LASIK is a surgical procedure intended to reduce a person's dependency on glasses or contact lenses. The goal of this Web site is to provide objective information to the public about LASIK surgery.
What You Should Know About LASIK:
How LASIK Works:What happens before, during and after surgery.
The LASIK Procedure: A Complete Guide
LASIK, or "laser-assisted in situ keratomileusis," is the most commonly performed laser eye surgery to treat myopia (nearsightedness), hyperopia (farsightedness) and astigmatism.
Like other types of refractive surgery, the LASIK procedure reshapes the cornea to enable light entering the eye to be properly focused onto the retina for clearer vision.In most cases, laser eye surgery is pain-free and completed within 15 minutes for both eyes. The results — improved vision without eyeglasses or contact lenses — can usually be seen in as little as 24 hours.
If you're not a good LASIK candidate, a number of other vision correction surgeries are available, such as PRK and LASEK laser eye surgery and phakic IOL surgery. Your eye doctor will determine if one of these procedures is suitable for your condition and, if so, which technique is best.
How Is LASIK Surgery Performed?
First, your eye surgeon uses either a mechanical surgical tool called a microkeratome or a femtosecond laser to create a thin, circular "flap" in the cornea.The surgeon then folds back the hinged flap to access the underlying cornea (called the stroma) and removes some corneal tissue using an excimer laser.
This highly specialized laser uses a cool ultraviolet light beam to remove ("ablate") microscopic amounts of tissue from the cornea to reshape it so it more accurately focuses light on the retina for improved vision.
For nearsighted people, the goal is to flatten the cornea; with farsighted people, a steeper cornea is desired.
Excimer lasers also can correct astigmatism by smoothing an irregular cornea into a more normal shape. It is a misconception that LASIK cannot treat astigmatism.
After the laser reshapes the cornea, the flap is then laid back in place, covering the area where the corneal tissue was removed. Then the cornea is allowed to heal naturally.
Laser eye surgery requires only topical anesthetic drops, and no bandages or stitches are required.
Before LASIK Surgery
Your eye doctor will perform a thorough eye exam to ensure your eyes are healthy enough for the procedure. He or she will evaluate: the shape and thickness of your cornea; pupil size; refractive errors (myopia, hyperopia and astigmatism); as well as any other eye conditions.The moistness of your eyes will also be evaluated, and a precautionary treatment may be recommended to reduce your risk of developing dry eyes after LASIK.
Usually, an automated instrument called a corneal topographer is used to measure the curvature of the front surface of your eye and create a "map" of your cornea.
With wavefront technology associated with custom LASIK, you also are likely to undergo a wavefront analysis that sends light waves through the eye to provide an even more precise map of aberrations affecting your vision.
Your eye doctor will also note your general health history and any medications you are taking to determine if you are a suitable candidate for LASIK.
You should stop wearing contact lenses for a period of time advised by your doctor (typically around two weeks) before your eye exam and before the LASIK procedure, as contacts can alter the natural shape of your cornea.
How LASIK Works
Before your surgery begins, numbing eye drops are applied to your eye to prevent any discomfort during the procedure. Your doctor may also give you some medication to help you relax.Your eye will be positioned under the laser, and an instrument called a lid speculum is used to keep your eyelids open.
The surgeon uses an ink marker to mark the cornea before creating the flap. A suction ring is applied to the front of your eye to prevent eye movements or loss of contact that could affect flap quality.
After the corneal flap is created, the surgeon then uses a computer to adjust the excimer laser for your particular prescription.
You will be asked to look at a target light for a short time while he or she watches your eye through a microscope as the laser sends pulses of light to your cornea.
The laser light pulses painlessly reshape the cornea, although you may feel some pressure on your eye. You'll also hear a steady clicking sound while the laser is operating.
Immediately After LASIK Surgery
Upon completion of your LASIK surgery, your surgeon will have you rest for a bit. You may feel a temporary burning or itching sensation immediately following the procedure. After a brief post-operative exam, someone can then drive you home. (You cannot drive yourself until your eye doctor confirms your uncorrected vision meets the legal standard for driving.)LASIK is performed on each eye separately, with each procedure taking only about five minutes.
You should expect some blurry vision and haziness immediately after surgery; however, clarity should improve by the very next morning.
Your eyesight should stabilize and continue to improve within a few days, although in rare cases it may take several weeks or longer. For most people, vision improves immediately.
You may be able to go to work the next day, but many doctors advise a couple of days of rest instead.
Also, it is usually recommended that you refrain from any strenuous exercise for at least a week, since this can traumatize the eye and affect healing.
Generally, you will return to see your eye doctor or your LASIK surgeon the day after surgery.
At this initial check-up, he or she will test your vision to make sure you are legal to drive without glasses or contact lenses. In most states, this requires uncorrected visual acuity of 20/40 or better.
As with any other surgery, always follow your doctor's instructions and take any medication prescribed. Also, avoid rubbing your eyes, as there’s a small chance this could dislodge the flap until it heals and adheres more securely to the underlying cornea.
Long-Term Results
Laser eye surgery offers numerous benefits and can dramatically improve your quality of life. Most people achieve 20/20 vision or better after the surgery, but LASIK results do vary. Some people may achieve only 20/40 vision or less.You may still need to wear glasses or contact lenses following laser vision correction, though your prescription level typically will be much lower than before.
While the procedure has an excellent safety profile, LASIK complications can occur and may include infection or night glare (starbursts or halos that are most noticeable when you're viewing lights at night, such as while you're driving).
A small percentage of people will need a LASIK enhancement, or "touch up" procedure, a few months after the primary LASIK surgery to achieve acceptable visual acuity.
You also may still need reading glasses once you reach your 40s, due to a normal age-related loss of near vision called presbyopia.
While LASIK surgery has a high success rate, it is important that you discuss all facets of the procedure with your surgeon prior to consenting to the surgery.
How to Choose a LASIK Surgeon
Choosing a surgeon for LASIK or PRK is not as difficult as it can be for many other kinds of surgery.
But a bad eye procedure outcome can affect your life almost as
negatively as a bad heart operation outcome. That's why it is so
important to choose the best surgeon available.Indicators of a quality surgeon can include experience, great credentials and willingness to work with a patient to resolve possible problems following a procedure.
Finding a Good LASIK Surgeon
Factors to consider when you check qualifications and abilities of a refractive surgeon include:- Licensing. State licensing boards can validate a surgeon's credentials. You also can check a surgeon's credentials through the National Practitioner Data Bank.
- Board certification. Ask if your surgeon is board certified beyond having a basic license to practice medicine. This means that an entity recognized by the American Board of Medical Specialties has certified the surgeon to practice in his or her specialty. The American Board of Ophthalmology is one such entity that requires board-certified physicians to complete specific training and continuing education related to the specialty.
- American College of Surgeons (ACS) membership. The ACS upholds ethical standards of conduct for all members, who must be board certified.
"A lot of companies make LASIK sound like it's a flap-and-zap commodity. But the truth is, it's surgery," said Steve Updegraff, MD, a LASIK surgeon and medical director of Updegraff Vision in Tampa Bay, Fla. He recommends that you choose a doctor who is a Fellow of the ACS. "The credentialing process there is pretty steep; also, that group is diligent about advancing the field of surgery."
Surgeons who use the designation "FACS" after their names are Fellows of the American College of Surgeons. - Advertisements. Many refractive surgery centers advertise in newspapers and on radio, television and the Internet. Some ads are more informative than others. Some tout extremely good pricing. But while this can be a starting point, an ad or a procedure price should not be your only criterion when choosing a doctor.
- Referrals. Ask for a referral from your regular eye care practitioner, whether an optometrist or an ophthalmologist. Tell him or her that you want the LASIK surgeon in your area with the best reputation in the profession. Also, reputable LASIK surgeons themselves can be great sources of referrals. If you know of a refractive surgeon who is well respected in another state, call his or her office and ask for recommendations regarding good surgeons in your area.
- Other resources. Visit the American Academy of Ophthalmology's website at www.aao.org, where you can use the "Find an Eye MD" feature. Be sure to specify "refractive surgery" under "specialty." The American Society of Cataract and Refractive Surgery (ASCRS) also maintains an online membership list and "Find a Surgeon" feature.
What To Ask a Refractive Surgeon
After you find a surgeon, make an appointment for a consultation. This is an important meeting. To take full advantage of it, write down as many relevant questions about LASIK and refractive surgery you can think of, and ask every single one during your visit.Some recommended questions are:
- How many procedures have you done?
- What is your complication rate, and how does this compare with national averages?
- Do you perform procedures at your own center, or do you need to travel elsewhere?
- What are your outcome statistics, and how do these compare with national averages?
- Has the surgical center you use ever had an outbreak of serious eye infections? If so, what caused this?
- If a complication does occur, what is your specific policy regarding follow-up?
- Do you charge extra if an enhancement is required?
- If you do charge extra for enhancements, what kind of a price break can be expected?
- If you don't charge extra for enhancements, what is your cutoff date (one year, for example) for addressing problems after the initial procedure?
- Does your billing department break out and explain all costs associated with a LASIK or other vision correction procedure?
In addition to the above concerns, you also need to consider the surgeon's versatility and competency in a variety of refractive procedures. LASIK isn't the only game in town, and it isn't the best procedure for every person.
Choose a surgeon who is comfortable and experienced with several procedures — such as LASIK, PRK, LASEK, CK and clear lens replacement (refractive lens exchange) — and the latest technology. If your doctor displays a thorough understanding of these different procedures, he or she can confidently choose the one that will be best to correct your particular vision problems.
If you're considering a surgeon who doesn't perform a particular procedure you're interested in, ask for an explanation of why, beyond "I don't do that."
It's also a good idea to know if a surgical center has had any unusual or ongoing outbreaks of eye infections, which potentially can be quite serious. With strains of antibiotic-resistant bacteria on the increase, it's essential that surgical center personnel observe impeccable standards regarding sterilizing instruments and equipment.
It's also appropriate to ask if the surgeon performs procedures at his or her own surgical center. Surgeons in this category likely have considerable experience because they perform enough procedures to support a center of their own. If a surgeon needs to travel to an outside surgical center or share a laser, then this may be evidence that he or she performs fewer refractive surgery procedures.
After a consultation, never feel that you are obligated to use that surgeon. You are completely free to talk to other surgeons as well. And don't feel that you are offending anyone. It has long been an accepted practice to seek a second opinion, and most doctors would urge patients with lingering doubts to do so.
The LASIK Surgeon's Office: "That Personal Touch"
While you might hear of a terrific surgeon who practices outside your area, it really is best and far more convenient to find someone close to home. If you do have a rare complication that requires ongoing attention, it will be much easier for you if you can avoid traveling long distances for appointments or even routine follow-up care."As with any relationship you have with someone in the medical profession, it has to be one of trust," said Penny Asbell, MD, ophthalmology professor at Mount Sinai School of Medicine and director of Cornea Service and Refractive Surgery Center in New York. "You have to feel that you trust the person and that they're personally interested in you."
She said it's normal to be concerned if you think you lack rapport with your eye surgeon.
"If everything goes well, you probably won't have to see that person too often, and that's the end of it," Dr. Asbell said. "But if for any reason you're not happy with the quality of the result, or there's any issue with healing that's going to require more attention, you want to know that you have someone who is personally connected to you and is working hard to address your concerns — someone who isn't just running a mill where they don't even remember who you are."
But to be fair, most good surgeons understandably have only a certain amount of time to spend with their patients when routine procedures are involved. So a good surgeon also recognizes that it's important to have friendly, competent staff available who also can assist with answering your questions and concerns.
The initial impression you receive at the "front desk" may be an important indicator of how comfortable you will be made to feel as you go through the remaining steps of scheduling and undergoing a surgical procedure.
Are staff members friendly or indifferent? Do they seem competent or disorganized? Are they willing to take the time to answer questions, particularly about costs and billing?
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