LASIK (Laser assisted in-situ keratomileusis) is a refractive surgical procedure that results in rapid recovery of vision and has the capability to benefit patients with nearsightedness, farsightedness, and astigmatism by reducing dependence on eyeglasses and contact lenses. Millions of people worldwide have already undergone this exciting and marvelous procedure. The great majority of individuals who wear glasses or contacts may now benefit from LASIK. Candidates must be at least 18 years of age.

LASIK is a procedure in which the eye surgeon creates a thin surface flap of the cornea using a microkeratome to expose underlying tissues (stromal bed). It is within the deeper layers of the cornea that the surgeon then applies the Excimer laser beam to create the refractive ablation. This reshapes the cornea using the extraordinary precision of the Excimer laser. The laser is programmed prior to each procedure for the ablative "cut" based on the patient's pre-operative refractive error (nearsightedness, farsightedness, and astigmatism). Once the laser ablation is completed, the surgeon gently replaces the corneal surface flap to restore surface integrity of the eye. It's as if the refraction is "ground in" to the middle layers of the cornea! The results are often dramatic and very rapid, with most patients seeing well enough to drive a car without correction the very next day. However, the best post-operative visual acuity may not be obtained until 2 to 3 weeks, or in some cases, even a few months, after the procedure.

Indications for the LASIK Procedure

1. Appropriate Levels of Nearsightedness, Farsightedness, or Astigmatism
2. Relative Intolerance of Glasses or Contact Lenses
3. Properly Motivated and Realistic Patient

LASIK may be used to treat nearsightedness (myopia), farsightedness (hyperopia), and astigmatism. However, not all Excimer lasers are presently FDA approved to treat all three types of refractive errors. For example, some Excimer lasers are not yet FDA approved to treat farsightedness. Your surgeon can provide this information to you at your request.

LASIK is an elective procedure which, like any procedure, has potential risks and benefits. In general, indications for surgery must include an appropriate level of nearsightedness, farsightedness, or astigmatism, as well as an educated and properly motivated patient with realistic expectations. The best candidate for LASIK is an individual who desires to be less dependent on glasses or contact lenses, is willing to accept the risks of the procedure, and understands that an enhancement procedure may sometimes be required.
The primary potential risks include postoperative glare, halos or starburst around lights at night, and infection in the cornea with loss of best corrected visual acuity. Fortunately, risks that threaten vision in the eye, such as infection in the cornea, are very rare.

LASIK Pre-Operative Evaluation

Patients who wear soft contact lenses or rigid gas-permeable contact lenses should discontinue their contact lens wear at least 3 days or 3 weeks prior to the evaluation, respectively. Prior to the LASIK procedure, one or more careful refractions (determinations of eyeglass correction needed) will be completed.
Contact lens wearing patients who are believed to have an unstable refraction will be asked to discontinue contact lens wear and return for a repeat refraction in one to three weeks. When back-to-back refractions are stable (equivalent), the procedure may be scheduled. Corneal topography, or a detailed surface map of the cornea, will also be completed to rule-out keratoconus and irregular astigmatism of the cornea. A complete and thorough eye examination including determination of eye pressure, slit-lamp examination, and dilated retinal evaluation will be completed.

The LASIK Procedure

The LASIK procedure is completed under topical (eye drop) anesthesia and is typically entirely painless during and after the procedure. A few minutes prior to the procedure, anesthetic eye drops will be applied to numb the eye and prevent discomfort during the procedure. A speculum is placed to hold the lids apart, thereby preventing blinking during the procedure. The surgeon places a ring on the surface of the eye designed to hold the eye steady and increase the pressure in the eye. A microkeratome is utilized to create a thin flap of the corneal surface. The surface flap is gently folded to one side in preparation for the laser refractive "cut." The laser, being computer driven for accuracy and precision, is programmed based on the patient's refractive error (nearsightedness, farsightedness, astigmatism).
The laser delivery is completed next, and takes less than one minute for most patients. Laser delivery may take slightly longer for patients with hyperopia (farsightedness). Finally, the surface flap is returned to its original position restoring the surface integrity of the eye. The surgeon will often observe the eye under the laser microscope for up to 5 minutes to be certain the flap is securely in position. The speculum is removed and the patient may typically leave the laser center within the hour. Many patients now have both eyes treated with LASIK on the same day.


The surgeon uses a microkeratome to create the flap. The flap is then positioned to one side of the corneal "bed" as the Excimer laser beam (left) is applied.




The broad beam Excimer laser widens the treatment zone as the procedure progresses.



The laser beam ablation nearing completion as the edge of the laser beam approaches the borders of the flap.



The laser ablation is complete and the flap is being replaced. Once The flap is returned to preoperative position, the surgeon carefully checks and rechecks the flap to be certain it is secure and well-positioned.

Postoperative Management

Post-operatively, most patients will be instructed to use antibiotic and anti-inflammatory eye drop medications for 3 to 7 days. A shield is usually worn over the operated eye while sleeping for the first few days or week following surgery. The patient is also typically instructed to avoid rubbing the eye for the first few weeks following surgery.

Post-operative visits are typically minimal, but vary widely from one surgeon to another. Most patients will only require one to three post-operative evaluations, which take place in the first six months following surgery. Patients who are over-corrected, or under-corrected, may require an "enhancement," utilizing a procedure similar to the initial LASIK. Depending on the chosen time frame for an enhancement (when necessary), the surgeon may elect to lift the original flap or create a new flap with the microkeratome.

 
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