LASIK Refractive Eye Surgery Before the Procedure Before your doctor can decide if you are a candidate for this procedure, he will have to evaluate your condition during a consultation visit. He will perform a medical history and physical and complete eye exam. He will discuss with you the therapeutic choices available to you and determine if you are a good candidate for LASIK. If so, an appointment will be made at the local outpatient surgical facility. For most patients undergoing the LASIK procedure, there is no need for hospitalization. In fact, the LASIK procedure only takes about 20 minutes to complete, about the same length of time as PRK. Most patients are amazed how simple and painless the process is. A mild sedative is sometimes administered to relax the patient and relieve any anxiety. Before the procedure, the doctor applies anesthetic eyedrops to numb the eye. An eyelid support is inserted to prevent blinking while the drops eliminate the natural reflex to blink. The LASIK "flap"
In the PRK procedure, the top protective layer of the cornea is first removed revealing the next layer known as Bowman's layer. This removal can be performed mechanically or with the laser. With LASIK, this top layer is left intact, allowing for both faster visual recovery and improved comfort. Once the eye is numb, a small suction ring is painlessly positioned on the eye to secure position during the procedure. The surgeon then uses a device called a microkeratome to raise a thin flap of tissue which is folded out of the way. The microsurgical instrument similar in concept to a carpenter's plane. Amazingly, the corneal flap that is creates is only about 180 microns thick about 25% of the corneal thickness. ( For comparison, a human hair is about 500 microns in diameter.) Similar corneal flaps have actually been performed for forty years establishing a long history of safety and stability. The patient does not feel or see the the flap being created which takes only seconds. Reshaping the Surface
Upon completion of the laser aspect of the treatment, the flap is gently laid back into its original position over the treated corneal tissue where it serves like a bandage protecting the surgical site. The cornea has extraordinary natural bonding qualities which allow effective healing without the necessity of stitches. After a few minutes, the flap becomes fully adhered in its original position. The area is then irrigated and inspected carefully. Recovery The patient returns to the recovery room for a short rest, given postop instructions, and then is allowed to return home to the care of a companion. They may now blink normally and the corneal flap remains secured in position by the natural attraction forces within the cornea. Rubbing the eye should be avoided for the first week while the flap continues to heal. After the first week, LASIK patients can generally resume their full exercise activities while protecting the eye against injury or accident. Post-operatively, PRK patients are fitted with a protective contact lens to improve the comfort during healing while the surface protective layer is healing. It usually takes about 2-3 days for the surface to heal and frequent examinations are required to ensure an infection does not develop. No such lens is required for LASIK patients The use of the LASIK flap allows the protective top layer to remain intact, thus no bandage contact lens is required and an examination is only required on the first post-operative day. LASIK patients are only placed on an antibiotic and anti-inflammatory drop for 5-7 days. Whereas the vision is usually quite blurry with PRK for 3 to 5 days, it is usually better the following day with LASIK. PRK patients are placed on antibiotic drops and anti-inflammatory drops to promote rapid safe healing and ensure comfort. Once the epithelial protective layer is healed, usually on the third post-operative day, the bandage contact lens is removed. PRK patients are then maintained on steroid anti-inflammatory drops for 1 to 4 months. LASIK patients are instructed to wear a protective eyeshield while sleeping for the first week to prevent accidental trauma to the cornea flap during early healing. Patients are able to fly immediately after either PRK or LASIK and cautiously resume exercise and swimming after 1 week. Benefits of LASIK The following are some of the benefits of LASIK:
Possible risks of LASIK Side effects are minimal following LASIK surgery since most of the surface of the cornea has not been affected by the procedure. But people who have the surgery may experience some light sensitivity and glare for a few days or weeks. Full visual stabilization may take several weeks. Possible rare complications may include:
Copyright: Daniel J. Nadler, M.D.
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