LASIK Refractive Eye Surgery

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"

Corneal 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

Corneal Flap with Excimer Laser

After the corneal flap is folded back, the inner layers of the cornea are are exposed and treated with the programmed VISX STAR Excimer Laser System based on the predermined exact vision prescription. The laser precisley removes a thin layer of cornea surface which reshapes the eyeball and refocuses light directly on the back wall of the eye, the retinal plane. In fact, the Eximer laser is so precise, it can notch out a human hair.

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.


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:

  • brief recovery time
  • very low infection risk
  • relatively quick procedure to complete
  • very low risk of scarring
  • minimal discomfort
  • high degree of predictability
  • preservation of the cornea (all corneal layers preserved)
  • excellent ocular integrity post-treatment
  • widest range of correctable prescriptions

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:

  • Creating too deep a flap of corneal tissue by fully removing the top of the cornea rather than just lifting it. This removed tissue still heals back into place but requires extra care in positioning.
  • Infection - Very rare and usually controlled with medications.
  • Epithelial tissue growth underneath the flap - Can usually be solved by lifting the flap and gently removing these tissue cells.
  • Increased or decreased improvement to surgery - Surgery can usually be modified by lifting the cap and removing more tissue with the laser. Sometimes other types of surgery can be combined with LASIK to give improved results.



Daniel J. Nadler, M.D.

Daniel J. Nadler & Associates
Eye Physicians and Surgeons

Sewickley Office
409 Broad Street - Suite 270
Sewickley, PA 15143
Phone 412 741-5577
Beaver Office
1200 Sharon Road - Suite 202
Beaver, PA 15009
Phone 724 774-5920

Text & Images Courtesy of Three Rivers Endoscopy Center
© Dr. Robert Fusco, Three Rivers Endoscopy Center, All Rights Reserved

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