LASIK

LASIK Image by Jacob Davies via Flickr

Ok, so a more accurate title for this page would be “What you should know about Refractive Surgery,” but I’m pretty sure LASIK is much more firmly ingrained in our collective lexicon at this point.  In any case, I will herein be discussing both LASIK and its most-used alternative, PRK.

Disclaimer: the information contained in this article should and does not constitute a replacement for information obtained through a formal consultation with your optometrist or at a refractive surgery clinic!

The longer I have practiced and the more patients I have seen, the more excited I am to recommend refractive surgery to my patients.  Certainly, as the name implies, refractive surgery is in fact a surgery with its own set of inherent risks and potential side effects. That said, I can definitely say that even just with the advances made so far within my own optometric career, refractive surgery has become safer, more predictable, and in my mind a seriously viable (and superior?) choice for many of my patients.  Even I, a generally conservative individual, am going in for a consultation next week for possible surgery later this month!

Following are several main terms in the refractive surgery world that I’d like to briefly explain, as I also touch on several potential side effects of surgery and – in general – what to expect if you choose to undergo laser vision correction.

LASIK is the most commonly performed refractive surgery procedure in the US today.  It involves creating a small flap on the surface of the cornea, pulling back the flap to expose the corneal stroma, using a laser to reshape the stroma, and then laying the flap back in place to aid in quick healing after surgery.  The main advantage of this over PRK is fast visual result and healing – patients often see very well just a day or two after surgery, and medicated eye drops are generally only needed for 1 week after surgery, after which frequent lubricating drops with still be recommended.  Possible disadvantages/complications include increased dryness, possible halos or glare – especially at night – and severe vision decrease if the flap becomes dislocated during the healing process.

Two major advances have greatly decreased the incidence and severity of LASIK-related complications.  Bladeless (or all-laser) LASIK refers to the fact that traditional LASIK used a tiny blade (“microkeratome“) to create the corneal flap.  With bladeless LASIK, a laser is used not only for vision correction but also for flap creation, which results in more uniform and predictable flaps.  In turn, this leads to more predictable and excellent outcomes.  Laser-created flaps also tend to be more stable, resulting in less flap dislocation or other flap complications.

Another major advancement in recent years is Custom (or wavefront) LASIK, in which the laser targets not only nearsightedness, astigmatism, and farsightedness; but it also works to remove other slight imperfections in the cornea to reduce symptoms such as halo and glare and improve overall visual clarity.  This wavefront procedure also blends the peripheral treatment zone so there’s not such a large shift from treated to non-treated cornea, which was a major cause of night vision problems in traditional LASIK.

Besides LASIK, the other most widely used refractive surgery procedure is PRK, which uses the same laser corneal reshaping as LASIK (also available as a Custom or wavefront procedure), but does not involve a corneal flap.  Instead, the top layer of the cornea (the epithelium) is physically removed, treatment is applied to the stroma, and a soft contact lens is placed on the eye after surgery to protect it while the corneal epithelium regenerates over the course of about a week.  Because the epithelium is completely regenerating itself after PRK, the healing time is a little longer and more gradual than LASIK.  Generally, it is expected that you will have good usable vision by 1-2 weeks, but it will not reach its desired clarity until about 1-2 months.  During the healing process, it is possible that you may benefit from the temporary use of soft contact lenses.

PRK is generally indicated for higher prescriptions, and it can also be preferred over LASIK for patients who have dry eyes, because the corneal flap with LASIK may lead to worse dry eyes after the procedure.

Those are the major points for refractive surgery.  The average cost for all-laser custom surgery in the Denver metro area is about $2000 per eye – other centers may advertise a discounted price, but this is often for a lower quality procedure.  Bottom line: when considering refractive surgery, make sure you’re comparing apples to apples as far as type and quality of procedure, and make sure the price includes all pre- and post-operative care.

As far as knowing if you personally are a good candidate for LASIK or PRK, here are a few guidelines:

1) Your glasses or contacts prescription should be stable for at least two exams before considering surgery.  For many people, surgery is a realistic possibility by their mid to late 20’s, but this is not always the case.

2) It’s important to make sure your expectations are realistic prior to surgery – you should realize that risks DO exist, you should expect great uncorrected vision after surgery but not necessarily x-ray 20/10 vision – even though a lot of people obtain truly excellent vision after surgery – and you should know that the surgery generally targets your distance vision, meaning you’ll still need reading glasses to some extent by about age 45.  Some people will opt for what is called “monovision” correction, which leaves one eye slightly nearsighted for close reading, but your optometrist will absolutely need to fit you into monovision contact lenses beforehand to ensure you like it.

3) At the end of the day, to know if you’re a good candidate you’ll need to visit a refractive surgery center so they can discuss the surgery with you and take some pretty fancy scans to see if your eyes should tolerate the procedure without complication.  I send the majority of my patients to TLC Laser Eye Centers, which is a nationwide company with great doctors, great facilities, and a Lifetime Commitment – which basically acts as a warranty against vision change down the road.  Ask your optometrist if you’re a good candidate, and if you are, schedule a consultation!