LASIK MD Laser Eye Surgery – FAQ

LASIK MD Common Questions

You have questions, we have the answers! The laser eye doctors at LASIK MD have put together this frequently asked questions section in order to answer all of your laser vision correction questions! Just click on your question of interest and you will be directed to its answer.

LASIK surgery is a surgical procedure that corrects a wide range of nearsightedness (myopia), farsightedness (hyperopia) and astigmatism.

LASIK is the acronym for laser in situ keratomileusis, sometimes referred to as laser assisted in situ keratomileusis. The name refers to the use of a laser to reshape the cornea without invading the adjacent cell layers. In situ is Greek for "in the natural or normal place". Medically, in situ means “confined to the site of origin without invasion of neighbouring tissues”. Kerato is the Greek word for “cornea” and mileusis means "to shape".

LASIK vision correction has been performed around the world for more than 10 years. It was first performed in clinical trials in the U.S. in 1995. The major components of the procedure have a long history. Ophthalmologists have been reshaping the cornea for over 50 years, creating a protective layer of tissue over the cornea for over 35 years, and using the excimer laser since the 1980s.

LASIK eye surgery combines the precision of the excimer laser that is used in PRK surgeries with the corneal flap technique. It has greater precision than PRK vision correction, less complications, quicker recovery time, requires less post-operative eye drops, and is more comfortable.

LASIK eye surgery can benefit a great number of people with myopia, hyperopia and astigmatism. Candidates should have a strong desire to be less dependent on corrective lenses and willing to accept the risks of surgery. Learn more about benefits and eligibility.

There are a number of factors that doctors must evaluate before they can determine who is an eligible candidate for LASIK vision correction. Some doctors deem certain pre-existing conditions contraindications to the procedure and will not perform surgery if you possess them. Other conditions may complicate the laser eye surgery and increase your risk of developing a complication. Patients with these conditions need to consult their doctors in regards to eligibility and expectation levels. Learn more about eligibility.

Most surgeons agree that if you are comfortable wearing contact lenses and are not bothered by being dependent on them, you should carefully evaluate the risks and benefits of LASIK eye surgery. Ultimately, it will depend on your needs and lifestyle.

The price varies, depending on the conditions specific to the patient and the country. Find out about pricing in your area.

LASIK surgery improves the uncorrected vision—one's visual capacity while not wearing corrective lenses—in most patients who have the procedure. Over 90% of patients with low to moderate myopia achieve 20/40 vision, which most states and provinces consider good enough to drive without having to wear contacts or glasses, and many can expect to achieve 20/20 vision or better.

However, there are no guarantees that you will have perfect vision. Patients with high myopia (more than -8D) and high hyperopia (more than +4D) should have realistic expectations. People who are most satisfied with the results of laser correction clearly understand the potential risks and complications and possess realistic expectations as to what their vision will be like after surgery.

The effects of the LASIK procedure are permanent. The effects of LASIK eye surgery do not wear off, but it is important to realize that a person's eye can still change internally. That is why many vision correction surgeons recommend having the procedure done after the major eye changes have occurred in one's life. For instance, LASIK eye surgery is not recommended on children because their eyes change a great deal and their vision would need to be fine-tuned in a few years. If the procedure is performed after the age of 18, the chance of long-term stable correction is more likely. Even the eyes of patients over the age of 18 can still change. Therefore, we recommend a good conversation with your eye surgeon so that they can review the changes you have undergone and, if applicable; they can help you make a decision in regards to whether or not you should wait until the changes have slowed down.

Patients should also note that while results are usually stable, they can be modified by enhancement procedures – procedures performed after the initial one – if necessary.

No. Our team of eye care professionals can evaluate your eye prescription and assess your vision correction needs. However, it is always beneficial to seek the advice of your optometrist, ophthalmologist, or your family doctor. We also have a list of LASIK MD affiliate eye doctors in your area.

Retreatment may be a viable solution to vision changes later in life. However, it is important to be aware that other treatment options also exist. In due course, you should consult your eye doctor to determine the cause of the change and to determine which option is best for you. If a retreatment is required, a patient must wait at least 3 month after the initial laser eye surgery. Only 1 eye is done at a time (4 weeks between each eye.)

The whole procedure takes about 10 minutes for two eyes, including creating the flap and performing the laser procedure under the latter. The actual laser is used less than one minute. Learn more about what to expect before, during, and after the procedure.

Patients may experience some discomfort and/or blurred vision for a few hours after laser eye surgery. In addition, most patients receive a sedative prior to vision correction surgery. Therefore, you cannot drive home after undergoing the LASIK procedure and you should plan not to drive for at least twenty-four hours. Learn more about our recommended activity schedule after surgery.

The procedure is done with topical anesthetic (eye drops) to numb the eye. Patients may be given a small amount of oral sedative to help them relax.

Patients are given a topical anesthetic (eye drops) to numb the eye, so they experience no pain during the procedure. When the surgeon applies the vacuum ring, the patient experiences a sensation of slight pressure just before his or her vision fades away for a few seconds. The microkeratome – the instrument the surgeon uses to create the flap - and the laser do not cause any pain or discomfort. For several hours after the procedure, many patients describe a mild "foreign body" sensation, such as after opening the eyes while swimming in chlorinated water. Some people feel as though there is a dirty contact lens in their eye. After the first few hours, this uncomfortable feeling usually subsides.

You can have bilateral simultaneous LASIK eye surgery (both eyes done at the same time). In the vast majority of cases, bilateral LASIK eye surgery has been shown to be safe and effective. In fact, more than 95% of people choose to have both eyes done at the same time. If the surgery of your first eye is not perfect, your doctor will likely hold off on proceeding with the second eye. For more on bilateral surgery, consider the following resource:

• "Complications of Laser In Situ Keratomileusis for the Correction of Myopia" Ophthalmology, 1999; 106(1). (Published results of the Emory Study that considered 1062 eyes failed to notice any statistically significant differences with bilateral surgery.).
  
  

It depends on your occupation. Certain jobs that require intense clarity of vision (dentistry and surgery, for example) may be difficult to perform for one or two days. Most patients can return to work the next day, assuming their vision is adequate for their job. However, some people may feel fatigued for a day or so following surgery. Learn more about our recommended activity schedule after surgery.

You can resume most normal activities immediately after laser eye surgery. However, for at least two weeks you will need to avoid activities that could cause perspiration to run into your eyes. You should wear safety glasses while playing contact sports whether or not you have had surgery. If you do not routinely wear safety glasses, your eye surgeon may recommend wearing them for at least one month after LASIK surgery. You will also need to avoid certain activities, such as contact sports and swimming, for several weeks. It is important to consult your doctor in regards to the limitations on specific activities following LASIK eye surgery. Learn more about our recommended activity schedule after surgery.

Fast visual recovery characterizes this operation. Most patients achieve good vision the day of surgery and find that their eyes feel fairly normal within a day. However, vision can continue to improve and best vision can still take two to three months to occur, particularly with higher prescriptions. If necessary, adjustments to the surgery, called enhancements, can be done. Patients who undergo hyperopic LASIK eye surgery often need to wait longer to see clearly. Typically, they are unable to see with intense clarity for one or two weeks, with best vision arriving several months following surgery.

Most patients who have the LASIK procedure do not wear glasses for their daily activities. However, patients may need to wear reading glasses if they are over the age of 40. This is caused by the normal aging of the eye, also known as presbyopia. It remains important to note that this condition occurs with or without LASIK vision correction. It is also possible that some patients need a minimal prescription for certain activities, such as night driving.

No. Your eyes will look exactly the same

Most studies show that the LASIK procedure poses minimal risks of complications. The overall complication rate is a fraction of one percent. Even if complications do occur, most of the complications are resolved within three months and do not result in long-term interference with vision. More precisely, the complication rate cited in large studies is between 0.5% and 1.9%. LASIK surgery is a surgical procedure done on a delicate part of the eye and therefore, complications can occur. Learn more about safety. For additional information, read our LASIK Information Booklet.

With LASIK eye surgery, the vast majority of night vision disturbances are eliminated since the area of cornea treated is larger than the dilated pupil size. Some patients may see mild glare, halos or starbursts around lights in dim or low-light conditions temporarily following surgery. These symptoms do not usually interfere with driving at night, or night time activities. For the vast majority, these symptoms are temporary, usually lasting a few days to a week. With this newer technology, it is extremely rare for these symptoms to be permanent.

Although occurring very rarely, all patients should be aware that dry eyes are a possible complication following LASIK eye surgery. The laser eye surgery makes everyone's eyes somewhat dryer afterwards, but only temporarily. Your laser eye doctor will carefully test you for the potential of developing this complication after surgery if you suffer from a history of dry eyes or are severely bothered by contact lenses. After surgery, all patients should use tear drops as required.

Most people in their 40s or older will need reading glasses despite whether their eyes are corrected for distance vision. This is caused by the eye's loss of lens flexibility as we age. This condition, called presbyopia, cannot currently be treated by the LASIK procedure. Learn more about new procedures that do correct presbyopia.

Some patients in this age group choose monovision to correct this condition. This option allows patients to use one of their eyes for distance and the other to see up close. Although monovision proves to be satisfactory for some patients, many are not comfortable with this procedure.

 Patients need to discuss the options with their doctors. Most doctors suggest that patients test monovision with contact lenses for a few weeks prior to opting for monovision with LASIK vision correction. Be sure to ask if this trial option is available to you. Learn more about monovision.

If you undergo LASIK eye surgery to correct your distance vision, you can expect clear overall vision. However, images close to you may not appear as clear after having LASIK eye surgery if you are over 40. After the age of 40, expect to need reading glasses for up-close work.

Although LASIK vision correction is not a cosmetic procedure, it is considered an elective surgery. Such surgeries are covered in many European and Asian countries. However, in the United States and Canada insurance policies often will not cover the procedure, nor will Medicare usually cover it.

 If you reside in the U.S. you should check with your insurance company to see if your policy offers partial or full coverage. In some cases, the cost of the procedure can be covered by medical flex plans that allow pretax dollars to be set aside for medical expenses.

You should check with your employer to see if your company offers this type of benefit (see group rates). It is possible that the cost of LASIK surgery may be deducted from your U.S. federal income taxes. You should check with your accountant to see if you can take LASIK surgery as a deductible health expense. See more information on insurance coverage.

PRK, or photorefractive keratectomy, laser eye surgery is similar to LASIK eye surgery in the sense that both procedures employ a computer-controlled excimer laser to reshape the cornea of the affected eye. However, during the LASIK procedure, the surgeon preserves the epithelium (the outermost protective layer of the eye) by creating a flap. During PRK vision correction, the epithelium is removed by gently scraping the surface. Anesthetic drops in the eye ensure that the patient experiences as little discomfort as possible.

PRK laser eye surgery is also characterized by a lengthier healing process and greater discomfort than LASIK eye surgery.

All patients can have PRK surgery except for those who have autoimmune disorders (Lupus, rheumatoid arthritis) or those who have a history of aggressive scar formation after a skin incision (called Keloids).

During the healing process, a number of factors occur that allow the corneal flap to stick back onto the eye.

• The corneal flap made during the LASIK procedure is able to lay flat and aligned for 2 reasons:

1) The Hinge:
The corneal flap is created with a superiorly located hinge. When the flap is laid back down (after the procedure is completed), this hinge allows the flap to remain attached and aligned.

2) The "trough":
When the corneal flap is created, a trough (the "bed") is created in the cornea which is the exact same size as the flap. A flap that is replaced properly will lie perfectly in this trough. This is more stable than a contact lens which sits on top of the cornea and moves with each blink.

• The sequence of events for corneal flap adherence is as follows:

1) Negative suction:
During the first few seconds to the first few hours after surgery, the corneal flap begins to stick with the help of negative suction pressure exerted by the cornea. This is the same suction that allows contact lenses to stick to your eyes.

If the eye is too dry during this time, the eyelid can spontaneously stick to the flap. Friction with the surface can cause the flap to move. This can occur in about 0.1-0.5% of patients. For this reason, it is important that patients ensure that their eyes are well lubricated with artificial tears. Hitting the flap can also gently move it. This is why it is important not to rub your eyes after surgery.

2) Epithelial sealing:
During the first few minutes and up to 24 hours after the surgery, the surface epithelium (the transparent surface skin) grows over the incision and seals the flap. Simple lid contact with the flap should not move a flap with sealed epithelium. Moderately hitting the flap (with a finger, mascara, or a drop bottle) will move it.

3) Cornea stromal scarring:
Finally, after a few weeks to a few months, a scar begins to form around the edge of the flap. This results in the flap being well sealed. Only a severe blow (punch, squash ball) can now move the flap. After 6 months, surgical instruments are required to move a flap.

All three lasers incorporate wavefront technology, which allows the surgeon to treat higher order aberrations beyond sphere and cylinder, and potentially improve vision to beyond the capabilities of non-wavefront lasers.

The three lasers each incorporate a slightly different method of acquiring the wavefront data. They each also use a slightly different shape of laser beam, a different speed, and a different tracking system. Finally, their ergonomics are also different.

Which laser is the best? There is no clear answer to this question. LASIK MD surgeons believe the ergonomics and tracking system of the Zyoptix Technolas 217z system are preferred, while the speed of the Wavelight Allegretto is faster than the Zyoptix.

The real underlying question in most patients’ minds is which laser gives the best results. The answer is open to debate, but at LASIK MD we currently feel that the Zyoptix Technolas 217z system and the Wavelight Allegretto system give equally good results - and possibly better results than the VISX STAR S3 system.