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LASIK, which stands for laser-assisted in situ keratomileusis, is a type of refractive eye surgery. This procedure can correct nearsightedness (myopia), farsightedness (hyperopia), and astigmatism.
Many patients choose LASIK because it is a quick and safe procedure with minimal downtime. If you wear glasses or contact lenses, LASIK eye surgery may be a potential way to improve your vision.
According to the American Refractive Surgery Council, over 20 million LASIK surgery procedures have been performed in the United States. LASIK patients are generally very satisfied with their improved vision after laser eye surgery.
"The latest research reports 99 percent of patients achieve better than 20/40 vision and more than 90 percent achieve 20/20 or better. In addition, LASIK has an unprecedented 96 percent patient satisfaction rate – the highest of any elective procedure"—American Refractive Surgical Council
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There are a few different LASIK treatment options to choose from, including:
During LASIK, the surgeon operates on your cornea, which is the clear covering on the front of your eye. The cornea controls the way light rays enter your eye.
There are two ways the surgeon can cut a flap in your cornea:
The results of bladeless LASIK are generally more accurate, reproducible, and cause fewer side effects, such as dry eye. Overall, surgeons consider LASIK an extremely safe medical procedure, whether it is traditional or bladeless.
Customized LASIK gives you sharper, higher quality vision than conventional LASIK. Conventional LASIK uses measurements based on your eyeglass prescription, while customized LASIK is much more detailed. The surgeon can combine customized LASIK with either a traditional or bladeless flap procedure.
There are different types of customized LASIK procedures:
Monovision is a special LASIK technique for patients who need reading glasses, typically those in their 40s or older. This procedure corrects one eye to see distance and the other eye to see near. Your eye doctor will test your eye dominance to determine which is which.
Ask your eye doctor to try monovision with contact lenses first to see if you can adapt.
There are some potential drawbacks to consider:
Potential monovision patients should consider their type of refractive error:
The entire LASIK surgery procedure usually takes less than 30 minutes for both eyes. Approximately 10 minutes is needed to complete the surgery on each eye.
You are awake and alert during the procedure. Surgeons often offer a mild sedative to help you relax before the surgery.
LASIK causes little to no pain during the procedure. Your surgeon will administer local anesthetic eye drops to numb your eyes before the LASIK eye surgery begins. Many patients describe feeling a "slight pressure sensation" during the surgery. But in most cases, patients feel no pain throughout the procedure.
Here's what to expect during LASIK surgery:
Step 1: Your eyelids are held open with a tool so the eye surgeon can work. First, your eye doctor places eye drops that contain a numbing agent in your eyes.
Step 2: The surgeon uses a small blade or special laser to cut a thin flap in your cornea. This is the part that may cause some discomfort for the patient. Many people report feeling "a sensation of pressure" during this part of the surgery.
Step 3: The excimer laser gently reshapes your cornea. It is guided by a computer that has a map of your eye preloaded into it.
Step 4: After the excimer laser finishes, the surgeon smooths the corneal flap back into place.
Step 5: If you are getting both eyes operated on, this process will immediately be repeated on the other eye.
Step 6: That's it, your LASIK eye surgery is complete! Once you're finished, your eye surgeon, or a team member, will provide you with an eye shield, along with detailed instructions for recovery.
There is minimal downtime after LASIK eye surgery. Many patients can see well within a day. If you feel comfortable, you may even drive and go back to work or resume normal activities the next day.
You will take a regimen of antibiotics and steroid eye drops for a few weeks after surgery. Your doctor will also recommend lubricating eye drops to help with any dryness.
The most common side effects include:
Most patients' side effects clear up within a few hours or a few days of the surgical procedure. If you experience fluctuating vision for a week after surgery, consult your eye doctor.
Here are seven conditions that good candidates for LASIK eye surgery have:
Your overall eye health determines how well your eyes heal after surgery and whether or not you are at risk for certain complications. In general, any active eye infections, inflammation, or abrasions must be resolved before you get LASIK.
If you have an eye disease that affects the function or shape of your corneas, such as keratoconus or corneal dystrophy, you are most likely not a good candidate for LASIK. Tell your surgeon if you have a history of herpes-related eye infections since LASIK can reactivate the herpes virus.
LASIK can also affect your eye pressure. If you have glaucoma or are at risk for glaucoma, your eye doctor can determine whether or not LASIK surgery is safe for you.
LASIK procedures can treat a wide range of prescriptions, including myopia (nearsightedness), hyperopia (farsightedness), and astigmatism. The treatment range varies between different types of LASIK procedures. Your eye surgeon can help you determine which type of LASIK is right for you.
The higher your prescription, the more corneal tissue the laser must remove to correct your vision. When undergoing LASIK, the surgeon cuts a flap on your cornea, then uses a laser to remove tissue underneath the flap. If your corneas are thin, LASIK can increase your chances of corneal ectasia, which is a vision-threatening condition that causes abnormal corneal thinning.
Typically, you must be at least 18 years old to have LASIK. However, it is best to wait until you are in your mid-20s, which is when your vision stabilizes for the most part.
There is no upper age limit for receiving LASIK, although there are some important considerations. After age 40, presbyopia begins to set in. This process affects your ability to focus up close and continues until about age 60.
If you have stable vision for at least 1-2 years before LASIK, this reduces your chances of regression and needing a touch-up procedure. Stable vision does not necessarily mean your prescription cannot change at all. In most cases, a change of 0.25 or 0.5 Diopters is acceptable. Diopters are the units used to measure your prescription.
Common post-LASIK symptoms include glare, halos, and starbursts at night. Previously, eye doctors linked these symptoms to pupils that were larger than the LASIK treatment zone, particularly in dim light. However, many studies show that with modern LASIK procedures and wider treatment zones, large pupils do not significantly affect visual outcomes.
Although LASIK success rates are very high, it may not be realistic to expect perfect vision. Even the refractive surgeon cannot predict with complete certainty how your eyes will heal after surgery since everyone is different. Also, keep in mind the possibility of needing to wear glasses after surgery, such as for reading or night driving.
You may not be a good candidate if one or more of the following applies to you:
1. Pregnancy or nursing. Many women experience fluctuations in their vision during pregnancy related to hormonal changes. Also, the medications you may take for the LASIK procedure are not safe for the baby. It is best to wait until you have your baby and are finished nursing.
2. General health problems. People with certain medical conditions, such as autoimmune or immunodeficiency diseases are at higher risk for healing complications and generally should not receive LASIK. Diabetic patients may experience delayed wound healing after LASIK and may experience visual fluctuations related to blood sugar changes.
3. Cataracts. Age-related cataracts usually start to develop around age 60 and cause the lens inside your eye to become cloudy. Generally, LASIK is not recommended if you already have cataracts. LASIK cannot correct your vision entirely, and your vision will continue to change as the cataracts progress.
4. High-impact activities. If you engage in contact sports such as basketball or martial arts, consider your options carefully. Although this complication is rare, eye trauma can potentially dislodge the corneal flap, even long after your surgery.
5. Medications. Certain drugs are not safe to use if you are having a LASIK procedure. Immunosuppressants and anti-inflammatories can affect the healing process. Some medications that should not be taken before LASIK include steroids, isotretinoin (Accutane), and amiodarone. Your eye surgeon can advise you how long you need to discontinue the medications before surgery.
6. Previous eye injury or surgery. If you had an eye injury that left a significant corneal scar, you might not qualify for LASIK. Previous eye injury or eye surgery may increase your risk for LASIK complications, so be sure to give the eye surgeon your complete health history.
The average cost of LASIK surgery in the United States is approximately $2,200 per eye or $4,400 for both.
Unfortunately, most health insurance plans do not cover LASIK surgery. Most health insurance companies deem laser eye surgery an elective procedure — meaning not medically necessary. Neither Medicare nor Medicaid pays for elective eye surgery like LASIK surgery.
Some larger vision insurance carriers offer laser vision correction benefits, including discounts on laser vision correction procedures with specific providers and frame benefits for non-prescription sunglasses after vision correction surgery. UnitedHealthcare vision insurance offers its members 35% off LASIK at over 900 locations.
There are some alternative laser eye surgeries to LASIK, including photorefractive keratectomy (PRK) and small incision lenticule extraction (SMILE). Your eye surgeon will determine if you are a candidate for LASIK or an alternative procedure. There are some key differences between LASIK, PRK, and SMILE.
Below is a comparison of these two procedures:
SMILE is a newer type of refractive eye surgery that is gaining popularity. Below is a comparison of SMILE versus LASIK:
Types of LASIK:
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