LASIK stands for Laser Assisted In Situ
Keratomileusis. In LASIK surgery, precise and controlled removal of corneal
tissue by a special laser reshapes the cornea changing its focusing power.
The eye and vision
errors
The cornea is a part of the eye that helps focus light to create an image on the
retina. It works in much the same way that the lens of a camera focuses light to
create an image on film. The bending and focusing of light is also known as
refraction. Usually the shape of the cornea and the eye are not perfect and the
image on the retina is out-of-focus (blurred) or distorted. These imperfections
in the focusing power of the eye are called refractive errors.
You are probably NOT a good candidate for
refractive surgery if:
You are not a risk taker
.
Certain complications are unavoidable in a percentage of patients, and there
are no long-term data available for current procedures.
It will jeopardize your career.
Some jobs prohibit certain refractive procedures. Be
sure to check with your employer/professional society/military service before
undergoing any procedure.
Cost is an issue.
Most medical insurance will not pay for refractive
surgery. Although the cost is coming down, it is still significant.
You required a change in your contact lens or
glasses prescription in the past year.
This is called refractive instability. Patients who are:
In their early 20s or younger,
Whose hormones are fluctuating due to disease such
as diabetes,
Who are pregnant or breastfeeding, or
Who are taking medications such as steroids that
cause fluctuations in vision,
are more likely to have refractive instability and
probably should not have a refractive procedure.
You have a disease (e.g. lupus, rheumatoid
arthritis) or are on medications that may affect wound healing
.
Certain conditions, such as autoimmune diseases and immunodeficiency states,
and some medications, such as retinoic acid and steroids, may prevent proper
healing after a procedure.
You actively participate in contact sports.
You participate in boxing, wrestling, martial arts or other activities in
which blows to the face and eyes are a normal occurrence.
You are not an adult. Currently, no lasers
are approved for LASIK on persons under the age of 18.
Contraindications
The safety and effectiveness of refractive procedures has not been determined in
patients with some diseases. Do NOT have LASIK surgery if you have a history of
any of the following:
Herpes simplex or Herpes zoster (shingles) involving
the eye area.
Glaucoma, glaucoma suspect, or ocular hypertension.
Eye diseases, such as uveitis/iritis (inflammations
of the eye) and blepharitis (inflammation of the eyelids with crusting of the
eyelashes).
Eye injuries or previous eye surgeries.
Keratoconus
Other Risk Factors
Your doctor should screen you for the following conditions or indicators of
risk:
Large pupils.
Make sure this evaluation is done in a dark room. Younger patients and
patients on certain medications may be prone to having large pupils under dim
lighting conditions. This can cause symptoms such as glare, halos, starbursts,
and ghost images (double vision) after surgery. In some patients these
symptoms may be debilitating. For example, a patient may no longer be able to
drive a car at night or in certain weather conditions, such as fog.
Thin Corneas.
The cornea is the thin clear covering of the eye that is over the iris, the
colored part of the eye. Most refractive procedures change the eye’s focusing
power by reshaping the cornea (for example, by removing tissue). Performing a
refractive procedure on a cornea that is too thin or has too few cells lining
the back surface (endothelial cells) may result in blinding complications.
Previous refractive surgery (e.g. RK, PRK,
LASIK). Additional refractive surgery may not be recommended. The
decision to have additional refractive surgery must be made in consultation
with your doctor after careful consideration of your unique situation.
Most patients are very pleased with the results of
their refractive surgery. However, like any other medical procedure, there are
risks involved. That's why it is important for you to understand the limitations
and possible complications of refractive surgery.
Before undergoing a refractive procedure, you should
carefully weigh the risks and benefits based on your own personal value system,
and try to avoid being influenced by friends that have had the procedure or
doctors encouraging you to do so.
You may be undertreated or overtreated.
Only a certain percent of patients achieve 20/20
vision without glasses or contacts. You may require additional treatment, but
additional treatment may not be possible. You may still need glasses or
contact lenses after surgery. If you used reading glasses before surgery, you
will still need reading glasses after surgery.
Results are generally not as good in patients with
very small or very large refractive errors.
Patients that require rather weak or very strong
glasses or contact lens prescriptions to see well before the procedure are
less likely to have 20/20 vision without glasses or contacts after the
procedure.
Results may not be lasting.
The level of improved vision you experience after
surgery may be temporary, especially if you are farsighted or currently need
reading glasses. It is especially important for farsighted individuals to have
a cycloplegic refraction (a vision exam with lenses after dilating drops) as
part of the screening process. Patients whose manifest refraction (a vision
exam with lenses before dilating drops) is very different from their
cycloplegic refraction are more likely to have temporary results.
Some patients lose vision.
Some patients lose lines of vision on the vision
chart that cannot be corrected with glasses, contact lenses, or surgery as a
result of treatment. There is little known about how refractive procedures
affect other aspects of vision, such as contrast sensitivity (the ability to
see objects clearly against a similar background or in dim lighting
conditions). Some studies suggest that patients do not see as well in
situations of low contrast, such as at night or in fog, after treatment as
compared to before treatment. Therefore, patients with low contrast
sensitivity to begin with probably should not have a refractive procedure. It
is important for you to know that not all eye centers test contrast
sensitivity, and that when it is tested, it should be done in a dark room.
Some patients may develop severe dry eye
syndrome. As a result of surgery, your eye may not be able to produce
enough tears to keep the eye moist and comfortable. This condition may be
permanent. Intensive drop therapy and the use of plugs or other procedures
may be required.
Additional Risks if you are Considering the
Following:
Monovision
Monovision is one clinical technique used to deal with
the correction of presbyopia, the gradual loss of the ability of the eye to
change focus for close-up tasks that progresses with age. The intent of
monovision is for the presbyopic patient to use one eye for distance viewing and
one eye for near viewing. This practice was first applied to fit contact lens
wearers and more recently to LASIK and other refractive surgeries. With contact
lenses, a presbyopic patient has one eye fit with a contact lens to correct
distance vision, and the other eye fit with a contact lens to correct near
vision. In the same way, with LASIK, a presbyopic patient has one eye operated
on to correct the distance vision, and the other operated on to correct the near
vision. In other words, the goal of the surgery is for one eye to have vision
worse than 20/20, the commonly referred to goal for LASIK surgical
correction of distance vision. Since one eye is corrected for distance viewing
and the other eye is corrected for near viewing, the two eyes no longer work
together. This results in poorer quality vision and a decrease in depth
perception. These effects of monovision are most noticeable in low lighting
conditions and when performing tasks requiring very sharp vision. Therefore, you
may need to wear glasses or contact lenses to fully correct both eyes for
distance or near when performing visually demanding tasks, such as driving at
night, operating dangerous equipment, or performing occupational tasks requiring
very sharp close vision (e.g., reading small print for long periods of time).
Many patients cannot get used to having one eye
blurred at all times. The difference between monovision with contact lenses and
monovision with LASIK is that you can always take contact lenses out or have
them changed (the treatment is reversible and adjustable) as opposed to LASIK,
where the result of the surgery is not reversible or adjustable.
Therefore, if you are considering monovision with LASIK, make sure you go
through a trial period with contact lenses to see if you can tolerate monovision,
before having the irreversible surgery performed on your eyes. Just before this
trial period starts, find out if you pass your state's driver's license
requirements with monovision, or if you need supplemental glasses to drive.
In addition, you should consider how much your
presbyopia is expected to increase in the future. Ask your doctor when you
should expect the results of your monovision surgery to no longer be enough for
you to see near-by objects clearly without the aid of glasses or contacts, or
when a second surgery might be required to further correct your near vision.
Bilateral Simultaneous Treatment
You may choose to have LASIK surgery on both eyes at
the same time or to have surgery on one eye at a time. Although the convenience
of having surgery on both eyes on the same day is attractive, this practice is
riskier than having two separate surgeries. The second eye may have a higher
risk of developing an inflammation if surgery is done on the same day than if
surgery is performed on separate days. If a malfunction of the laser or
microkeratome occurs causing a complication with the first eye, the second eye
is more likely to also experience the same complication if the surgery is
performed on the same day rather than on separate days.
If you decide to have one eye done at a time, you and
your doctor will decide how long to wait before having surgery on the other eye.
If both eyes are treated at the same time or before one eye has a chance to
fully heal, you and your doctor do not have the advantage of being able to see
how the first eye responds to surgery before the second eye is treated.
Another disadvantage to having surgery on both eyes at
the same time is that the vision in both eyes may be blurred after surgery until
the initial healing process is over, rather than being able to rely on clear
vision in at least one eye at all times.
Even the best screened patients under the care of most
skilled surgeons can experience serious complications.
During surgery.
Malfunction of a device or other error, such as
cutting a flap of cornea through and through instead of making a hinge during
LASIK surgery, may lead to discontinuation of the procedure or irreversible
damage to the eye.
After surgery.
Some complications, such as migration of the flap, inflammation or infection,
may require another procedure and/or intensive treatment with drops. Even with
aggressive therapy, such complications may lead to temporary loss of vision or
even irreversible blindness.
Under the care of an experienced doctor, carefully
screened candidates with reasonable expectations and a clear understanding of
the risks and alternatives are likely to be happy with the results of their
refractive procedure.
What to expect before, during, and after surgery will
vary from doctor to doctor and patient to patient. This section is a
compilation of patient information developed by manufacturers and healthcare
professionals, but cannot replace the dialogue you should have with your
doctor. Read this information carefully and with the
checklist, discuss your
expectations with your doctor.
Before Surgery
If you decide to go ahead with LASIK surgery, you will need an initial or
baseline evaluation by your eye doctor to determine if you are a good candidate.
This is what you need to know to prepare for the exam and what you should
expect:
If you wear contact lenses, it is a good idea
to stop wearing them before your baseline evaluation and switch to
wearing your glasses full-time. Contact lenses change the shape of your cornea
for up to several weeks after you have stopped using them depending on the type
of contact lenses you wear. Not leaving your contact lenses out long enough for
your cornea to assume its natural shape before surgery can have negative
consequences. These consequences include inaccurate measurements and a poor
surgical plan, resulting in poor vision after surgery. These measurements, which
determine how much corneal tissue to remove, may need to be repeated at least a
week after your initial evaluation and before surgery to make sure they have not
changed, especially if you wear RGP or hard lenses. If you wear:
soft contact lenses, you should stop wearing
them for 2 weeks before your initial evaluation.
toric soft lenses or rigid gas permeable (RGP)
lenses, you should stop wearing them for at least 3 weeks before your
initial evaluation.
hard lenses, you should stop wearing them for
at least 4 weeks before your initial evaluation.
You should tell your doctor:
about your past and present medical and eye
conditions
about all the medications you are taking, including
over-the-counter medications and any medications you may be allergic to
Your doctor should perform a thorough eye exam
and discuss:
whether you are a good candidate
what the risks, benefits, and alternatives of the
surgery are
what you should expect before, during, and after
surgery
what your responsibilities will be before, during,
and after surgery
You should have the opportunity to ask your doctor
questions during this discussion. Give yourself plenty of time to think about
the risk/benefit discussion, to review any informational literature provided by
your doctor, and to have any additional questions answered by your doctor before
deciding to go through with surgery and before signing the informed consent
form.
You should not feel pressured by your doctor, family,
friends, or anyone else to make a decision about having surgery. Carefully
consider the pros and cons.
The day before surgery, you should stop using:
creams
lotions
makeup
perfumes
These products as well as debris along the eyelashes
may increase the risk of infection during and after surgery. Your doctor may ask
you to scrub your eyelashes for a period of time before surgery to get rid of
residues and debris along the lashes.
Also before surgery, arrange for transportation
to and from your surgery and your first follow-up visit. On the day of surgery,
your doctor may give you some medicine to make you relax. Because this medicine
impairs your ability to drive and because your vision may be blurry, even if you
don't drive make sure someone can bring you home after surgery.
During Surgery
The surgery should take less than 30 minutes. You will lie on your back in a
reclining chair in an exam room containing the laser system. The laser system
includes a large machine with a microscope attached to it and a computer screen.
A numbing drop will be placed in your eye, the area
around your eye will be cleaned, and an instrument called a lid speculum will be
use to hold your eyelids open. A ring will be placed on your eye and very high
pressures will be applied to create suction to the cornea. Your vision will dim
while the suction ring is on and you may feel the pressure and experience some
discomfort during this part of the procedure. The microkeratome, a cutting
instrument, is attached to the suction ring. Your doctor will use the blade of
the microkeratome to cut a flap in your cornea.
The microkeratome and the suction ring are then
removed. You will be able to see, but you will experience fluctuating degrees of
blurred vision during the rest of the procedure. The doctor will then lift the
flap and fold it back on its hinge, and dry the exposed tissue.
The laser will be positioned over your eye and you
will be asked to stare at a light. This is not the laser used to remove
tissue from the cornea. This light is to help you keep your eye fixed on one
spot once the laser comes on. NOTE: If you cannot stare at a fixed object
for at least 60 seconds, you may not be a good candidate for this surgery.
When your eye is in the correct position, your doctor
will start the laser. At this point in the surgery, you may become aware of new
sounds and smells. The pulse of the laser makes a ticking sound. As the laser
removes corneal tissue, some people have reported a smell similar to burning
hair. A computer controls the amount of laser delivered to your eye. Before the
start of surgery, your doctor will have programmed the computer to vaporize a
particular amount of tissue based on the measurements taken at your initial
evaluation. After the pulses of laser energy vaporize the corneal tissue, the
flap is put back into position.
A shield should be placed over your eye at the end of
the procedure as protection, since no stitches are used to hold the flap in
place. It is important for you to wear this shield to prevent you from rubbing
your eye and putting pressure on your eye while you sleep, and to protect your
eye from accidentally being hit or poked until the flap has healed.
Immediately after the procedure, your eye may burn, itch, or feel like there is
something in it. You may experience some discomfort, or in some cases, mild pain
and your doctor may suggest you take a mild pain reliever. Both your eyes may
tear or water. Your vision will probably be hazy or blurry. You will
instinctively want to rub your eye, but don't! Rubbing your eye could dislodge
the flap, requiring further treatment. In addition, you may experience
sensitivity to light, glare, starbursts or haloes around lights, or the whites
of your eye may look red or bloodshot. These symptoms should improve
considerably within the first few days after surgery. You should plan on taking
a few days off from work until these symptoms subside. You should contact
your doctor immediately and not wait for your scheduled visit, if you
experience severe pain, or if your vision or other symptoms get worse instead of
better.
You should see your doctor within the first 24 to
48 hours after surgery and at regular intervals after that for at least the
first six months. At the first postoperative visit, your doctor will remove the
eye shield, test your vision, and examine your eye. Your doctor may give you one
or more types of eye drops to take at home to help prevent infection and/or
inflammation. You may also be advised to use artificial tears to help lubricate
the eye. Do not resume wearing a contact lens in the operated eye, even if your
vision is blurry.
You should wait one to three days following
surgery before beginning any non-contact sports, depending on the amount of
activity required, how you feel, and your doctor's instructions.
To help prevent infection, you may need to wait for up
to two weeks after surgery or until your doctor advises you otherwise
before using lotions, creams, or make-up around the eye. Your doctor may advise
you to continue scrubbing your eyelashes for a period of time after surgery. You
should also avoid swimming and using hot tubs or whirlpools for 1-2 months.
Strenuous contact sports such as boxing, football,
karate, etc. should not be attempted for at least four weeks after
surgery. It is important to protect your eyes from anything that might get in
them and from being hit or bumped.
During the first few months after surgery, your
vision may fluctuate.
It may take up to three to six months for your
vision to stabilize after surgery.
Glare, haloes, difficulty driving at night, and
other visual symptoms may also persist during this stabilization period. If
further correction or enhancement is necessary, you should wait until your eye
measurements are consistent for two consecutive visits at least 3 months apart
before re-operation.
It is important to realize that although distance
vision may improve after re-operation, it is unlikely that other visual
symptoms such as glare or haloes will improve.
It is also important to note that no laser company
has presented enough evidence for the FDA to make conclusions about the safety
or effectiveness of enhancement surgery.
Contact your eye doctor immediately, if you
develop any new, unusual or worsening symptoms at any point after surgery. Such
symptoms could signal a problem that, if not treated early enough, may lead to a
loss of vision.
Career impact - does your job prohibit refractive surgery?
Cost - can you really afford this procedure?
Medical conditions - e.g., do you have an autoimmune disease or
other major illness? Do you have a chronic illness that might slow or alter
healing?
Eye conditions - do you have or have you ever had any problems
with your eyes other than needing glasses or contacts?
Medications - do you take steroids or other drugs that might
prevent healing?
Stable refraction - has your prescription changed in the last
year?
High or Low refractive error - do you use glasses/contacts only
some of the time? Do you need an unusually strong prescription?
Pupil size - are your pupils extra large in dim conditions?
Corneal thickness - do you have
thin corneas?
Know all the risks and procedure
limitations
Overtreatment or undertreatment - are you willing and able to
have more than one surgery to get the desired result?
May still need reading glasses - do you have presbyopia?
Results may not be lasting - do you think this is the last
correction you will ever need? Do you realize that long-term results are not
known?
May permanently lose vision - do you know some patients may lose
some vision or experience blindness?
Development of visual symptoms - do you know about glare, halos,
starbursts, etc. and that night driving might be difficult?
Contrast sensitivity - do you know your vision could be
significantly reduced in dim light conditions?
Bilateral treatment - do you know the additional risks of having
both eyes treated at the same time?
Patient information - have you
read the patient information booklet about the laser being used for your
procedure?
Know preoperative, operative, and
postoperative expectations
No contact lenses prior to evaluation and surgery - can you go
for an extended period of time without wearing contact lenses?
Have a thorough exam - have you arranged not to drive or work
after the exam?
Read and understand the informed consent - has your doctor given
you an informed consent form to take home and answered all your questions?
No makeup before surgery - can you go 24-36 hours without makeup
prior to surgery?
Arrange for transportation - can someone drive you home after
surgery?
Plan to take a few days to recover - can you take time off to take it easy for a
couple of days if necessary?
Expect not to see clearly for a few days - do you know you will
not see clearly immediately?
Know sights, smells, sounds of surgery - has your doctor made you
feel comfortable with the actual steps of the procedure?
Be prepared to take drops/medications- are you willing and able
to put drops in your eyes at regular intervals?
Be prepared to wear an eye shield - do you know you need to
protect the eye for a period of time after surgery to avoid injury?
Expect some pain/discomfort - do you know how much pain to
expect?
Know when to seek help - do you understand what problems could occur and when to
seek medical intervention?
Know when to expect your vision to stop changing - are you aware
that final results could take up to months?
Make sure your refraction is stable before any further surgery -
if you don't get the desired result, do you know not to have an enhancement
until the prescription stops changing?
There are several ways of reaching the ophthalmologists of EYE REPUBLIC Ophthalmology Clinic:
Hover note: Please place your mouse cursor over the red box
to click on the web and email links. For websites, a new browser
window will open. For emails, your default email program will
open. You may cut and paste the URLs or email addresses if you
prefer not to open new windows.
ONLINE ACCESS
WEBSITES.
http://www.EyeRepublic.com.ph - EYE REPUBLIC
Ophthalmology Clinic
http://www.OCP.com.ph - Ophthalmic
Consultants Philippines Co. -
http://www.LASIK.com.ph - Refractive
Surgery Resource
http://www.Cataract.com.ph - Cataract Surgery Resource
http://www.Eye.com.ph - Eye
Information Online
http://www.EyeDoc4Kids.com.ph - Eye Information for Kids
http://www.Retina.com.ph - Retina
Surgery Resource
http://www.Glaucoma.com.ph - Glaucoma
Online
http://www.Uveitis.com.ph - Uveitis Online
EMAIL. After writing down your comments,
suggestions, problems and/or questions, kindly tell us how
to get in touch with you by providing your name, email,
home/office numbers, and mobile phone.
General inquiries - help@EyeRepublic.com.ph
Refractive Surgery Service - refractive.surgery@EyeRepublic.com.ph
Glaucoma Service - glaucoma@EyeRepublic.com.ph
Cataract Service - cataract@EyeRepublic.com.ph
Doctors - eyemd@EyeRepublic.com.ph
Administrative - president@EyeRepublic.com.ph
Website - webmaster@EyeRepublic.com.ph
Newsletter -
newsletter@EyeRepublic.com.ph (receive
news and updates, discounts and promotions)
BLOG. Send us your comments.
EYE REPUBLIC
Ophthalmology Atlas
CLINIC INFORMATION
Mobile E-Yellow Pages. Via
SMS, text LUK4 EYEREPUBLIC
(send to 2851 for Globe and Sun Cellular, and 2951 for Smart).
Initial laser shots at the optical zone.
LASIK flap made. 
