of the “one in a million”.
Will LASIK work after 50?
Each of your eyes has two lenses—the cornea (the general focusing lens) and the inside lens (the fine focusing lens). Laser surgery works effectively to correct the general focus of eyes, no matter what your age. However, the inside fine focusing lens of your eye hardens and no longer provides clear reading vision past 45 years of age. This means that even if you have laser surgery, you will still need reading glasses to see clearly up close from 45 or 55 years of age on. However laser surgery may be able to give you clear vision for all the other focal distances, without regular glasses, for the rest of your life.
If you are over 65 years of age, we generally recommend that you wait and have your vision corrected at the time of your cataract surgery. The lens placed in your eye at the time of your cataract surgery can correct your nearsightedness and farsightedness. Most people develop cataracts sometime between 60 and 85 years of age. Arrangements can sometimes be made to have your cataract surgery early, even before you develop a noticeable cataract, for the sake of enhanced focusing benefits.
What is wavefront technology?
Wavefront is a new technology used to measure high order aberrations (defects) within the optical system. The only way to identify if you have high order aberrations is to have a complete evaluation and testing on a specialized piece of equipment called an “aberrometer”. Age, glasses prescription have no bearing on the potential for high order aberrations in the eye, and size of the pupil does have a direct correlation. The larger the pupil, the increased incidence of aberrations. Custom Wavefront technology reduces these aberrations, improving both your clarity of vision and your contrast sensitivity.
Is LASIK safe?
One of the most important and reasonable concerns a patient might have is about the safety of LASIK. The short answer is, in the experienced hands of a qualified surgeon, LASIK can be as safe as it is effective. But with any medical procedure, there are risks including those referenced on the FDA website. Your assessment of LASIK surgery should consider these risks, and they should be part of a discussion with your ophthalmologist. Of course, clinical studies also attest to the safety and efficacy of LASIK. Perhaps the most impressive testimonial comes from the many ophthalmologists who have chosen to have LASIK performed on themselves. These men and women who perform the procedure are aware of the potential risks and are saying “yes” for themselves. We are proud to say that each of the experienced ophthalmologists affiliated with Joffe has either had the procedure himself, performed the procedure on a close family member, or both.
Does the treatment hurt?
With both PRK and LASIK, there is no pain or discomfort at the time of surgery, as anesthetic eye drops are used. With LASIK, there may be a mild foreign body sensation for several hours after care, accompanied by some tearing. After that, there should be no discomfort at all. After PRK, there can be mild to moderate discomfort for 1-3 days. The discomfort is minimized by use of a ‘band-aid’ soft contact lens and special eye drops. When epithelial healing is complete, the lens is removed, and there is generally no further risk of discomfort. With LASIK, many patients observe that they experience no pain, no irritation, and not even any slight foreign body or ‘eyelash’ sensation. Most are pleasantly surprised at how little discomfort they had, and usually mention this fact when they talk about their LASIK experience.
Is everyone a candidate for LASIK?
It depends on your prescription, corneal shape and thickness, age, other eye problems, general health, etc. At Joffe, we will determine if you are a good candidate during your free, comprehensive diagnostic eye exam.
AFTER LASIK TREATMENT
What about long-term results?
The long-term stability of laser vision surgery is remarkable. In all the years of practice, we have seen patients retain excellent unaided vision (in the range of “20/20” and even “20/15”) for well over 10 years. Laser vision correction is at least 1,000 times more accurate, and more stable, than any prior corrective surgery ever performed, including radial keratotomy (“RK”). Excimer laser surgery was first performed in 1988. Extensive testing around the world has confirmed that there are no long-term health problems to the eye from this type of care.
Will my eyes deteriorate in the future?
Most people see the eye doctor for a checkup and prescription update every one to three years. It is normal for a person’s optical prescription to change a very small amount every several years. This slow rate of change of the prescription through life is not worsened, nor is it eliminated, by having LASIK. After LASIK, if the eyes were to change, the change generally will be very slight and should stay close to the “zero prescription” point where you want them!
Will I need to wear an eye patch after the procedure?
No. Some patients are given a “band-aid” contact lens overnight to promote healing.
If I don’t get a full correction, will I be able to have a repeat procedure to improve the results?
Approximately 5% to 7% of our patients return for an enhancement procedure. These patients have had a dramatic improvement in their vision, but have not achieved a “perfect” correction. After LASIK, a “touch-up” or “enhancement” is even easier than the original treatment, because we can find and carefully lift the original flap.
What are the options for retreatment?
If re-treatment is necessary due to undercorrection or overcorrection, patients have two options. One is for the surgeon to free the edge of the original corneal flap, lift it open, and then re-treat with the laser. The other option is to create an entirely new flap and re-treat the cornea with the laser. Preference varies among surgeons and partly depends on the amount of time that has elapsed since surgery.
How soon can I return to work and other activities?
The answer is different for PRK and LASIK. We recommend a return to full work activities no sooner than about 3 days after PRK. For that reason, most people choose to have their PRK on a Thursday or Friday. With LASIK, many patients often feel so good the day after surgery that they feel like going right back to work. It would not be realistic to promise that everyone will feel perfect the next day after LASIK, but certainly the overwhelming majority of individuals we have cared for have expressed this sentiment. Almost all other activities including strenuous exercise, reading, and even driving at night are OK as soon as you feel comfortable.
Can my results be guaranteed?
As in any medical procedure, especially any type of surgery or laser therapy, there can be no guarantee of results in any individual case. We work extremely hard to see that each person we care for gets the maximum possible benefit. Even though the laser treatment is exquisitely precise and our experience is significant, variations in final visual result can arise due to individual variations in healing, among other factors.
Will the treatment cause cataracts, or influence the treatment of cataracts?
No. Laser corrective treatment does not cause cataracts, nor does it affect the removal of cataracts.
Will I achieve 20/20 vision after my LASIK procedure?
The goal of refractive surgery is to reduce the dependency on glasses or contacts. Patients goals can vary based upon their level of correction and expectations. Most patients achieve 20/20 correction after surgery while others still require the need to wear glasses for night driving and reading. Your outcome is based on your individual parameters and will be discussed with you by our medical staff during your consultation.
Will I need to have a re-treatment after my initial procedure?
No, not everyone requires an additional re-treatment. However, re-treatments are necessary to achieve the best corrected vision, in fact, 5% to 7% of our patients for LASIK, and if required an additional procedure is completely covered for up to one year at no cost to the patient.
Will I still need glasses after my LASIK procedure?
Most patients below the age of 40 do not require glasses to see after the LASIK procedure. If you are 40 years old or older, due to the natural aging process of the eye you will require reading glasses. Laser vision surgery will correct your distance vision but will not prevent the need for reading glasses. If this is a concern, some clients consider monovision as an alternative to reading glasses.