LASIK stands for Laser Assisted In Situ Keratomileusis. In LASIK
surgery, precise and controlled removal of corneal tissue by a special laser
reshapes the cornea changing its focusing power.
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 significant.
You required a change in your contact lens or glasses
prescription in the past year.
This is called
refractive instability. Patients who are:
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 such as steroids that cause
fluctuations in vision,
are more likely to have refractive instability and probably
should not have a refractive procedure.
You have a disease (e.g. lupus, rheumatoid arthritis) or are on
medications that may affect wound healing
. Certain
conditions, such as autoimmune diseases and immunodeficiency states, and
some medications, such as retinoic acid and steroids, may prevent proper
healing after a 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.
Contraindications
The safety and effectiveness of refractive procedures has not been determined in
patients with some diseases. Do NOT have LASIK surgery 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)
and blepharitis (inflammation of the eyelids with crusting of the
eyelashes).
Eye injuries or previous eye surgeries.
Keratoconus
Other Risk Factors
Your doctor should screen you for the following conditions or indicators of
risk:
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 or has too few cells lining the back
surface (endothelial cells) 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.
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.
You may be undertreated or overtreated.
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. If you used reading glasses before surgery, you will
still need reading glasses after surgery.
Results are generally not as good in patients with very small
or very large refractive errors.
Patients that require rather weak or very strong glasses or
contact lens prescriptions to see well before the procedure are less likely
to have 20/20 vision without glasses or contacts after the procedure.
Results may not be lasting.
The level of improved vision you experience after surgery may
be temporary, especially if you are farsighted or currently need reading
glasses. It is especially important for farsighted individuals to have a
cycloplegic refraction (a vision exam with lenses after dilating drops) as
part of the screening process. Patients whose manifest refraction (a vision
exam with lenses before dilating drops) is very different from their
cycloplegic refraction are more likely to have temporary results.
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. There is little known about how refractive procedures affect
other aspects of vision, such as contrast sensitivity (the ability to see
objects clearly against a similar background or in dim lighting conditions).
Some studies suggest that 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. Therefore, patients with low contrast sensitivity to begin with
probably should not have a refractive procedure. It is important for you to
know that not all eye centers test contrast sensitivity, and that when it is
tested, it should be done in a dark room.
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. This condition may be permanent.
Intensive drop therapy and the use of plugs or other procedures may be
required.
Additional Risks if you are Considering the Following:
Monovision
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. The difference between monovision with contact lenses and monovision with
LASIK is that you can always take contact lenses out or have them changed (the
treatment is reversible and adjustable) as opposed to LASIK, where the result of
the surgery is not reversible or adjustable. 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
irreversible surgery performed on your eyes. Just before this trial period
starts, find out if you pass your state's driver's license requirements with
monovision, or if you need supplemental glasses to drive.
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. The second eye may have a higher risk of
developing an inflammation if surgery is done on the same day than if surgery is
performed on separate days. If a malfunction of the laser or microkeratome
occurs causing a complication with the first eye, the second eye is more likely
to also experience the same complication if the surgery is performed on the same
day rather than on separate days.
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 treated.
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.
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 blindness.
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
procedure.
What to expect before, during, and after surgery will vary from
doctor to doctor and patient to patient. This section is a compilation of
patient information developed by manufacturers and healthcare professionals, but
cannot replace the dialogue you should have with your doctor. Read this
information carefully and with the
checklist, discuss your
expectations with your doctor.
Before Surgery
If you decide to go ahead with LASIK surgery, you will need an initial or
baseline evaluation by your eye doctor to determine if you are a good candidate.
This is what you need to know to prepare for the exam and what you should
expect:
If you wear contact lenses, it is a
good idea to stop wearing them before your baseline evaluation and switch
to wearing your glasses full-time. Contact lenses change the shape of your
cornea for up to several weeks after you have stopped using them depending on
the type of contact lenses you wear. Not leaving your contact lenses out long
enough for your cornea to assume its natural shape before surgery can have
negative consequences. These consequences include inaccurate measurements and a
poor surgical plan, resulting in poor vision after surgery. These measurements,
which determine how much corneal tissue to remove, may need to be repeated at
least a week after your initial evaluation and before surgery to make sure they
have not changed, especially if you wear RGP or hard lenses. 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.
You should tell your doctor:
about your past and present medical and eye conditions
about all the medications you are taking, including
over-the-counter medications and any medications you may be allergic to
Your doctor should perform a thorough eye exam
and discuss:
whether you are a good candidate
what the risks, benefits, and alternatives of the surgery are
what you should expect before, during, and after surgery
what your responsibilities will be before, during, and after
surgery
You should have the opportunity to ask your doctor questions
during this discussion. Give yourself plenty of time to think about the
risk/benefit discussion, to review any informational literature provided by your
doctor, and to have any additional questions answered by your doctor before
deciding to go through with surgery and before signing the informed consent
form.
You should not feel pressured by your doctor, family, friends, or
anyone else to make a decision about having surgery. Carefully consider the pros
and cons.
The day before surgery, you should stop using:
creams
lotions
makeup
perfumes
These products as well as debris along the eyelashes may increase
the risk of infection during and after surgery. Your doctor may ask you to scrub
your eyelashes for a period of time before surgery to get rid of residues and
debris along the lashes.
Also before surgery, arrange for transportation to and
from your surgery and your first follow-up visit. On the day of surgery, your
doctor may give you some medicine to make you relax. Because this medicine
impairs your ability to drive and because your vision may be blurry, even if you
don't drive make sure someone can bring you home after surgery.
During Surgery
The surgery should take less than 30 minutes. You will lie on your back in a
reclining chair in an exam room containing the laser system. The laser system
includes a large machine with a microscope attached to it and a computer screen.
A numbing drop will be placed in your eye, the area around your
eye will be cleaned, and an instrument called a lid speculum will be use to hold
your eyelids open. A ring will be placed on your eye and very high pressures
will be applied to create suction to the cornea. Your vision will dim while the
suction ring is on and you may feel the pressure and experience some discomfort
during this part of the procedure. The microkeratome, a cutting instrument, is
attached to the suction ring. Your doctor will use the blade of the
microkeratome to cut a flap in your cornea.
The microkeratome and the suction ring are then removed. You will
be able to see, but you will experience fluctuating degrees of blurred vision
during the rest of the procedure. The doctor will then lift the flap and fold it
back on its hinge, and dry the exposed tissue.
The laser will be positioned over your eye and you will be asked
to stare at a light. This is not the laser used to remove tissue from the
cornea. This light is to help you keep your eye fixed on one spot once the laser
comes on. NOTE: If you cannot stare at a fixed object for at least 60
seconds, you may not be a good candidate for this surgery.
When your eye is in the correct position, your doctor will start
the laser. At this point in the surgery, you may become aware of new sounds and
smells. The pulse of the laser makes a ticking sound. As the laser removes
corneal tissue, some people have reported a smell similar to burning hair. A
computer controls the amount of laser delivered to your eye. Before the start of
surgery, your doctor will have programmed the computer to vaporize a particular
amount of tissue based on the measurements taken at your initial evaluation.
After the pulses of laser energy vaporize the corneal tissue, the flap is put
back into position.
A shield should be placed over your eye at the end of the
procedure as protection, since no stitches are used to hold the flap in place.
It is important for you to wear this shield to prevent you from rubbing your eye
and putting pressure on your eye while you sleep, and to protect your eye from
accidentally being hit or poked until the flap has healed.
Immediately after the procedure, your eye may burn, itch, or feel like there is
something in it. You may experience some discomfort, or in some cases, mild pain
and your doctor may suggest you take a mild pain reliever. Both your eyes may
tear or water. Your vision will probably be hazy or blurry. You will
instinctively want to rub your eye, but don't! Rubbing your eye could dislodge
the flap, requiring further treatment. In addition, you may experience
sensitivity to light, glare, starbursts or haloes around lights, or the whites
of your eye may look red or bloodshot. These symptoms should improve
considerably within the first few days after surgery. You should plan on taking
a few days off from work until these symptoms subside. You should contact
your doctor immediately and not wait for your scheduled visit, if you
experience severe pain, or if your vision or other symptoms get worse instead of
better.
You should see your doctor within the first 24 to 48 hours
after surgery and at regular intervals after that for at least the first six
months. At the first postoperative visit, your doctor will remove the eye
shield, test your vision, and examine your eye. Your doctor may give you one or
more types of eye drops to take at home to help prevent infection and/or
inflammation. You may also be advised to use artificial tears to help lubricate
the eye. Do not resume wearing a contact lens in the operated eye, even if your
vision is blurry.
You should wait one to three days following surgery before
beginning any non-contact sports, depending on the amount of activity required,
how you feel, and your doctor's instructions.
To help prevent infection, you may need to wait for up to two
weeks after surgery or until your doctor advises you otherwise
before using lotions, creams, or make-up around the eye. Your doctor may advise
you to continue scrubbing your eyelashes for a period of time after surgery. You
should also avoid swimming and using hot tubs or whirlpools for 1-2 months.
Strenuous contact sports such as boxing, football, karate, etc.
should not be attempted for at least four weeks after surgery. It is
important to protect your eyes from anything that might get in them and from
being hit or bumped.
During the first few months after surgery, your vision may
fluctuate.
It may take up to three to six months for your vision to
stabilize after surgery.
Glare, haloes, difficulty driving at night, and other visual
symptoms may also persist during this stabilization period. If further
correction or enhancement is necessary, you should wait until your eye
measurements are consistent for two consecutive visits at least 3 months
apart before re-operation.
It is important to realize that although distance vision may
improve after re-operation, it is unlikely that other visual symptoms such
as glare or haloes will improve.
It is also important to note that no laser company has
presented enough evidence for the FDA to make conclusions about the safety
or effectiveness of enhancement surgery.
Contact your eye doctor immediately,
if you develop any new, unusual or worsening symptoms at any point after
surgery. Such symptoms could signal a problem that, if not treated early enough,
may lead to a loss of vision.
Career impact
- does your job prohibit refractive surgery?
Cost - can
you really afford this procedure?
Medical
conditions - e.g., do you have an autoimmune disease or other major illness? Do
you have a chronic illness that might slow or alter healing?
Eye
conditions - do you have or have you ever had any problems with your eyes other
than needing glasses or contacts?
Medications -
do you take steroids or other drugs that might prevent healing?
Stable
refraction - has your prescription changed in the last year?
High or Low
refractive error - do you use glasses/contacts only some of the time? Do you
need an unusually strong prescription?
Pupil size -
are your pupils extra large in dim conditions?
Corneal
thickness - do you have thin corneas?
Know all the risks and procedure limitations
Overtreatment or undertreatment - are you willing and able to have more than one
surgery to get the desired result?
May still
need reading glasses - do you have presbyopia?
Results may
not be lasting - do you think this is the last correction you will ever need? Do
you realize that long-term results are not known?
May
permanently lose vision - do you know some patients may lose some vision or
experience blindness?
Development
of visual symptoms - do you know about glare, halos, starbursts, etc. and that
night driving might be difficult?
Contrast
sensitivity - do you know your vision could be significantly reduced in dim
light conditions?
Bilateral
treatment - do you know the additional risks of having both eyes treated at the
same time?
Patient
information - have you read the patient information booklet about the laser
being used for your procedure?
Know preoperative, operative, and postoperative expectations
No contact
lenses prior to evaluation and surgery - can you go for an extended period of
time without wearing contact lenses?
Have a
thorough exam - have you arranged not to drive or work after the exam?
Read and
understand the informed consent - has your doctor given you an informed consent
form to take home and answered all your questions?
No makeup
before surgery - can you go 24-36 hours without makeup prior to surgery?
Arrange for
transportation - can someone drive you home after surgery?
Plan to take a few days to recover - can you take time off to take it easy for a
couple of days if necessary?
Expect not
to see clearly for a few days - do you know you will not see clearly
immediately?
Know sights,
smells, sounds of surgery - has your doctor made you feel comfortable with the
actual steps of the procedure?
Be prepared
to take drops/medications- are you willing and able to put drops in your eyes at
regular intervals?
Be prepared
to wear an eye shield - do you know you need to protect the eye for a period of
time after surgery to avoid injury?
Expect some
pain/discomfort - do you know how much pain to expect?
Know when to seek help - do you understand what problems could occur and when to
seek medical intervention?
Know when to
expect your vision to stop changing - are you aware that final results could
take up to months?
Make sure
your refraction is stable before any further surgery - if you don't get the
desired result, do you know not to have an enhancement until the prescription
stops changing?
The very latest development in laser eye treatment from Bausch and Lomb is a
system called Zyoptix, a system that takes LASIK to a new frontier. Learn more
about it by linking to the Zyoptix section.
There are several ways of reaching the ophthalmologists of EYE REPUBLIC Ophthalmology Clinic:
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ONLINE ACCESS
WEBSITES.
http://www.EyeRepublic.com.ph - EYE REPUBLIC
Ophthalmology Clinic
http://www.OCP.com.ph - Ophthalmic
Consultants Philippines Co. -
http://www.LASIK.com.ph - Refractive
Surgery Resource
http://www.Cataract.com.ph - Cataract Surgery Resource
http://www.Eye.com.ph - Eye
Information Online
http://www.EyeDoc4Kids.com.ph - Eye Information for Kids
http://www.Retina.com.ph - Retina
Surgery Resource
http://www.Glaucoma.com.ph - Glaucoma
Online
http://www.Uveitis.com.ph - Uveitis Online
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EYE REPUBLIC
Ophthalmology Atlas
CLINIC INFORMATION
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Initial laser shots at the optical zone.
LASIK flap made. 
