Lasik

What is Lasik?
Lasik stands for laser assisted in-situ keratomileusis. It is widely considered as the procedure of
choice for correction of most cases of myopia. Lasik sometimes is called the “flap and zap”
procedure. It combines an established cutting technique using a cutting device called the
microkeratome with the more recently developed excimer laser technique. First a circular
superficial cornea flap is made with the help of the mircokeratome. Next the flap is folded back to
allow the excimer laser to reshape the deeper layers of the cornea according to the patient’s
spectacles prescription. The flap is then folded back and will adhere itself naturally without the
need for stitches.

 FAQ

1)What is laser vision correction?

It is a surgical procedure that uses a cool (non-thermal) beam of light to gently reshape the
cornea — the surface of the eye — to improve vision. The laser removes microscopic bits of
tissue to flatten the cornea (for nearsightedness), steepen the cornea (for farsightedness), and/or
smooth out corneal irregularities (for astigmatism).

The goal of laser eye surgery is to change the shape the cornea so it does a better job of
focusing images onto the retina, for sharper vision. LASIK and PRK are two types of laser vision
correction.

2)Are LASIK and PRK safe?

The FDA recognizes LASIK and PRK as proven, safe and effective. Laser vision correction uses
a cool (non-thermal) beam of light controlled by a computer. The surgeon is able to turn the laser
on or off at any moment. There are many safeguards in place to reduce the risk of error.

Although no one knows the exact number of complications, studies suggest that the incidence of
minor difficulties such as dry eyes and nighttime glare is around 3% to 5%, while the risk of
serious incidents such as lost vision is thought to be less than 1%. There are no known cases of
blindness from LASIK or PRK. Read more about outcomes and complications.

3)Can I have both eyes done at the same time?

Most surgeons perform LASIK on both eyes at the same time. Because it takes longer for clear,
comfortable vision after PRK, many surgeons will wait a week or two between eyes for PRK.

4)How is eye laser surgery different from previous types of refractive eye surgery?
Current FDA-approved laser vision correction methods, such as LASIK (laser-assisted in situ
keratomileusis), have a higher predictability of the final result with a lower incidence of
complications. Additionally, older techniques typically involved manually performed incisions
rather than automated lasers for correction.
5)Does laser vision correction hurt?
During LASIK or PRK, your surgeon will place anesthetic drops in your eye. Afterwards, he or she
may prescribe medication if necessary. Many LASIK patients report no more than mild discomfort
for a day or so — often it's an itchy feeling. There is more discomfort after PRK because the
procedure exposes the deeper layers of the cornea. For clear and comfortable vision after PRK,
protective surface cells have to grow back over the treated area. This process can take 2 weeks
or longer.

6)How long does LASIK take?

The laser treatment itself usually takes less than a minute, while the entire procedure takes
around 15 minutes per eye.

7)What happens before laser eye surgery?

Your eyecare practitioner will give you a thorough eye examination to make sure your eyes are
healthy and you're a suitable laser vision correction candidate. He or she will test for glaucoma,
cataracts and other disqualifying conditions. He or she will also use a machine called a corneal
topographer to photograph and electronically map your eye. The surgeon will use this map to
plan your surgery for the most precise results possible.

8)What happens on the day of treatment?

LASIK and PRK are outpatient procedures. You'll need to spend around an hour at the surgeon's
office. Someone else should drive you home, since your vision might be a little blurry right after
surgery.

You'll lie down in a reclining chair. The surgeon will place anesthetic drops in your eye, position
your head under the laser and place an eyelid speculum (retainer) in your eye to hold the lids
open.

In LASIK, the surgeon creates a thin flap in the top of the cornea, folds it back out of the way,
uses the laser to remove some corneal tissue, then puts the flap back in place. If you're having
PRK, the laser removes the outer layer of the cornea.

9)What happens afterward?

The surgeon will place drops or ointment in your eye. You may relax for a little while, then go
home and rest. You'll probably notice clearer vision immediately, and it may improve even more
as the weeks go by.

10)When may I resume driving?

You may begin driving as soon as you can see well enough, excluding the day you had LASIK or
PRK performed.

11)Can I go back to work right away?

Some people return to work the next day, but surgeons usually recommend 2 or 3 days of rest
instead.

12)When may I go back to wearing makeup?

You may resume wearing makeup about one week after your surgery. However, throw out your
old makeup and buy new to decrease your risk of infection.

13)Are there any side effects?

Some people experience dry eye, which usually is alleviated with drops and disappears over
time. Others may experience starbursts or halos around lights, especially at night. Usually this
effect lessens or disappears over time, too. In a small number of people (probably less than 1%),
their vision worsens rather than improves.
14)How many checkups will I need after LASIK?
Depending on your surgeon, you will probably return the next day, then one week or one month
later and then three months later. Your doctor will let you know if more visits are necessary after
that.

The LASIK Procedure: A Complete Guide

LASIK is the most commonly performed refractive surgery procedure. You may hear people
calling it "LASIX," but the correct name is LASIK, which is short for "laser-assisted in situ
keratomileusis."

Why is it so popular? LASIK has advantages over other vision correction procedures, including a
relative lack of pain afterward and the fact that good vision usually is achieved by the very next
day.

An instrument called a microkeratome is used in LASIK eye surgery to create a thin, circular flap
in the cornea. Another, newer way of making the flap is with a laser.

The surgeon folds the hinged flap back out of the way, then removes some corneal tissue
underneath using an excimer laser. The excimer laser uses a cool ultraviolet light beam to
precisely remove ("ablate") very tiny bits of tissue from the cornea to reshape it.

When the cornea is reshaped in the right way, it works better to focus light into the eye and onto
the retina, providing clearer vision than before. The flap is then laid back in place, covering the
area where the corneal tissue was removed.

Both nearsighted and farsighted people can benefit from the LASIK procedure. With nearsighted
people, the goal is to flatten the too-steep cornea; with farsighted people, a steeper cornea is
desired. Excimer lasers also can correct astigmatism by smoothing an irregular cornea into a
more normal shape.

Before the LASIK Procedure

If you are considering LASIK eye surgery, your first step is to choose a LASIK surgeon.

To decide whether you're a good candidate for LASIK, your eye doctor will perform an eye exam
to determine if your eyes are healthy enough for the procedure, what kind of vision correction you
need and how much laser ablation is required.

Your doctor also will look for signs of dry eye disease, which must be treated and cleared up
before LASIK can be performed. Even if your eyes have a normal tear film, your eye surgeon as a
precaution may recommend treatment to reduce your risk of developing dry eyes after LASIK.

Also, a corneal topographer usually is used; this device measures the curvature of your eye and
creates a kind of "map" of your cornea. With new wavefront technology associated with custom
LASIK, you also are likely to undergo a wavefront analysis that sends light waves through the eye
to provide an even more precise map of aberrations affecting your vision.

Finally, the doctor will ask you about any health problems you have or medications you take.
Some health conditions will disqualify you altogether for LASIK, but others may just postpone the
procedure until a later date.
During LASIK Surgery

LASIK is an ambulatory procedure — you walk into the surgery center, have the procedure and
walk out again. In fact, the actual surgery usually takes less than five minutes, and you're awake
the whole time.

Want a visual? View our

LASIK slide show!

Occasionally, the surgeon will give you a mild oral sedative beforehand.

Even though the surgery is relatively quick, LASIK is a very delicate procedure and it's important
to have it performed by a highly skilled surgeon with proper equipment. You also should have
someone accompany you to the surgery center and drive you home afterward.

Before your LASIK begins, numbing eye drops will be applied to your eyes so you don't feel any
discomfort during the procedure.

The doctor will have you lie down, then make sure your eye is positioned directly under the laser.
(One eye is operated on at a time.) A kind of retainer is placed under your eyelids to keep them
open — normally, this is not uncomfortable.

The surgeon will use an ink marker to mark the cornea before the flap is created. The flap is then
created with either a microkeratome or a femtosecond laser. Whichever device is used, it is
securely attached to your cornea with a suction ring to prevent eye movements or loss of contact
that could affect flap quality. During the procedure you won't actually see the creation of the flap,
which is very thin.

An ultra-thin flap is created on the eye's surface during LASIK corrective eye surgery. After laser
energy is applied to reshape the eye, the flap is replaced to serve as a type of natural bandage.
The surgeon uses a computer to adjust the excimer laser for your particular prescription. You will
be asked to look at a target light for a short time while he or she watches your eye through a
microscope as the laser sends pulses of light to your cornea.

The laser light pulses painlessly reshape the cornea. You'll hear a steady clicking sound while the
laser is operating. You also may smell a mild odor during the laser treatment; this is normal.

The higher your prescription, the more time the surgery will take. The surgeon has full control of
the laser and can turn it off at any time.

After the procedure is finished, you will rest for a little while. If you're having both eyes done the
same day, the surgeon typically will begin working on your second eye immediately after
treatment of the first eye is finished. Some people choose to have their second eye done a week
later.

Your surgeon may prescribe medication for any postoperative pain, but many people feel no
more than mild discomfort after LASIK. That's one advantage of LASIK over PRK, which can
cause significant eye discomfort for a few days.

After LASIK: Short-Term

As with any kind of surgery, it's important that you follow your doctor's instructions to the letter.
Get proper rest, use all prescribed medications as directed and call your doctor immediately if you
suspect a problem.

Immediately after LASIK, the doctor will have you rest for a bit, then you can go home (someone
else must drive). At home, you should relax for at least a few hours.

You may be able to go to work the next day, but many doctors advise a couple of days of rest
instead. They also recommend no strenuous exercise for up to a week, since this can traumatize
the eye and affect healing.

Avoid rubbing your eye, as there is a chance (though slim) of dislodging the corneal flap.

After LASIK: Longer Term

With LASIK surgery, most people's vision improves right away, but some find that their vision
gradually improves even more over the next few days or even weeks.

LASIK outcomes may vary. Most people achieve 20/20 or better vision with LASIK. Some may
achieve only 20/40 or not quite as good. In fact, 20/40 is fairly good vision. In most states, the law
considers it good enough for driving.

Some patients still need glasses or contact lenses following laser vision correction, though their
prescription level typically will be much lower than before.

Postoperative LASIK complications can include infection or night glare (starbursts or halos that
are most noticeable when you're viewing lights at night, such as while you're driving).

Rarely, people will experience clear vision after LASIK, then notice a gradual worsening of their
eyesight over time (called "regression"). If this happens, discuss it with your Post-LASIK Quality
of Life
In late 2009, the FDA announced it had launched a major LASIK quality of life survey in
collaboration with the National Eye Institute (NEI) and the U.S. Department of Defense.

One survey objective is to assess LASIK outcomes from the patient's viewpoint. Any adverse
LASIK events also will be identified and evaluated, with the idea of decreasing their frequency.

Three phases of the study include:

 Design and implement a Web-based questionnaire for patients.

 Evaluate quality of life and satisfaction in active duty personnel treated at the Navy
Refractive Surgery Center.
 Conduct a national multi-center clinical trial to assess outcomes of the LASIK procedure
in a general patient population.

The study should be completed by the end of 2012. — M.H.

surgeon to determine if more surgery (called an enhancement or "touch-up") will be necessary.

Even if you see perfectly after laser eye surgery, you may still need reading glasses or bifocal
contact lenses once you hit your 40s. This is because of a condition called presbyopia, which is a
normal, age-related loss of near vision. Your distance vision probably will remain crisp, but seeing
up close will be more difficult.

Researchers are studying ways to correct presbyopia surgically. So it's possible that when you
start needing reading glasses you could have one of these presbyopia-correcting procedures
performed to restore your near vision, once they are FDA-approved.

These are important topics to discuss with your LASIK surgeon before deciding on the surgery.