Tired of wearing glasses? Need glasses just to find your glasses? Are you unable to see the clock across the room or navigate your room in the dark? Done with ripping your contact lens in the middle of your beach vacation?
You might consider refractive surgery known as LASIK. Let’s discuss what expect and consider when deciding on a refractive surgery like LASIK—and a few other options you might have.
What is LASIK surgery?
The most-widely performed type of refractive surgery, LASIK stands for laser-assisted in situ keratomileusis, a procedure where a laser is used to reshape the cornea. The laser is also used on the eye’s surface to remove small layers of corneal tissue.
For patients who are unable to see in the distance (nearsighted), the laser will flatten the curvature of the cornea, and for patients who have astigmatism, the laser is used to reshape portions of the irregular cornea making it smoother and more symmetric.
What to expect prior to LASIK surgery
Prior to surgery, your eye doctor will perform a series of tests to determine if you are a candidate for the procedure. The tests include scans of your eyes, a comprehensive eye exam, and a determination of your prescription.
In most cases, your eyes will be dilated. You should plan on taking the day off from work. If you wear soft contact lenses, you should not wear your lenses for one week prior. If you wear RGP lenses, you should consult with the surgeon’s office as each may have its own rule for discontinuing the use of hard lenses.
During the surgery, two lasers will be used on your eyes and each takes less than 15 seconds for treatment. The first laser will create a flap that the surgeon will pull back, and the second one will change the shape of the cornea. Afterward, the surgeon will put the flap back down over the top of the cornea.
Following surgery, you will be able to see, but things may appear fuzzy. You will be instructed to go home and sleep for several hours and when you wake up, begin using the prescribed eye drops. Your doctor will want to see you the next day to make sure you are healing properly.
Are you a good candidate for refractive surgery?
Stable prescription
If your vision is still changing, you may not be a good candidate. Doctors will compare your current prescription, and your last several exams to determine stability. Eye doctors prefer to see only a change of 0.50D over the last 2 years.
When you are younger, your vision changes a lot, but when you reach early or mid-twenties, it is most likely to be stable. Pregnancy may also affect vision and most doctors recommend waiting several months after birth to have LASIK surgery.
Healthy corneas
A scan will be used to check your corneal health. The scan uses data to look at the front and back of the cornea for irregularities and disease. It may show corneal dryness, problems from sleeping in contact lenses, and keratoconus.
Keratoconus is a disease of the cornea where it gradually becomes thinner and steeper at the bottom, causing it to bulge forward from the pressure. LASIK can cause disastrous effects on a cornea with keratoconus so a surgeon must identify it prior to surgery.
Adequate corneal tissues
Corneal surgeons use a calculation to determine if a patient has an adequate corneal thickness for LASIK surgery. An average corneal thickness is around 545 microns and on average 15 microns must be removed for each diopter value of your prescription.
In addition, for cornea safety and integrity, the surgeon must leave a healthy amount of tissue on the corneal bed to prevent thinning or ectasis after the procedure. If your corneas are thinner than 500 microns or you have a significant prescription, PRK or an ICL procedure may be better options.
Systemic disease or ocular disease history
Certain systemic or ocular diseases may prevent you from being a LASIK surgery candidate. Patients with significant eye scarring, glaucoma, keratoconus or advanced cataracts may be disqualified. If you have a history of lazy eye, the surgeon will assess your ocular condition and determine the potential for success.
Many patients with systemic conditions like fibromyalgia, migraines or other autoimmune conditions may not be an ideal candidate. Some patients may be more likely to experience corneal neuralgia after surgery. Corneal neuralgia is caused by damage to the corneal nerves during surgery which results in nerve activation even though no injury or pathogen exists to cause it.
What to expect after refractive surgery
Your vision will continue to improve over the next 3-4 weeks after surgery, but dry eye, halo effect at night, and fluctuations in your vision are common responses.
Like any surgery, there can be healing complications and you should understand you may still need glasses or contact lenses afterward. If you are over 40, most likely refractive surgery can eliminate your need for distance glasses, but you may still need readers. If you are under 40, you should understand that after 40, you will need glasses again. LASIK will not correct your vision for your entire life.
You may have other options
Photorefractive keratectomy (PRK)
PRK is an alternative to LASIK. Like LASIK, PRK uses a laser to change the shape of your cornea. It may be a preferable option for patients with dry eye disease or thin corneas.
PRK differs from LASIK because a flap is not created, but instead the surgeon removes the outer layer of cells, the epithelium, from the cornea. PRK can be a little more uncomfortable and the healing process will take several weeks longer. For 2-5 days after surgery, you may have some eye pain and blurry vision that will resolve with time.
Refractive lens exchange (RLE)
RLE is a lens replacement surgery where the natural lens is removed, and an artificial lens is inserted. RLE could be an option for a patient after 40 who wants to eliminate the need for glasses for both distance and near vision. RLE corrects all types of refractive errors: myopia, hyperopia, astigmatism, and presbyopia. It is the same procedure as cataract surgery.
Implantable collamer lens (ICL)
If you are under 40, and not an ideal candidate for LASIK or PRK, ICL surgery may work for you. The procedure is like cataract surgery; however, the surgeon leaves your natural lens and inserts an artificial lens. The purpose for leaving your natural lens is to allow for accommodation. Prior to 40, the lens can accommodate or focus up close, but after 40, that is no longer the case.
Refractive surgery can be an excellent option for those looking to reduce their reliance on glasses or contacts. While LASIK is the most well-known, there are additional surgical methods. A comprehensive eye exam, medical history, and advanced scans of the eye are necessary for a surgeon to determine the surgical solution best for you.
