Discover Step-By-Step What The LASIK Experience Is All About

On the day of your LASIK procedure, it is natural to experience both excitement and nervousness. Patients who feel most at ease on that day are those who have asked questions, read about the LASIK procedure, and perhaps talked with former patients. Understanding LASIK and trusting your surgeon are important to helping you feel confident, calm, and prepared on the day of your procedure. You won't be able to drive immediately after the procedure, so it is recommended that you have someone drive you to the surgery center and pick you up when you're ready to leave.

How should I prepare for the day of my surgery?

Make an effort to arrive at the center rested and relaxed. You should plan to spend up to three hours at the laser center, although this amount of time varies from center to center. Wear comfortable clothing the day of your surgery. Do not wear makeup, skin moisturizer, perfume, or cologne, since LASIK requires clean, sterile conditions. Earrings should not be worn.

How the LASIK procedure performed?

LASIK is performed while the patient is awake. However, if you are experiencing anxiety, the surgeon may give you a mild oral sedative. Many surgeons talk to the patient throughout the procedure, so the individual knows what is happening and what to expect next.

What happens before the surgery?

Before the surgery begins, your face will be cleaned with a disinfectant, and you will be asked to wear a surgical cap. You will be given an antibiotic eye-drop and possibly an anti-inflammatory eye-drop. These may sting for a few seconds.

What happens during the procedure?

Once in the laser suite, you will be positioned comfortably on your back, under the excimer laser. Your surgeon will give you anesthetic eye-drops to numb the surface of your eyes. Your eyelashes will be taped out of the way, and an eyelid speculum will be placed between your eyelids, to keep you from blinking. The speculum sometimes causes mild pressure or discomfort to your eyelids at first, but with the numbing drops, these sensations dissipate.

The surgeon will make small reference marks on your cornea with water-soluble ink. These marks will serve as positional guides when it is time to realign the corneal flap. A suction ring is then placed on your eye to hold it in position to maintain pressure within the eye. Keeping the eye pressurized is essential for the keratectomy, or flap-making process, which comes next. Your vision will dim during this step.

Next the surgeon will create the corneal flap, using the microkeratome, the small instrument with a blade that passes over the eyeball. The extremely thin flap is made from the outermost 25 percent of the cornea. (The average cornea is only about the thickness of a credit card.) This flap-making process takes about thirty seconds. When the microkeratome is making the flap, you may feel slight pressure and the instrument will block out light as it passes over your pupil.

Next, the surgeon will ask you to fix your vision on a target light - usually red, green, or yellow. Then, the surgeon will gently lift back the hinged flap. At this point your vision will become blurry.

The surgeon will now perform the laser procedure. This usually takes twenty to ninety seconds. You will not feel any pain as the laser sculpts the cornea by vaporizing small amounts of tissue. This process is called photoablation. You will also hear a clicking or buzzing sound with each pulse of the laser. The surgeon is reshaping your cornea.

During the laser procedure, individuals have different responses to staring at the fixation light. Some patients report that the fixation light becomes a blur. Others report that it seems to momentarily disappear. If this happens and your eye starts to wander, the surgeon will stop the laser. You will be coached to look again at the target light so the laser procedure can resume.

Once the process of reshaping your corneal tissue is complete, the excimer laser will be turned off. Using a sterile saline solution, the surgeon will flush the treated surface of the eye to ensure that any debris is washed away. The surgeon then carefully replaces the corneal flap to its original position, using the ink marks as guides.

It takes about one to five minutes for the eye to create a natural vacuum to hold down the flap. The cornea has the unique ability to seal itself back into place. No sutures are necessary. Your eyes will be dried with a sterile cloth, and the eyelid speculum will be removed. You will now be able to blink normally. At this point, you will be asked to sit with your eyes closed for about thirty minutes. Then your physician will examine your eyes one more time to ensure that the corneal flap is properly positioned.

Patients who have undergone LASIK experience some discomfort, which may last six to eight hours. Patients describe this as a sensation of having sand or a dirty contact lens in their eye. Tylenol, aspirin, ibuprofen, or similar over-the-counter pain medications can help. By the following day, this sensation is usually gone.

Immediately after surgery, expect your vision to be somewhat blurred, similar to looking through a glass of water or wearing a dirty contact lens. However, upon awakening later in the day or the next morning, you should experience improved vision. Most patients report dramatic improvement within twenty-four hours.

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Learn The 7 Levels Of The Visual Disability Scale

20/25 to 20/65: Subnormal vision, but not seriously impaired. Those below 20/45 have difficulty reading a newspaper, but most can hold it closer to their face and still read with good light. Many states will license people to drive with visual acuity as low as 20/60, but most such drivers will carry restricted licenses. Telescopic glasses allow all of this group to drive as long as their state permits it and if they do not also have serious field loss. These people have excellent object and travel vision, except for those who have lost considerable field vision as well as visual acuity.

20/70: Mildly impaired. This is the point where people really begin to feel handicapped. Reading newspapers is very difficult without magnification, and most states refuse to license persons to drive with a visual acuity this low unless they are equipped with telescopic glasses. Object and travel vision are still excellent, except for those who have lost field vision as well.

20/75 to 20/200: Moderately impaired. This group can still function as sighted in most regards with the use of low-vision aids. Object vision for this group is poorer, but it is still adequate for almost all activities. These people can see the car but may have trouble identifying its make and model. Recognizing friends may be difficult, but they see the person. Travel vision is still quite good unless there is also field vision loss.

Reading is the primary problem for this group, but good equipment and training eliminate this problem. People in this group can be equipped and trained to read using numerous low-vision aids. All members of this group should be able to drive with telescopic glasses unless there is also serious peripheral-vision loss, or other limiting factors.

20/200 to 20/800: Seriously impaired, but still with travel vision and reduced but useful object vision. People in this group can read with low-vision aids of various kinds. Those below 20/500 might consider learning Braille, but even then it certainly isn't mandatory. These people will not be able to drive, even with telescopic glasses. Object vision diminishes but is still useful. Travel vision is still adequate, although those at the lower end of the scale may sometimes trip over curbs. Crossing streets can be hazardous for people at the lower end of this scale because they cannot see distant oncoming cars.

20/800 to 20/1200: Severely impaired. At this level of visual acuity a person loses travel vision. People suffering a loss of peripheral vision may find a white cane useful or even necessary before this point is reached, but at this stage, use of the white cane becomes necessary, regardless of the cause of vision loss. Some in this group are able to use very strong magnifiers to read large print. A +50 diopter lens will give almost all in this group the ability to read textbook-size print.

20/1200 to 20/6000: Very severely impaired. Many doctors reject the use of visual acuity figures this low. While it is true that letter sizes larger than 700 do not exist on test charts, there are mathematical equivalents. Doctors categorize this level as the ability to see a hand moving one foot away, without the ability to count fingers. People in the 20/1200 to 20/6000 group are dependent on the white cane or a guide dog for independent mobility. A video visual aid for reading print is the aid of choice and the only aid that provides visual access to print. Voice synthesizers are available that convert print into speech. Persons in this group are legitimate users of such equipment.

This group has little object vision, but as long as there is any light perception, that vision is useful. For example, a man walking down the street with his white cane sees two shadows ahead. He sees light between the two objects. He probably can't tell what the objects are, but he knows there is space enough between them for him to pass through.

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Beyond LASIK: A Complete List Of Eye Corrective Procedures (Pt 3)

Bioptics: Bioptics is a combination procedure involving a PIOL implant followed by LASIK. It is recommended for the most extreme levels of myopia and hyperopia when neither technique alone will entirely correct the refractive error. This combined technique can be used to correct over 30.00 diopters of myopia - twice the maximum amount that can be safely corrected with LASIK.

Clear Lens Extraction (CLE): Clear lens extraction (CLE) involves removing the eye's lens, just like in a cataract operation. This is done with a special ultrasound instrument and may be accompanied by eye-drop anesthesia. A flexible synthetic lens implant of the proper power is then placed inside the eye through an extremely small incision to correct the refractive error. The procedure can be completed without sutures. Visual recovery is quite rapid. As with LASIK, most patients are able to return to work the day following their procedure.

CLE is most commonly performed to treat higher levels of farsightedness in patients over age forty. The optical results are superior to LASIK for these higher corrections. CLE may also be used to correct higher levels of nearsightedness and may be fine-tuned with LASIK if a small refractive error remains. Some surgeons have used CLE to treat extremely nearsighted or farsighted patients who are not candidates for LASIK or PRK.

The major drawbacks of CLE are the risk of postoperative retinal detachment (more of a risk with nearsighted than farsighted patients), and the risks of intraocular surgery (including the potential, albeit uncommon, risk of endophthalmitis).

If both eyes are corrected for distance vision, CLE patients will require reading glasses after their procedure. As with LASIK and PRK, however, monovision corrections are possible with CLE to decrease or even eliminate one's need for reading glasses. Or, a new intraocular lens called the ARRAY lens can be implanted at the time of lens extraction. The multi-focal ARRAY lens allows you to see both near and far after the operation. For the best results, both eyes should be implanted with the lens. Because of its multi-focal capacity, some patients experience a loss of contrast at night and also develop halos around lights. If these symptoms become problematic, the ARRAY lens can be removed and replaced with a conventional lens implant.

Laser Thermal Keratoplasty (LTK): For low amounts of farsightedness, a technique called laser thermal keratoplasty (LTK) is a possible method of thermally changing the shape of the cornea. A special holmium laser is used to deliver laser energy to the peripheral cornea to slightly tighten the fibers and thereby steepen its curvature. The technique seems to work only for low amounts of farsightedness.

There are two disadvantages of LTK. First is the long time needed for vision to stabilize. This process can take months, requiring multiple pairs of glasses in the interim. The second disadvantage is that the effect wears off in a substantial percentage of patients. A patient in whom the effect wears off either faces having the treatment repeated every year or so, or turns to LASIK for a permanent correction.

Conductive Keratoplasty (CK): In conductive keratoplasty (CK), a special probe introduces an electrical current to the peripheral cornea, shrinking the corneal fibers. Similar to LTK, this acts like tightening a belt, causing the central cornea to steepen. It is effective for small amounts of hyperopia. The procedure takes less than five minutes and is essentially painless. It may be performed in a doctor's office without the need of a laser suite. The major advantage of CK is its relative safety. Because all the work is done on the peripheral cornea, the risk of central corneal scarring (through the visual axis, or line of sight) is minimal. The visual recovery with CK is fairly quick, although generally somewhat slower than with LASIK. CK is considered by many surgeons to be the next advance over LTK because its effect appears to be permanent.

Surgery for Presbyopia: One of the more exciting areas of ophthalmology is the surgical treatment of presbyopia - the stiffening of the natural lens that decreases near vision as we age. Several devices and surgeries have been tried, all of which attempt to enlarge the circumference of the eye and tighten the fibers that control the focus of the lens. These fibers are thought to stretch and become less effective as we age.

Anterior Ciliary Sclerotomy (ACS): Anterior ciliary sclerotomy (ACS) is a surgical procedure for relieving presbyopia. Several small incisions are made in the sclera (coating of the eye) directly over the muscle that controls the lens. This procedure expands the circumference of the eye. ACS may be combined with the placement of small silicone plugs into the scleral grooves. These plugs may help the effect last longer.

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Beyond LASIK: A Complete List Of Eye Corrective Procedures (Pt 2)

Astigmatic Keratotomy (AK): Astigmatic keratotomy (AK) is similar to RK, but its purpose is to correct only astigmatism. Usually, one or two incisions are made in the peripheral cornea to make it more round (as if loosening the laces on a football). This procedure is often combined with RK and has a similar long track record.

AK is a reasonable procedure for correcting pure astigmatism (patients without coexisting nearsightedness or farsightedness) with results that are almost as good as those with LASIK and PRK. AK can also be used to enhance the results of LASIK and PRK by correcting small residual amounts of astigmatism. The most frequent use of AK today is to correct astigmatism at the time of lens implant surgery (either cataract or clear lens extraction surgery).

Cataract Surgery: For patients with significant cataracts who are looking to correct their nearsightedness or farsightedness, cataract surgery presents the best option. After removing the cataract with ultra-sonic power, the surgeon can implant a lens that will reduce or eliminate nearsightedness and farsightedness.

This procedure is not performed on younger patients without cataracts because the surgery involves entering the eye and, therefore, slightly increases the risk of more serious complications. The surgery also involves removing the natural crystalline lens, which in young people allows them to focus up close. LASIK, which leaves the lens intact, is a better option for younger patients.

Modern cataract surgery, when performed by an experienced surgeon, can allow patients a recovery period rather similar to that of LASIK. In its most sophisticated form, cataract surgery can be performed with eye-drop anesthesia (just like LASIK or PRK) and require no sutures. An outpatient procedure in skilled hands, it takes twenty minutes or less to complete.

Automated Lamellar Keratoplasty (ALK): Automated lamellar keratoplasty (ALK) was done on high myopes prior to the invention of the excimer laser. ALK is not performed today. LASIK has essentially replaced ALK because of the increased accuracy and safety afforded by the excimer laser in making the second "cut." ALK is similar to LASIK in that it uses a microkeratome to separate the surface layer of the cornea. This flap is temporarily folded back (similar to the first part of the LASIK procedure), and a thin disc of corneal tissue is removed with a second pass of the microkeratome. ALK, much less precise than LASIK, was associated with a much higher complication rate. It was primarily used to correct large amounts of myopia.

Satisfactory results are not always obtained the first time, and a high percentage of eyes need additional procedures to achieve the desired result. Sometimes an irregular corneal surface results from the procedure, causing some distortion of vision.

Phakic Intraocular Lens (PIOL) Implants: A phakic intraocular lens (PIOL) implant may correct either extreme nearsightedness or extreme farsightedness. Unlike cataract surgery, your natural lens is not removed; rather, the implant sits in front of the natural lens. In effect, the PIOL becomes an internal contact lens.

Implantable contact lens technology has arisen out of the incredible advances in modern cataract surgery. Current technology allows ophthalmologists to insert flexible intraocular lenses (used to replace the natural lens after cataract surgery) through extremely small incisions. Some PIOL implants, too, are flexible enough to allow folding as they are inserted through small incision openings.

Because of the slightly increased risk of more serious complications, PIOL implants are reserved for high amounts of nearsightedness or farsightedness - beyond the safe limits of LASIK. In places where this technology is available, surgeons are implanting PIOLs in patients with myopia greater than 12.00 to 15.00 diopters and hyperopia greater than 4.00 to 6.00 diopters. In addition, PIOL implants may be preferable to LASIK in patients who fall within the safe LASIK parameters with regard to their prescription but who have thinner corneas, making the tissue removal aspect of LASIK less desirable.

Despite the excellent outcomes in most cases, complications associated with PIOL implants are currently the biggest concern. Specifically, in the early studies, a small percentage of patients developed cataracts shortly after implantation of one brand of the lens There is also a small risk of endophthalmitis (infection within the eye) because the surgical incision actually enters the eye. This rare complication could lead to a complete loss of vision. Endothelial cell loss with some lens designs is also a concern and is being studied rigorously.

Some ophthalmologists in the United States are currently implanting PIOLs as part of an FDA clinical trial. The procedure holds a lot of promise for extremely nearsighted and farsighted individuals. Ophthalmologists are eager to see how PIOL implants fare in current studies using newer lens designs and implantation techniques These lenses are currently being used in Europe and South America with very high success rates. The results of the U.S clinical trial will be presented to the FDA with the hope that it will authorize other eye surgeons to use this exciting new technology.

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Beyond LASIK: A Complete List Of Eye Corrective Procedures (Pt 1)

Photorefractive Keratectomy (PRK): Laser vision correction with PRK is very similar to LASIK. The biggest difference is that no microkeratome is used and no corneal flap is created. Instead, the excimer laser makes its correction directly on the surface of your cornea, removing the central epithelium and Bowman's layer (the second corneal layer) in the process. This results in several days of potential discomfort and blurred vision until the epithelium regenerates.

The actual laser part of the procedure takes twenty to ninety seconds. At the end of the procedure, a clear-bandage contact lens is placed over your eye to help keep you comfortable while the corneal epithelium regenerates (usually three to five days).

A typical PRK procedure takes about three to five minutes per eye. Operating on just one eye, or both eyes on the same day, is a decision to be made by the patient after discussing the pros and cons with the surgeon. Because the return of functional vision is prolonged under PRK, most surgeons prefer to wait at least one week before operating on the second eye.

Patients with certain corneal problems, such as an irregular corneal surface or a thin cornea, may be better candidates for PRK than for LASIK. The ultimate visual results are similar with PRK, although the recovery is somewhat prolonged in comparison.

One advantage of PRK over LASIK is that there is no risk of flap complications since no corneal flap is created. However, other potential complications of PRK are similar to those of LASIK. They include undercorrection, overcorrection, induced astigmatism, dry eye, haze, night glare and halos, loss of best corrected vision, infection or severe inflammation, and regression. Other disadvantages of PRK include the need for anti-inflammatory eye-drops for three months and the risk of corneal haze or scarring.

Regression occurs when a patient appears to be adequately treated on the first few postoperative visits, but over the next several weeks to months begins to return toward the original prescription. The amount of regression is usually small; however, occasionally it is visually significant and requires an enhancement procedure. The enhancement procedure is usually performed six to nine months after the original procedure. The time period before the return of optimal vision is significantly longer than with an enhancement after LASIK.

Intacs Corneal Ring Segments: Approved by the FDA in April 1999, Intacs corneal ring segments offer patients with mild myopia and minimal astigmatism another option for correcting their nearsightedness. Currently, the rings are approved for correction of nearsightedness up to 3.00 diopters in patients twenty-one years or older who have no more than 1.00 diopter of astigmatism. This procedure does not correct astigmatism. Patients who have astigmatism - even less than 1.00 diopter - need to understand they will be astigmatic postoperatively. Intacs are newer than LASIK and PRK, so they don't yet have a track record like the other two procedures.

With Intacs, two small plastic ring segments are inserted in the peripheral cornea through small incisional channels. A temporary suture is then used to close the incision. The rings cause the central cornea to flatten. The rings are intended to be permanent, but they may be removed if the patient wishes to reverse the correction. In clinical trials, when the rings were removed, many patients' eyes went back to their preoperative state. In some patients, they did not. Because some patients' eyes did not return exactly to their preoperative condition, the PDA will not allow the use of the term reversible, but Intacs are certainly removable if desired.

Intacs insertion takes slightly longer than LASIK, roughly fifteen minutes per eye under anesthetic drops. The recovery of clear vision takes slightly longer than LASIK. In addition, patients tend to experience more postoperative discomfort.

The cost of Intacs is roughly equal to, or more than, LASIK in most centers. Removal of the rings, either for fine-tuning the result or from dissatisfaction, is accomplished with a second surgery. The segments are removed, the eyes are allowed to heal, and an alternate procedure (such as LASIK, PRK, or a change in ring size) may be performed once the eyes have healed. The treatment range for Intacs is currently very limited.

Radial Keratotomy (RK): Until excimer lasers became available, radial keratotomy (RK) was the most commonly performed refractive procedure for nearsighted patients. With the aid of a high-powered microscope, the surgeon makes a series of radial microscopic incisions (usually between four and eight) on the surface of the cornea to reduce its curvature. This procedure was well suited for patients with low myopia and has been used for over twenty-five years. One form of RK, mini-RK, is still used occasionally for very minute degrees of nearsightedness, such as those resulting from slight undercorrections in LASIK or following cataract or clear lens extraction surgery.

Although outdated by excimer laser techniques, RK is still an effective procedure. It is used in those areas of the world that do not have access to the much more expensive laser technologies.

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Am I Qualified To Have Eye Surgery?

That's one of the first questions most people ask about refractive surgery. What they really want to know is: Will I be happy with my eyesight after my operation? Unfortunately, there is no simple formula to determine answers to these questions. Although general guidelines help eye doctors decide who might benefit from refractive surgery, each candidate must be carefully reviewed on a case-by-case basis. That is why you go to your eye doctor for individualized care and advice. Every operation must be considered in terms of a benefit-to-risk ratio for that specific patient. With elective surgery, it always pays to be conservative.

Figuring out if you might be a good candidate for refractive surgery is as much an art as a science. How will your doctor decide if you will be happy with your outcome? The process is inexact. Looking for people with reasonable expectations, eye doctors try to screen out patients who expect perfect results. Of course, what the laser does is science. With excimer laser surgery, your doctor enters a specific set of numbers into the laser's computer, and the software executes the instructions that control the laser pulses. But how does your doctor decide what numbers should be put in the computer? He must consider how your age will affect your wound-healing response and also must enter data in the computer that will produce a result that will work for your individual eyes and lifestyle. It takes long experience talking with many patients before and after each type of procedure to do this well.

Your doctor will want to know if you are happy with your eyesight with contact lenses. If you are, then the physician can attempt to duplicate your prescription with laser surgery. If you are thrilled with your vision with contact lenses that undercorrect your nearsightedness, your doctor can be more conservative in programming your surgical refraction. In other words, by targeting your correction at slightly under 20/20 in the distance, the risk of making you farsighted or overcorrecting you can be diminished. After discussing your personal expectations, your job, and your hobbies - and studying your eye examination and history - your surgeon must pick the exact numbers to put in the computer that, along with your healing response, will determine your future vision. This is the art of vision correction surgery.

Successful eye surgeons want to match your expectations to what they can deliver. Doctors look for indications that patients are highly motivated to improve their vision. Striving to operate on people who will be pleased with their outcomes, ophthalmologists should avoid performing surgery on anyone who expresses major doubts about a procedure. After years of observing patients' reactions to refractive surgery, physicians who specialize in this field start to develop a "sixth sense" about who will be happy with the results. But no matter how long surgeons have performed laser surgery, they continue to learn more from their patients. Such invaluable experience helps doctors identify people who should avoid having these elective procedures.

The range or degree of your refractive error is a key consideration in determining whether you are a good surgery candidate. Your physician will measure your corrected and uncorrected visual acuity. If you are nearsighted, can you read the 20/30 line on the eye chart? Or do you strain to see the big E (about 20/400 on some charts)? Generally, the higher the correction, the greater the motivation to have a laser operation.

LASIK surgery, unlike radial keratotomy (the older, non-laser operation), can improve a wide range of refractive errors, including farsightedness. Nearsighted persons currently can be treated if their refraction is between -1 and -12 diopters - sometimes, depending on the individual case, up to -14 diopters. Although extremely myopic people need help the most, LASIK can leave some of these patients with an unacceptable amount of residual error, meaning that they still will need glasses for distance. So if your correction is greater than -14 diopters, you may want to wait until medical technology has more to offer you. LASIK could improve your vision, but you probably still would have to wear corrective lenses after surgery.

Years ago, in doing refractive surgery before the modern LASIK technique was available, doctors often had to tell extremely near-sighted patients, "We're sorry. You're not a candidate. We can only make your vision about 50 percent better." Some people would respond, "I'll take it! I would like to have thinner glasses. I want to be less helpless without correction." They had reasons for seeking even a partial improvement in their eyesight. For them, better was better, whether better was perfect or not. Other patients would say, "Well. if you only can make my eyesight 50 percent better, why bother having surgery? I would still have to wear glasses even though they would be thinner." For these patients, not having a refractive operation would be the correct choice.

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