What is LASIK, and how is it done? LASIK is a surgical procedure that is capable of correcting a wide range of nearsightedness (myopia), farsightedness (hyperopia) and astigmatism. Although LASIK is the most commonly performed refractive procedure in the United States, the FDA considers the performance of LASIK a practice-of-medicine issue. (This means that physicians can perform LASIK should the physician and the patient make the joint decision to do so.) LASIK is the acronym for laser in situ keratomileusis, sometimes referred to as laser assisted in situ keratomileusis. The name refers the use of a laser to reshape the cornea without invading the adjacent cell layers. In situ is Greek for "in the natural or normal place." Medically, in situ means confined to the site of origin without invasion of neighboring tissues. Kerato is the Greek word for cornea and mileusis means "to shape." How long has LASIK been performed? LASIK has been performed internationally for approximately 10 years. It was first performed in clinical trials in the U.S. in 1991. It is important to note that the major components of the procedure have a long history. Ophthalmologists have been reshaping the cornea for over 50 years, creating a protective layer of tissue for over 35 years, and using the excimer laser since the 1980s.
Why is LASIK considered an advancement in refractive surgery? LASIK combines the precision of the excimer laser that is used in PRK surgeries with the flap technique that characterizes ALK.
Who can LASIK benefit? LASIK can benefit a great number of people with myopia, hyperopia and astigmatism. Candidates should have a strong desire to be less dependent on corrective lenses and willing to accept the risks of surgery. I am happy with my contact lenses. Should I pursue having LASIK?
Most surgeons agree that if you are comfortable wearing contact lenses and are not bothered by being dependent on them, you should carefully evaluate the benefit of LASIK. How much does LASIK cost? Generally speaking, most surgeons in the United States charge between U.S. $1,800 and $2,800 per eye, but the price will vary depending upon the conditions specific to the patient and the country. No. LASIK has been performed outside of the United States for approximately ten years and in U.S. clinical trials with excellent results since 1991. It is now the most commonly performed refractive procedure in the United States. Long-term studies indicate that LASIK is safe and effective.
LASIK is "outside the scope of current approved labeling" in the United States, and the FDA considers the decision to conduct LASIK as the "practice-of-medicine." This means that physicians can perform LASIK should the physician and the patient make the joint decision to do so.
LASIK improves the uncorrected vision – one's visual capacity while not wearing corrective lenses - in most patients who have the procedure. Almost all patients can expect to achieve 20/40 vision, which most states and provinces consider good enough to drive without having to wear contacts or glasses, and many can expect to achieve 20/20 vision or better.
However, there are no guarantees that you will have perfect vision. People who are most satisfied with the results of laser correction clearly understand the potential risks and complications and possess realistic expectations of what their vision will be like after surgery.
Are the results achieved from LASIK permanent? The effects of LASIK are permanent. The effects of LASIK do not wear off. But it is important to realize that a person's eye can still change internally. That is why many surgeons recommend having the procedure done after the major eye changes have occurred in one's life. For instance, LASIK is not recommended on children because their eyes change a great deal. They would need the vision fine-tuned in a few years. If the procedure is performed after the age of 18, the chance of long-term stable correction is more likely. Even the eyes of patients over the age of 18 can still be changing. Therefore, we recommend a good conversation with your surgeon so they can review the changes you have had and help you make a decision whether or not you should wait until the changes have slowed down.
Patients should also note that while results are usually stable, they can be modified by enhancement procedures – procedures performed after the initial one – if necessary.
If I have LASIK and my vision changes later in life, can it be redone? Retreatment may be a viable solution to vision changes later in life, and other treatment options exist. You would need to see your ophthalmologist to determine the cause of the change and to determine which option is best for you. How long will the LASIK procedure take? The whole procedure takes about 10 to 15 minutes for two eyes, including creating the flap and performing the laser under the flap. Can I drive immediately after having LASIK? Patients may experience some discomfort and/or blurred vision for a few hours after surgery. And most patients receive a sedative prior to surgery. Therefore, you cannot drive home after undergoing the procedure, and you should plan not to drive for at least twenty-four hours. The procedure is done with topical anesthetic (eye drops) to numb the eye. Patients may be given a small amount of oral sedative to help them relax. Does the LASIK procedure hurt? Patients are given a topical anesthetic (eye drops) to numb the eye, so they experience no pain. When the surgeon applies the vacuum ring, the patient experiences a sensation of pressure just before his or her vision fades for a few seconds. The microkeratome – the instrument the surgeon uses to create the flap - and the laser do not cause any pain or discomfort. For several hours after the procedure, many patients describe a mild burning sensation, such as after opening the eyes while swimming in chlorinated water. After the first few hours, this uncomfortable feeling usually subsides. You can have bilateral simultaneous LASIK (both eyes done at the same time), but the choice to do so depends on the surgeon's approach and your requirements. Some surgeons prefer to wait a few days to several weeks between eyes in order to evaluate the results of the first eye. While this practice affords the patient an opportunity to see clearly with at least one eye before the other is done, it somewhat inconveniences the patient. Some surgeons will do both eyes on the same day in order not to inconvenience the patient; however, others maintain that there may be additional risks associated with bilateral surgery. Patients should discuss their options with their ophthalmologist.
There are a number of different options to help patients deal with their vision between procedures. Some patients who do not have bilateral surgery will begin wearing a contact lens in the eye that has not undergone surgery. This practice gives them an opportunity to use their two eyes simultaneously. However, the contact lens will need to be removed at least two weeks prior to the second surgery.
Others function by using the operated eye immediately without use of a contact lens in the opposite eye. This solution may work for nearsighted patients with a refractive error of fewer than six diopters. A patient with a refractive error above six diopters who does not wear a contact lens may be unable to use both eyes together due to the large difference in refractive error between the eyes. Removing one lens from a pair of glasses is usually not useful. Doing so could cause double vision and eye strain.
How long will I be out of work after having LASIK? It depends on your occupation. Certain jobs that require intense clarity of vision (dentistry and surgery, for example) may be difficult to perform for one or two days. Most patients can return to work the next day, assuming their vision is adequate for their job. However, some people may feel fatigued for a day or so following surgery. You can resume most normal activities immediately after surgery. However, for at least two weeks you will need to avoid activities that would cause perspiration to run into the eyes. You should wear safety glasses while playing contact sports whether or not you have had surgery. But if you do not routinely wear safety glasses, your surgeon may recommend wearing them for at least one month after LASIK. You will also need to avoid such activities as contact sports and swimming for several weeks. It is important to talk specifically with your doctor about limitations on activities after LASIK. How long will it take before I can see well, and how long will it take before I have my best vision?
Fast visual recovery characterizes this operation. Most patients achieve good vision the day of surgery and find that their eyes feel fairly normal within a day. However, vision can continue to improve, and best vision can still take two to three months to occur. If necessary, adjustments to the surgery called enhancements can be done. Will I need to wear glasses once my eyes have healed? Most patients who have LASIK do not wear glasses for their daily activities. However, patients may need to wear reading glasses if they are over the age of 40. This is caused by the normal aging of the eye known as presbyopia. This condition occurs with or without LASIK. Some patients may need a minimal prescription for some activities such as night driving. Will my eyes look different after LASIK? No. Your eyes will look exactly the same. Most studies show that LASIK produces minimal risk of serious complications. However, LASIK is a surgical procedure done on a delicate part of the eye, and complications can occur. I wear bifocals now, and my doctor says that I'll still need to wear reading glasses even if I have LASIK done. Why is this?
Most people in their 40s or older will need reading glasses if their eyes are corrected for distance because the eye's lens loses flexibility as we age. This condition, called presbyopia, cannot currently be treated by surgical methods.
Some patients in this age group select monovision, such as is done with contact lenses. This option allows patients to use one of their eyes for distance and the other to see up close. Although monovision proves to be satisfactory for some patients, many are not comfortable with this arrangement. Patients need to discuss the options with their physicians.
If I'm corrected for distance, will I lose my ability to see well up close? If you have LASIK done to correct your distance vision, you can expect to have very clear overall vision. However, images close to you may not appear as clear after having LASIK if you are over 40. Does insurance cover this surgery? Although LASIK is not a cosmetic procedure, it is considered an elective surgery. Such surgeries are covered in many European and Asian countries. However, most United States, Canadian and Latin American insurance policies will not cover the procedure, nor will Medicare usually cover it. If you reside in the U.S., you should check with your insurance company to see if your policy offers partial or full coverage. In many cases, the cost of the procedure can be covered by medical flex plans or medical cafeteria plans that allow pretax dollars to be set aside for medical expenses. You should check with your employer to see if your company offers this type of benefit. It is possible that the cost of LASIK may be deducted from your U.S. federal income taxes. You should check with your accountant to see if you can take LASIK as a deductible health expense. What is PRK? PRK, or photorefractive keratectomy, is similar to LASIK in that both procedures employ a computer-controlled excimer laser to reshape the cornea of the affected eye. However, LASIK preserves the epithelium (the outermost protective layer of the eye) because the surgeon creates a flap. During PRK, the epithelium is removed by gently scraping the surface. Anesthetic drops in the eye ensure that the patient experiences as little discomfort as possible.
PRK is characterized by a lengthier healing process and more discomfort than LASIK. However, PRK requires less instrumentation and avoids the creation of the flap and its attendant risks.
Not everyone can have LASIK, but can anyone have PRK? PRK is not for everyone. Almost the same conditions that determine eligibility for LASIK are criteria for candidacy with PRK.
©2000 Gerald P. Clarke
e-mail: info@docclarke.com
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