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What is LASIK?
Laser in-situ keratomileusis, or LASIK eye surgery, is an outpatient procedure used to correct the following refractive errors:
- Myopia (nearsightedness)
- Hyperopia (farsightedness)
- Astigmatism (an imperfection in the corneal curvature)
- Presbyopia (age-related farsightedness)
LASIK surgery involves reshaping the cornea (clear front part of the eye) using laser technology. This enables light to focus well on the retina.1 The retina is the light-sensitive tissue at the back of the eye. It receives light and sends signals to the brain for interpretation, enabling clear vision.
During LASIK surgery, a device known as a femtosecond laser is used to create a corneal flap and expose tissues below. Another laser device, excimer laser, alters the underlying tissues based on your surgeon’s measurements.2
Types of LASIK
Over the years, the LASIK procedure has seen improvements to promote procedure safety protocols, minimize pain, and maintain a high success rate. The types of LASIK include:
Traditional LASIK uses a handheld blade known as a microkeratome to create the flap before an excimer laser reshapes the cornea., The handheld blade carries an elevated risk of concentration, flap wrinkles, and other flap complications. However, the overall rate of complications is still very low.
Blade-free LASIK uses a device known as a femtosecond laser to create the flap and an excimer laser to reshape the cornea. It’s considered safer than conventional LASIK because it uses laser beams instead of a hand-held sharp blade.
An example of bladeless LASIK is IntraLase LASIK or iLASIK. When coupled with the computer-guided WaveScan™ Wavefront Technology, the surgeon can accurately map your eyes, create the flap, and reshape your cornea with minimal risks.
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Who Can Get LASIK?
LASIK surgery is not ideal for everyone. Your doctor will ensure you meet specific requirements before recommending LASIK as a vision correction option.
A perfect candidate for LASIK:
- Is 18 years or older. Many surgeons recommend the mid-20s as the ideal age for eye stability3
- Has healthy eyes. Eye health will determine how effectively your eyes will heal after surgery.
- Has a refractive error (myopia, hyperopia, or astigmatism)
- Has a stable prescription (at least 1-2 years) to reduce the chances of regression
- Has a thick cornea. This reduces chances of corneal ectasia
- Wants to eliminate dependence on contacts or eyeglasses
- Has realistic expectations
Reasons that may disqualify a patient from LASIK include:
- Pregnancy or nursing
- A thin cornea
- Underlying health issues such as immunodeficiency or autoimmune diseases
- Presence of cataracts (cloudy eye lens)
- Previous eye injury or surgery
You may not qualify if you take certain medications such as immunosuppressants and anti-inflammatories (NSAIDS) that can affect the healing process. Your doctor will advise you on when to discontinue your medication before surgery.
LASIK Procedure (Step by Step)
Expect the following before, during, and after surgery:
During your LASIK consultation, the eye doctor will examine your health history, conduct a comprehensive eye exam, and discuss expectations of the procedure, including possible risks. Talk to them about all the medications you’re taking, previous eye problems, or surgeries.
At the end of the consultation, your doctor will determine your eligibility for the procedure and book you for surgery.
Before the Procedure
Before LASIK surgery, your doctor will give you pre-op instructions to follow.
If you wear glasses or contact lenses, keep them off for days or weeks before your initial evaluation to allow your eyes to stabilize.4 You’re also discouraged against facial makeup, lotions, and creams, especially on the day of surgery, as these may harbor bacteria.
The day before surgery, your surgeon may prescribe anti-inflammatory and antibiotic eye drops to reduce the bacterial flora in your eyes.
Prepare reliable transportation, as your driving ability may be impaired after surgery.
On the surgery day, your doctor will perform a final evaluation to ensure your eyes are ready. This will include measuring your cornea to guide the procedure.
During the Procedure
During surgery, you will sit on a reclining chair, and the surgeon will clean and prepare your eyes. A numbing agent will be applied to prevent pain and discomfort. You may also be sedated to help you relax.
A speculum will keep your eyes open. Then, with a blade or femtosecond laser, the surgeon creates a flap on the surface of your cornea.5
Traditional LASIK surgery uses a blade (microkeratome) to create a thin flap. The newer bladeless versions, such as iLASIK, use wave-front guided femtosecond lasers to create the flaps.
Once the LASIK flap is created, the surgeon will lift and fold it back to expose the deeper corneal tissue layers. The flap hinge will prevent complete detachment.
Both bladed and bladeless LASIK uses an excimer laser device to reshape the cornea. This device uses special UV beams that interact with the corneal tissue, creating a corneal shape that allows light to focus well on the retina.
After the laser treatment, the flap is repositioned without stitches. Your surgeon will then apply an eye shield to protect your healing wound and prescribe pain medications, antibiotics, and lubricating eye drops to ease pain and discomfort during recovery. They will also provide detailed post-op care instructions to follow.
The entire LASIK procedure takes about 30 minutes or less. You may need a brief rest in the recovery room to allow a post-operative examination before heading home.
After surgery, your doctor will provide you with post-op care instructions.6 First, you must give your eyes plenty of rest to promote healing. Most surgeons will recommend a few hours’ sleep to help you avoid some of the initial pain and discomfort. Keep your eye shield in place to avoid any unconscious touching or accidental trauma.
Also, take a few days off of work, especially if you work in a role that requires intense eye use, such as typing or reading on a computer screen. You may experience some mild pain or discomfort in the eyes. You can address these using antibiotic eye drops and ointments provided by your doctor.
Avoid the following during recovery:
- Rubbing your eyes
- Swimming (for about a week)
- High-impact activities, e.g., contact sport
- Eye-straining activities such as excessive reading
Continuous monitoring of the healing process is very important. It’s advisable to make your first follow-up appointment at least 24 hours after surgery and plan regular visits.
Most LASIK patients realize better vision a few hours to a day after surgery, although some may take up to five days. Generally, you’ll realize excellent results if you have reasonably good vision with only mild refractive errors.
Most LASIK patients achieve a clear vision (20/40 or better). Full recovery after LASIK may take about 3 to 6 months.
The outcomes of LASIK surgery typically last about 20 years to a lifetime. This depends on when you undergo surgery and the long-term health of your eyes.
In case of any concerns with the surgery outcomes, reach out to your surgeon as soon as possible.
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Risks and Side Effects of LASIK
The side effects of LASIK include:
- Increased sensitivity to light (photophobia)
- Blurred vision
- Gritty or burning sensation
- Bloodshot eyes
- Bacterial, viral, or fungal infections
- Overcorrection or undercorrection
- Decentration (when the laser centered incorrectly during surgery)
- Wrinkled flap
- Epithelial ingrowth
- Corneal ectasia (rare)
- Temporary vision loss
- Decreased visual clarity immediately after surgery
- Vision loss or serious changes (rare)
- Flap healing problems
LASIK Success Rates
LASIK is one of the most effective refractive surgeries available. According to the American Refractive Surgery Council, LASIK patients show a 96% satisfaction rate.7
Statistics also show that:
- About 99% of LASIK patients achieve 20/40 vision or better
- About 90% achieve 20/20 vision
- Less than 1% of patients may lose two lines of best-corrected visual acuity (BCVA)
Surgeons can address dissatisfactory LASIK outcomes through a second laser treatment (LASIK enhancement). LASIK enhancement is easy and quick since it only involves re-lifting the initial flap for further correction.8
Cost of LASIK
LASIK surgery is considered an elective, and many insurance providers may not cover it. The cost may vary depending on your location, available facilities, and surgeon’s experience.
The extent of correction may also affect pricing. On average, LASIK surgery will cost about $1,500 to $2,000 per eye.
Pros and Cons of LASIK
Below are the benefits and downsides of LASIK eye surgery:
Pros of LASIK
- Quick and long-lasting outcomes
- Results in 20/20 vision or better
- A relatively safe and painless procedure
- Reduces or eliminates dependence on glasses or contact lenses
- Enhancements are available to improve vision
- No need for bandages after surgery
- Low risk of dry eyes
- Customizable for every patient
Cons of LASIK
- Not everyone is eligible (18 years or older only)
- Risk of flap complications
- Not covered by insurance
- Risk of over/undercorrection, especially with bladed LASIK
- Risk of regression
Although LASIK surgery may not work for everyone, there are equally effective LASIK alternatives you can discuss with your doctor.
Photorefractive Keratectomy (PRK)
Unlike LASIK, PRK doesn’t create a flap in the cornea. During PRK, the laser directly removes the corneal epithelium (thin outer layer) to allow for corneal reshaping using an excimer laser. PRK is ideal for people with thin corneas because they lack enough tissue for flap creation.
Epithelial Laser in-Situ Keratomileusis (Epi-LASIK)
Epi-LASIK is less invasive than traditional LASIK surgery. It involves the formation of a thin epithelial flap instead of a corneal flap.
Laser Epithelial Keratomileusis (LASEK)
LASEK is a minimally invasive procedure, just like PRK. It also involves the epithelium, making it a great alternative for LASIK. However, unlike PRK, LASEK preserves the epithelium flap using diluted alcohol. The epithelial flap is repositioned after laser treatment.
Small Incision Lenticule Extraction (SMILE)
SMILE eye surgery doesn’t require a corneal or epithelial flap. Instead, a femtosecond laser targets the inner layer of the cornea and creates a lenticule, a thin, disc-shaped piece of tissue.
The lenticule is then removed via a small incision on the side of your cornea. This reshapes the cornea. Research shows that LASIK and SMILE yield comparable results.
Intraocular Lenses (IOLs)
Intraocular lens implants (IOLs) are artificial lenses inserted into the eye to replace the natural lens. They’re common during cataract surgery. These IOLs are categorized into mono-focal lenses, multifocal lenses, accommodating IOLs, and toric IOLs.
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