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Is LASIK Surgery the Right Choice for You?

Although your ophthalmologist will tell you if you’re a candidate for LASIK, there are certain criteria you must consider yourself apart from the doctor’s suggestions. The decision to opt for LASIK surgery must be based on three factors: Your requirements, medical history, and financial condition.

Requirements: If you wear lenses or spectacles on a very irregular basis, and can manage fine even without them, you might want to reconsider spending so much on LASIK. Same if you are over 40 years of age, since vision more or less tends to deteriorate around this age, with or without LASIK. Keep in mind that post-operation you will not be able to play sports that involve direct contact with the face for 6 months to a year. If you’re a professional, taking a year off might not be very easy.

Medical History: This is by far the most important factor in deciding if LASIK is for you. Your doctor must examine your medical history in detail particularly for the following:
• Herpes simplex or Herpes zoster (shingles) involving the eye area.
• Glaucoma, glaucoma suspect, or ocular hypertension.
• Eye diseases, such as uveitis/iritis (inflammations of the eye)
• Eye injuries or previous eye surgeries.
• Inflammation of the eyelids with crusting of the eyelashes, known as Belaphritis that may increase the risk of infection or inflammation of the cornea after LASIK.
• If you have large pupils, then you are susceptible to symptoms such as glare, halos, starbursts, and ghost images (double vision) after surgery. Post surgery, some patients with large pupils develop debilitating symptoms like not being able to drive at night or in fog.
• Thin Cornea: Performing LASIK that involves reshaping on a cornea that is too thin may result in blinding complications.
• Previous refractive surgery (e.g., RK, PRK, LASIK). If you decide to go in for additional refractive surgery, then you must carefully take into consideration your situation after consultation with multiple surgeons, if required

Financial Condition: Take a realistic view of your current financial conditions, the cost you incur on contact lenses and/or spectacles and what you will incur if you opt for LASIK. While calculating the cost of LASIK surgery, include the preoperative and post operative expenses as well as what you might incur to correct any mistakes that might happen during the procedure.

What You Need to Know About Pre-Operative LASIK Care

Although LASIK surgery is painless, fast and takes very little time for recovery, it is still not suitable for everyone. In order to determine your suitability your ophthalmologist will first examine your eyes to determine their health, what kind of vision correction you need and how much ablation is required. He will also check for dry eyes symptom and correct it before the surgery. The doctor will also use a corneal topographer to ‘photograph’ and create a map of your eyes. If you opt for wavefront LASIK, you are also likely to undergo wavefront analysis, which sends light waves through your eyes to create a better, more precise map of aberrations affecting your vision.

There are certain precautions you will need to observe before the surgery. Mainly you will have to stop wearing contact lenses for some weeks before your first evaluation. Contact lenses alter the shape of the cornea considerably for over a few weeks after you have stopped wearing them. This will cause improper measurements of your cornea while evaluation and a flawed surgical plan which will have disastrous impacts on the surgery. Typically if you wear:
• soft contact lenses, you should stop wearing them for 2 weeks before your initial evaluation.
• toric soft lenses or rigid gas permeable (RGP) lenses, you should stop wearing them for at least 3 weeks before your initial evaluation.
• hard lenses, you should stop wearing them for at least 4 weeks before your initial evaluation.

Be sure to inform your doctor of any medications that you might be taking, and medications you might be allergic to. Stop using any perfumes, creams, lotions or eye make-up the day before surgery as their particles collected in the eyelashes can cause infection after the surgery. It is also advisable to arrange for transportation to and from the clinic on the day of surgery, since there is bound to be some discomfort immediately after the surgery.

Ensure that you have a frank discussion and clarify all doubts with your doctor or surgeon. Do not hesitate to ask any questions. Look up additional information on the internet (like this website) or medical journal. Always remember to take the opinion of more than one doctor. While filling up the consent form do read the fine print and ensure you understand what you are agreeing to. It is important that you do not feel pressurized by anyone while making the decision to undergo surgery.

How to Care for Your Eyes Post LASIK Surgery

Along with preoperative, post operative care is also important to ensure success of the surgery. You doctor will obviously provide you with all the instructions required, but it will only help if you know beforehand.

There is bound to be some discomfort and you will face the following symptoms:
• Mild pain, irritation and itching for a few days after operation
• Blurry or hazy vision and sensitivity to light for about a week after the operation
• Halos, glares, starburst are also quite normal for up to 4 weeks after surgery.
• Fluctuations in vision for up to six months after surgery.

In some cases your doctor might prescribe a pain reliever to give you some relief. It is important that you do not scratch or rub your eye as this will damage the flap and not allow it to heal. It is obvious that you might not be able to go to work and your routine will also get disrupted. During this time, it is advisable to have help at home and preferably get someone to drop and pick you up from the clinic.

If your symptoms get worse instead of better you need to visit your doctor immediately without waiting for the scheduled visit. Regardless of your symptoms, you must visit your doctor within 24 to 48 hours of the surgery.

Your eye will be quite sensitive for a few months after the surgery, and is susceptible to much damage by any strenuous activity. Hence it is imperative that you do not:

• Indulge in any kind of sport for 3 weeks after surgery
• Indulge in any strenuous or contact sports (sport that involves direct contact with face) for 4 weeks
• Indulge in swimming or use a whirlpool or hot tub for 8 weeks
• Use make-up, creams or lotions around the eye for about two weeks after surgery

It is important to realize that vision stabilization will take a few months, and during this period halos and glares will persist. Hence you need to wait for at least six months before going in for enhancement surgery. Also note that although enhancement surgery will improve vision, it is unlikely that symptoms of glares and halos will improve. Another point is that the FDA does not conclusively state the safety or guarantee of any enhancement surgery.

What Happens During the LASIK Procedure Part 1

LASIK is an ambulatory procedure, which means you walk in to the surgery centre, finish the procedure and walk out again. Yet when you step in for the operation, you are bound to get a little overwhelmed by all the apparatus. In order to remain relaxed, it will help if you know what most of the instruments are called and what they are used for. We willl take you through the names and functions of all the equipment first and then explain the procedure in detail, so you can stay relaxed during the surgery.

Equipment:

Speculum: An instrument used to hold your eye lids apart

Suction ring: A ring placed around the cornea to apply pressure and create suction

Mechanical microkeratome: A blade device used to cut a flap on the cornea

Laser keratome: A laser device that is used to create a flap on the cornea instead of the mechanical device

Laser: The actual laser used to vaporize the tissue under the cornea. This laser is attached to a computer which determines how much of the cornea is to be reshaped.

Procedure:

Step 1: The surgeon will ask you to lie down on a reclining chair. The laser will be placed above your head. This laser will be attached to a computer screen and a microscope.

Step 2: A numbing drop is placed on the eye. The doctor might also administer a mild oral sedative. The speculum will hold your eyelids open. This will not cause any discomfort.

Step 3: (for mechanical microkeratome) – If the surgeon is using a mechanical microkeratome, the suction ring is placed over the cornea. This will apply high pressure around the cornea and you might experience some discomfort. The microkeratome is attached to the suction ring. This blade device will slide over the suction ring and cut a flap on the cornea. This flap is too thin for you to be able to see it. The keratome blade is to be used only once and then thrown away. After the flap is cut, the suction ring and mechanical microkeratome will be removed

Alternatively, if a laser keratome is used then Step 3 will vary slightly.

What Happens During the LASIK Procedure Part 2

Step 3: In case of a Laser keratome, a plastic plate is used in place of the suction ring over the cornea to flatten it. You might experience some discomfort due to the pressure. A laser light is then focused inside the cornea and thousands of gas and water bubbles are created that connect and expand to separate the layers of the corneal tissue. This creates a flap on the surface of the cornea.

Step 4: The flap will be hinged on one end, and the doctor will open it to expose the inner layer of the corneal tissue. The corneal tissue is dried before the laser begins its job. You will now be asked to focus on a spot of laser light directly above your head. It is important to note that if you cannot stare at one spot for 60 seconds, you might not be a good candidate for LASIK. The surgeon now starts the laser. The laser emits ultra-violet pulses of light which begin to painlessly vaporize parts of your cornea and reshape it. The computer is pre-programmed by the doctor with the correct specification required for reshaping your cornea. You might hear a clicking noise as the laser starts working. There will also be an acrid smell like that of hair burning which is caused due to vaporizing of the corneal tissue. The surgeon has complete control of the laser and can turn it off anytime.

Step 5: Once the corneal tissue has been vaporized according to specifications, the laser will be stopped and the flap will be put back into position. The doctor will ask you to rest for some time before beginning work on the other eye. Some even prefer doing the second eye a week later.

After the surgery is complete, a shield is placed over the eye to protect it from any foreign matter and to allow the flap to heal. You will experience very mild discomfort and some amount of itching, but keep your fingers as far away from your eyes as possible. You will need to arrange for transportation to and from the clinic. You might even want to take someone along. The entire process will not take more than 20 minutes.

How to Find the Right LASIK Surgeon

Finding a LASIK surgeon is not difficult, however, finding a good one is. Most of us feel intimidated by doctors and are shy or hesitant to ask frank questions, afraid we might offend them. However, when it comes to your well-being and safety, everything else is secondary. As a patient you have every right to not only ask but demand information. In case a doctor is not willing to share information, you know he is not the right kind to share your eyes with.

Where to look

The obvious answers would be advertisements, yellow pages, internet, or asking friends. These however, leave much to imagination. More credible sources would be –

GP- Your general physician or even your eye doctor (ophthalmologist or optometrist) will give you referrals. Take his suggestions into considerations, since he is already aware of your medical history and what kind of refractive surgery you require.

Organizations- There will be many refractive surgery centers in your area. You will also come across many associations of medical surgeons on the internet. These will mostly provide you with credentials and ratings of eye surgeons. Try the American Association of Ophthalmologists or the Fellowship of American Surgeons.

What to ask

Once you have picked out at least 2-3 surgeons, you will set up a consultation visit with each. Before the visit, it is best if you think up as many questions as you can and even write them down if required. Then ask each and every question (without batting an eyelid). Some questions that you just cannot ignore are:

• Years of practice (at least 3)
• Number of surgeries (minimum 500)
• Number of refractive surgeries that are exactly like your requirements (minimum 100)
• Number of patients that achieved 20/20 vision (generally should be 65%)
• Contact numbers of past patients
• Affiliation to any medical society or association (note down the name and look them up)

Apart from asking questions you can also judge the surgeons competency by his demeanor. If he answers even tough questions politely, offers additional literature, or informs you about various procedures apart from LASIK then you know he’s versatile and competent.

Although we tend to trust a doctor’s credentials in most cases, LASIK is big business. It’s a very lucrative money making option for most surgeons, and you do not want to be treated as just a customer. Take as much time as required while deciding on a surgeon, lest you regret your choice later.