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What is LASIK?LASIK eye surgery – short for Laser-Assisted In Situ Keratomileusis – is a procedure that uses a laser to correct refractive errors. Though other forms of laser vision correction exist, LASIK is often regarded as the best combination of precision, simplicity, and ease of recovery in laser eye surgery. LASIK has been perfected to the point that almost all patients improve vision to better than 20/40, and the majority reach 20/20. Including preparation, the entire process only takes about an hour, and the operation itself is unlikely to take longer than fifteen minutes. And, unlike other refractive techniques, recovery is usually fairly painless and complication free. Who is a Candidate for LASIK?Candidates for LASIK must have a strong desire to eliminate their dependency on corrective lenses. Also important is a cornea of significant thickness and of a fairly regular shape. The pupils must also be checked to ensure that they do not dilate to a diameter greater than that of the area to be ablated, which would create blind spots. Other risk factors for patients considering LASIK include:
How is LASIK Performed?LASIK begins with an initial consultation between doctor and patient. The two will discuss all refractive surgery options, and decide which one might be best for the patient. If it is decided that LASIK is the best choice, then the doctor will instruct the patient on how to prepare for LASIK surgery. A few weeks later, the patient comes in for the LASIK operation. The surgery may leave the eyes sensitive to light, so it is best to have someone else there to drive afterwards. The patient is called in and asked to sit in a reclining chair. He or she is then leaned back and the doctor places anesthetic eye drops in the eyes. With this anesthetic, the patient feels almost nothing throughout the procedure. Next, a device called a lid speculum is swung into place. The lid speculum holds the eyelids open while the LASIK doctor operates on the eye. A cutting instrument called a microkeratome is then attached to the lid speculum. The LASIK surgeon uses the microkeratome to cut a small flap in the outer layers of the eye’s cornea. The cut creates a ‘flap’ in the epithelium (thin outermost layer of the cornea) and stroma (thicker, more stable layer just beneath the epithelium), exposing the corneal bed for ablation (vaporization) by the laser. A hinge is left at one side, leaving the flap attached to the rest of the cornea. The width of the flap is important: if it is not wide enough, the laser cannot ablate the corneal tissue that sits at the periphery of the patient’s field of vision, and these points will be fuzzy. If something goes wrong in creating the flap, oftentimes the surgeon can stop the procedure immediately and reschedule the surgery for a later date. If the flap is completed to the doctor’s satisfaction, the microkeratome is pulled away and the eye tissue is dried. Next, the surgeon moves the excimer laser into place. The patient will be asked to practice focusing on a small light; this is preparation for the laser ablation process, and he or she will be asked to do the same while the laser is on. Once the surgeon is sufficiently convinced that the patient can maintain this focus, ablation can begin. At this point, the laser is turned on. The patient will hear a clicking noise and will probably smell the tissue of the eye burning, though little or nothing will be felt because of the anesthetic. The laser is typically used to remove tissue at the center of the eye to correct nearsightedness, at the periphery for farsightedness, and at various spots for astigmatism. It only takes about a minute to remove the predetermined amount of tissue. The laser is then shut down, the lid speculum removed, and the flap put back into place with a special spatula. Typically, no stitches are necessary; the surgeon simply keeps an eye on the flap for a few minutes to make sure that it settles back into place properly. The patient may be issued a protective eye shield to wear for a few days. What Complications Can Occur from LASIK?Most LASIK patients experience some mild after effects from the procedure. LASIK side effects include discomfort, hazy vision, sensitivity to light, and a number of other visual effects. Most of these last for only a few weeks. However, some, such as starbursts and haloes emanating from light sources, can remain for months or much longer. More serious LASIK complications are few, but do sometimes occur. Vision may be under- or overcorrected, but this can usually be solved with a second procedure. Certain flap complications, such as wrinkles, can usually be smoothed out in a visit with the ophthalmologist. Inflammation under the flap can sometimes occur, but is usually treatable with antibiotics or medication if caught early. Finally, decentered ablation with the laser can induce astigmatism, which can be difficult to treat. Patients can check with a LASIK specialist to find out more about these or other complications. |