LASIK is a surgical procedure intended to reduce a person's
dependency on glasses or contact lenses.
LASIK stands for Laser-Assisted In Situ Keratomileusis and is
a procedure that permanently changes the shape of the cornea, the clear
covering of the front of the eye, using an excimer laser. A knife, called a
microkeratome, is used to cut a flap in the cornea. A hinge is left at one
end of this flap. The flap is folded back revealing the stroma, the
middlesection of the cornea. Pulses from a computer-controlled laser
vaporize a portion of the stroma and the flap is replaced.
When is LASIK not for me?
You are probably NOT a good candidate for refractive surgery if:
* You are not a risk taker. Certain complications are unavoidable
in a percentage of patients, and there are no long-term data available
for current procedures.
* It will jeopardize your career. Some jobs prohibit certain
refractive procedures. Be sure to check with your employer/professional
society/military service before undergoing any procedure.
* Cost is an issue. Most medical insurance will not pay for
refractive surgery. Although the cost is coming down, it is still
* You required a change in your contact lens or glasses prescription
in the past year. This is called refractive instability. Patients
* In their early 20s or younger,
* Whose hormones are fluctuating due to disease such as diabetes,
* Who are pregnant or breastfeeding, or
* Who are taking medications that may cause fluctuations in vision,
are more likely to have refractive instability and should discuss the
possible additional risks with their doctor.
* You have a disease or are on medications that may affect wound
healing. Certain conditions, such as autoimmune diseases (e.g.,
lupus, rheumatoid arthritis), immunodeficiency states (e.g., HIV) and
diabetes, and some medications (e.g., retinoic acid and steroids) may
prevent proper healing after a refractive procedure.
* You actively participate in contact sports. You participate in
boxing, wrestling, martial arts or other activities in which blows to
the face and eyes are a normal occurrence.
* You are not an adult. Currently, no lasers are approved for
LASIK on persons under the age of 18.
The safety and effectiveness of refractive procedures has not been
determined in patients with some diseases. Discuss with your doctor if
you have a history of any of 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.
Other Risk Factors
Your doctor should screen you for the following conditions or indicators
* Blepharitis. Inflammation of the eyelids with crusting of the
eyelashes, that may increase the risk of infection or inflammation of
the cornea after LASIK.
* Large pupils. Make sure this evaluation is done in a dark room.
Younger patients and patients on certain medications may be prone to
having large pupils under dim lighting conditions. This can cause
symptoms such as glare, halos, starbursts, and ghost images (double
vision) after surgery. In some patients these symptoms may be
debilitating. For example, a patient may no longer be able to drive a
car at night or in certain weather conditions, such as fog.
* Thin Corneas. The cornea is the thin clear covering of the eye that is
over the iris, the colored part of the eye. Most refractive procedures
change the eye’s focusing power by reshaping the cornea (for example, by
removing tissue). Performing a refractive procedure on a cornea that is
too thin may result in blinding complications.
* Previous refractive surgery (e.g., RK, PRK, LASIK). Additional
refractive surgery may not be recommended. The decision to have
additional refractive surgery must be made in consultation with your
doctor after careful consideration of your unique situation.
* Dry Eyes. LASIK surgery tends to aggravate this
What are the risks and how can I find the right doctor
Most patients are very pleased with the results of their refractive
surgery. However, like any other medical procedure, there are risks
involved. That's why it is important for you to understand the
limitations and possible complications of refractive surgery.
Before undergoing a refractive procedure, you should carefully weigh the
risks and benefits based on your own personal value system, and try to
avoid being influenced by friends that have had the procedure or doctors
encouraging you to do so.
* Some patients lose vision. Some patients lose lines of vision
on the vision chart that cannot be corrected with glasses, contact
lenses, or surgery as a result of treatment.
* Some patients develop debilitating visual symptoms. Some
patients develop glare, halos, and/or double vision that can seriously
affect nighttime vision. Even with good vision on the vision chart, some
patients do not see as well in situations of low contrast, such as at
night or in fog, after treatment as compared to before treatment.
* You may be under treated or over treated. Only a certain
percent of patients achieve 20/20 vision without glasses or contacts.
You may require additional treatment, but additional treatment may not
be possible. You may still need glasses or contact lenses after surgery.
This may be true even if you only required a very weak prescription
before surgery. If you used reading glasses before surgery, you may
still need reading glasses after surgery.
* Some patients may develop severe dry eye syndrome. As a result
of surgery, your eye may not be able to produce enough tears to keep the
eye moist and comfortable. Dry eye not only causes discomfort, but can
reduce visual quality due to intermittent blurring and other visual
symptoms. This condition may be permanent. Intensive drop therapy and
use of plugs or other procedures may be required.
* Results are generally not as good in patients with very large
refractive errors of any type. You should discuss your expectations
with your doctor and realize that you may still require glasses or
contacts after the surgery.
* For some farsighted patients, results may diminish with age. If
you are farsighted, the level of improved vision you experience after
surgery may decrease with age. This can occur if your manifest
refraction (a vision exam with lenses before dilating drops) is very
different from your cycloplegic refraction (a vision exam with lenses
after dilating drops).
* Long-term data is not available. LASIK is a relatively new
technology. The first laser was approved for LASIK eye surgery in 1998.
Therefore, the long-term safety and effectiveness of LASIK surgery is
Additional Risks if you are Considering the Following:
Monovision is one clinical technique used to deal with the correction of
presbyopia, the gradual loss of the ability of the eye to change focus
for close-up tasks that progresses with age. The intent of monovision is
for the presbyopic patient to use one eye for distance viewing and one
eye for near viewing. This practice was first applied to fit contact
lens wearers and more recently to LASIK and other refractive surgeries.
With contact lenses, a presbyopic patient has one eye fit with a contact
lens to correct distance vision, and the other eye fit with a contact
lens to correct near vision. In the same way, with LASIK, a presbyopic
patient has one eye operated on to correct the distance vision, and the
other operated on to correct the near vision. In other words, the goal
of the surgery is for one eye to have vision worse than 20/20, the
commonly referred to goal for LASIK surgical correction of distance
vision. Since one eye is corrected for distance viewing and the other
eye is corrected for near viewing, the two eyes no longer work together.
This results in poorer quality vision and a decrease in depth
perception. These effects of monovision are most noticeable in low
lighting conditions and when performing tasks requiring very sharp
vision. Therefore, you may need to wear glasses or contact lenses to
fully correct both eyes for distance or near when performing visually
demanding tasks, such as driving at night, operating dangerous
equipment, or performing occupational tasks requiring very sharp close
vision (e.g., reading small print for long periods of time).
Many patients cannot get used to having one eye blurred at all times.
Therefore, if you are considering monovision with LASIK, make sure you
go through a trial period with contact lenses to see if you can tolerate
monovision, before having the surgery performed on your eyes. Find out
if you pass your state's driver's license requirements with monovision.
In addition, you should consider how much your presbyopia is expected to
increase in the future. Ask your doctor when you should expect the
results of your monovision surgery to no longer be enough for you to see
near-by objects clearly without the aid of glasses or contacts, or when
a second surgery might be required to further correct your near vision.
* Bilateral Simultaneous Treatment
You may choose to have LASIK surgery on both eyes at the same time or to
have surgery on one eye at a time. Although the convenience of having
surgery on both eyes on the same day is attractive, this practice is
riskier than having two separate surgeries.
If you decide to have one eye done at a time, you and your doctor will
decide how long to wait before having surgery on the other eye. If both
eyes are treated at the same time or before one eye has a chance to
fully heal, you and your doctor do not have the advantage of being able
to see how the first eye responds to surgery before the second eye is
Another disadvantage to having surgery on both eyes at the same time is
that the vision in both eyes may be blurred after surgery until the
initial healing process is over, rather than being able to rely on clear
vision in at least one eye at all times.
Finding the Right Doctor
If you are considering refractive surgery, make sure you:
* Compare. The levels of risk and benefit vary slightly
not only from procedure to procedure, but from device to device
depending on the manufacturer, and from surgeon to surgeon depending on
their level of experience with a particular procedure.
* Don't base your decision simply on cost and don't settle for the first
eye center, doctor, or procedure you investigate. Remember that the
decisions you make about your eyes and refractive surgery will affect
you for the rest of your life.
* Be wary of eye centers that advertise, "20/20 vision or your money
back" or "package deals." There are never any guarantees in medicine.
* Read. It is important for you to read the patient handbook provided to
your doctor by the manufacturer of the device used to perform the
refractive procedure. Your doctor should provide you with this handbook
and be willing to discuss his/her outcomes (successes as well as
complications) compared to the results of studies outlined in the
Even the best screened patients under the care of most skilled surgeons
can experience serious complications.
* During surgery. Malfunction of a device or other error, such as
cutting a flap of cornea through and through instead of making a hinge
during LASIK surgery, may lead to discontinuation of the procedure or
irreversible damage to the eye.
* After surgery. Some complications, such as migration of the flap,
inflammation or infection, may require another procedure and/or
intensive treatment with drops. Even with aggressive therapy, such
complications may lead to temporary loss of vision or even irreversible
Under the care of an experienced doctor, carefully screened candidates
with reasonable expectations and a clear understanding of the risks and
alternatives are likely to be happy with the results of their refractive
Be cautious about "slick" advertising and/or deals that sound "too good
to be true." Remember, they usually are. There is a lot of competition
resulting in a great deal of advertising and bidding for your business.
Do your homework.
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