Brought to you by Vision Quest Medical Center, expert(s) at Opthalmic Surgery.

Bringing Lasik surgery into focus

A growing number of people are finding they no longer have to live with poor eyesight. Instead of depending on glasses or contact lenses, they are undergoing Lasik surgery in an effort to bring their world into focus.

What is Lasik?

Laser in situ keratomileusis (LASIK) is a surgical procedure to reduce nearsightedness, farsightedness and astigmatism by reshaping tissue in the cornea, the clear covering of the front of the eye.
It evolved from a variety of refractive surgery techniques including photorefractive keratectomy (PRK). In LASIK, an automated device called a microkeratome is used to create a thin flap in the cornea that is lifted. An excimer laser is then used to reshape the underlying corneal tissue and the flap is replaced over the treated area.
The Food and Drug Administration first approved the excimer laser in 1995 for the PRK correction of nearsightedness and in 1998 for the Lasik correction of nearsightedness with or without astigmatism.

Is it Safe?

The American Academy of Ophthalmology looked at a number of scientific studies and found that Lasik is safe and effective for correcting low-to-moderate nearsightedness and astigmatism. However, the Academy also found the results of Lasik are less predictable in eyes with moderate-to-high nearsightedness.
The Academy found serious complications resulting in permanent visual loss rarely happen with Lasik, but side effects such as dry eyes, nighttime starbursts and reduced ability to see in dim light occur more frequently. Your doctor should talk to you about the possible risks and side effects of Lasik.

Who Shouldn't Have Lasik?

Lasik is an excellent procedure for many, but not all, people with refractive errors. Those who are not good candidates should not have the surgery.

If you have any of the following conditions, you may not be a good candidate for Lasik:
- Uncontrolled or advanced glaucoma
- Pregnant or breastfeeding
- Diabetes
- Some autoimmune disorders (rheumatoid arthritis, lupus, HIV/AIDS)
- Use of Prednisone pills or drops
- Dry eyes
- Irritation of the eyelids with itching and scaly skin
- Pupil size over seven millimeters
- Warped or thin corneas
- Genetic or metabolic problems affecting the cornea

If you wear contact lenses, especially rigid lenses, before performing Lasik your doctor will examine you using a series of measurements to see if your corneas are warped. Your eye doctor may ask you to remove your rigid contact lenses for several weeks or months, and soft contact lenses for several days or weeks prior to examination to allow your cornea to return to its normal shape.

Is Lasik Better Than PRK?

Lasik has become more popular than PRK for a number of reasons, including the fact that vision stabilizes sooner after surgery and there is less discomfort following surgery. Lasik patients also see faster improvement in vision and experience less corneal haze.
People who need higher levels of correction, vision is more predictable and stable with Lasik, and the corneas are clearer. These patients also spend less time on pain medication after surgery and if enhancement procedures are needed, they are easier.
However, Lasik may not be the best procedure for you. Other procedures such as PRK may be better suited for you. Your doctor will work with you to determine which, if any, procedure is best for you.

Will Lasik Create 20/20 Vision?

It might, but even after Lasik, you may not be able to throw away your glasses and contacts. Studies have shown that the majority of people who have Lasik will come away with 20/40 vision or better without the need of glasses or contact lenses.
Some people choose to have a second surgery, referred to as an enhancement, to further refine their vision and reduce their dependence on glasses or contact lenses. However, most people who have had Lasik will need reading glasses as they get into their 40s and 50s.

If You're Considering Lasik

Talk to an eye doctor to determine if you are a good candidate for the procedure. If you have any of the conditions mentioned earlier, you may not be.

If your doctor determines that you are a good candidate, before setting a date for surgery, find out:
- The possible risks and complications
- The experience of your surgeon
- The outcomes of the procedures performed by your surgeon
- The percent of patients returning for secondary procedures (enhancements)
- Whether your surgeon is using a laser approved by the FDA
- What is involved in after-surgery care
- Who will handle and be responsible for after-surgery care

If considering Lasik, it is important to understand that it is surgery and results cannot be guaranteed. Before making a decision about getting Lasik, make sure the surgeon fully explains the risks and benefits of the procedure. Those who expect perfect vision from Lasik may be disappointed.

Risks

Lasik is an outpatient surgical procedure, but like any surgery, it has risks that need to be carefully considered.

Lasik risk rates, types and degrees vary widely from person to person. The most common side effects are:
- Dry eye
- Changing and blurry vision
- Light sensitivity and glare
- Undercorrection or overcorrection
- Nighttime haloes and starbursts
- Temporary discomfort

For most people, these side effects resolve or decrease with time. Approximately 5 percent are undercorrected and return for enhancements.

Rare sight-threatening complications of LASIK are:
- Corneal infection
- Corneal inflammation
- Permanent vision loss
- Problems with the flap that is created in the cornea during surgery
- Foreign matter under flap

Fortunately, for some people, the side effects wear off or can be improved with glasses, contact lenses or additional laser surgery.

If You Choose Lasik

Before surgery, your doctor should give you an informed consent form. Make sure you read and understand it completely and get all the answers to your questions. Also, make arrangements from someone to drive you home after the surgery.
Plan to take at least two days off of work to rest and recuperate. Patients typically experience pain for a few days and most people will not be able to see clearly for a few days following the surgery. It could take several months to see final results.

Things to Consider

- Find the right doctor. Find out how many Lasik surgeries your doctor has done with the laser he or she will use, as well as if the laser is FDA-approved. Also, make sure the doctor takes the time to answer all your questions and that you feel at ease both getting and giving information to your doctor.
- Cost - Most medical insurance will not pay for this surgery.
- Lasik won't work well if your sight changes often. Vision changes are more likely if you are in your early 20s, are diabetic, pregnant, breastfeeding or taking medication that causes changes in vision.
- Laser eye surgery is not a good choice for those who play contact sports, including boxing, wrestling or martial arts.
- Laser surgery is not approved for anyone under age 18.

Conditions

Prior to surgery, your doctor should know your history of past or current eye diseases, including glaucoma and ocular hypertension. He or she should also know about other eye injuries, past laser surgeries, large pupils, thin corneas or dry eyes.

More Information

If you would like more information on LASIK, visit the American Academy of Ophthalmology's public information Web site at www.medem.com/eyemd.
Other sources of information on LASIK include the National Eye Institute at www.nei.nih.gov, the Food and Drug Administration at www.fda.gov and the Federal Trade Commission at www.ftc.gov.

Information Provided by the American Academy of Ophthalmology and the Food and Drug Administration.