A complete eye exam will confirm whether the patient is nearsighted, farsighted and/or has astigmatism. There must be no ocular health problems present, such as cataracts or untreated glaucoma. Additional measurements are needed, such as the thickness of the cornea and a corneal surface mapping. A qualified optometrist or ophthalmologist can ultimately determine whether the patient is a candidate for LASIK
The success of any LASIK procedure depends more on the skills and experience of the surgeon than other surgical procedures. A qualified surgeon should meet the following basic criteria: board certification by the American Board of Ophthalmology, with advanced training in cornea and refractive surgery; skills and experience with a prominent ophthalmology practice, having performed thousands of LASIK and refractive surgical procedures; and the ability to help patients understand potential outcomes and complications. While the proliferation of LASIK ad campaigns may tempt price-conscious consumers, remember this: LASIK is a lifetime investment. Taking the time to research the credentials and experience of the surgeon is important in achieving the best results.
The procedure takes 5-7 minutes per eye. It is done under topical anesthetic drops. Using the IntraLase all-laser method, a femtosecond laser is used to create a flap and remove a precise amount of corneal tissue. After that, an excimer laser treats the cornea, and the flap is laid back into position and kept in place by natural suction - no sutures. Eye drops are used and plastic shields are placed over the eyes to protect them until the following day. Results are almost immediate, with minimum discomfort during the first 24-hour period.
After the flap is created, the excimer laser uses a cold light beam to sculpt the cornea's surface to the desired shape, correcting nearsightedness, farsightedness and/or astigmatism.
The cornea is easily numbed with eye drops during the procedure. Most patients say they have little to no discomfort both during and after LASIK.
Recovery is fast. The first couple of hours after surgery, the eye feels somewhat irritated, with a burning sensation and some tearing. Vision is typically blurry during this time. Most patients nap for a couple of hours to rest the eyes. After several hours, the irritation goes away and the vision begins to clear. The day after surgery, most irritating sensations are completely gone and vision is remarkably clear.
A mild sedative is available prior to surgery to encourage relaxation during the procedure and to encourage sleep afterward. The surgeons and operating room technicians often talk throughout the procedure to put patients at ease.
Some patients may prefer to have each eye done on different days. In most cases, however, both eyes are done on the same day. This avoids the period of imbalance that occurs if one eye still needs correction while the other one doesn't.
You will be lying back in a comfortable chair, staring up into a fixation light. During the procedure, a speculum, or lid separator, is used to hold the eyelid open and to prevent blinking. The surgeon has complete control of the laser at all times and, if the need should arise, can stop the procedure until the patient can focus on the fixation light.
With any medical procedure, there is not a guarantee of perfect vision. Almost everyone experiences improved vision, however, and most see well enough to pass a drivers' test without corrective lenses. It is important to know that LASIK does not eliminate the need for reading glasses. Beginning at around the age of 40, a condition called presbyopia usually appears, requiring reading glasses or bifocal correction. The laser cannot correct presbyopia at this time; however, there are some promising treatment options on the horizon.
Most patients return to work within two days; some even go back the day after surgery.
Active sports should be postponed for two weeks or until the eye is fully healed, unless protective eyewear is approved by the surgeon. Swimming, hot tubs and saunas should be avoided, as well. After full recovery, normal activity can resume, and the ability to play sports without glasses makes them more enjoyable for many patients.
LASIK is a permanent procedure. In some cases, however, an enhancement procedure may be required. Some patients' eyes may change throughout their lifetime, which can happen with glasses or contact lenses as well.
Fluctuation can occur, but visual improvement is almost immediate following the procedure. Most patients feel that major fluctuations have stopped after two weeks. At the same time, it may take additional time for all of the swelling in the eye to resolve and fluctuations to cease. Many patients do have healing that, in a minor sense, may continue to improve over six to nine months.
The procedure is very safe, and that is why it has been so readily accepted. With any surgical procedures, however, there may be complications. Vision-threatening complications do exist, but they are extremely rare. These include infections (an incidence of 1 in 5,000) and irregular healing processes that can lead to something called "irregular astigmatism" that glasses cannot correct and contact lenses or further surgery may be required to improve. There are also complications, which may lead to temporary blurriness, temporary dependence on glasses or contact lenses or a need for additional surgery. In most cases, the patient can still do well and recover with good vision. It is for this reason that LASIK patients should confirm the experience of their surgeon to determine if he or she has specialized training in cornea surgery. Because LASIK is performed on the cornea, knowledge of the healing properties of the cornea and management of any complications are critical to the patient's well being. Knowing how to handle a complication, should one occur, can make a significant difference in the patient's outcome.
Success depends on several factors, the most important being the degree of nearsightedness, farsightedness or astigmatism. Depending on the prescription, the surgeon can help determine the likelihood of reaching 20/40 or greater vision. Approximately 95 percent of eyes treated with LASIK reach 20/40 or better vision with one procedure, which is the requirement for driving legally without correction. If a patient does not achieve his or her goal with one procedure, additional correction often improves their vision to a satisfactory level.
In the low and moderate ranges, LASIK can treat farsightedness. For high levels of farsightedness, LASIK does not work as well and other refractive procedures may provide a better level of correction.
Astigmatism occurs when the eye is oval rather than round. The laser can treat most levels of astigmatism. The laser does this by removing more tissue in one direction of the eye than another to make it more round.
Many patients who desire LASIK surgery have dry eyes. They have become intolerant of their contact lenses because the dryness makes them uncomfortable. LASIK occasionally worsens dry eyes, but typically, this is temporary and usually treated with frequent artificial tear lubrication. In special cases of severely dry eyes, special punctal plugs that are placed in the lower eyelid tear ducts can be inserted with a significant improvement in dryness. These are easily removed in the office once the dryness resolves, or they can be left in place permanently.
LASIK only corrects the distance vision. If LASIK is performed such that distance glasses are not needed, and the patient is over 40, it is likely that they will need to put on a pair of glasses to read. The exception to this is when patients opt to have monovision, when one eye is corrected fully for the distance and the other is left nearsighted. Only about 10 to 20 percent of patients opt to have monovision correction, and it is only recommended in patients who have tried it with contact lenses and liked the results.
The cost can vary depending on whether you have LASIK or a laser vision correction alternative. A Minnesota Eye Consultants surgeon will determine which treatment is best for you at your free screening. When considering the investment of laser vision correction, it is important to also consider your ongoing investment for contacts and glasses to get a better idea of the cost-comparison over your lifetime. Whether you are paying cash, using a Flexible Spending Account, or taking advantage of the financing options we offer through CareCredit, it can be quite affordable. Our patient care coordinators will be happy to answer any questisons about how to make your dream of better vision a reality.
Most insurance companies do not cover LASIK. Some special employee programs, however, do cover a certain percentage. Patients should inquire with their insurance representatives to determine benefits and coverage.