Lasic Surgery

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.

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.

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.

The cost of LASIK is probably the only deterring factor to your decision. What complicates matters is that there is no standard cost of LASIK – it differs from clinic to clinic. This is because the FDA (Food and Drug Association) of America is not authorized to regulate prices. However, because of its popularity prices are quite competitive.

The cost of LASIK can range from $499 to $2500 per eye. The cost will differ depending on the surgeon’s credentials, the location of the clinic, and what type of equipment is used for the surgery. For example using a laser keratome instead of mechanical microkeratome or technology like wavefront or custom LASIK can cost up to $500 more. Along with this many other components are part of the cost of LASIK and affect the price. Mainly the components are:

• Any royalties that the surgeon might be paying to the company that manufactures the lasers.
• Cost of purchasing and maintaining the equipment.
• All disposable materials used only for your surgery (gloves, masks, etc)
• Medications (including anesthesia) that you will be given pre and post surgery
• Rent/Lease charges
• Additional staff salaries.
• Charges of evaluation before and for 1 year after the surgery.
• Any enhancement you might require after the treatment

The other matter of concern is that LASIK is classified as a cosmetic procedure by most insurance companies and hence they will not cover it (grossly unfair, we know). However, LASIK can still become affordable with financing options. You can check with your surgeon the facility of paying in installments. You could also look for healthcare financing companies that offer loans for procedures like LASIK. There are companies that offer financing especially for LASIK through a variety of plans in which you can pay over three months to five years. However, before applying to such a company for a LASIK loan, ensure that you check with your surgeon. Not all companies work with all surgeons and it is best to clarify this beforehand.

You might have to submit certain personal details like age proof, driver’s license number and at times medical history. Ensure your papers are in order and read the fine print before signing any forms. If you are filling up an online form, ensure that the website is credible by checking with people who might have used it before. Also check the URL for ‘https’ as opposed to ‘http’ which means you are on a secure server and your personal information has been encrypted.