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Dr. Ronald Cauchard

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LASIK & Refractive Surgery Co-Management

Happy Woman Listening to Headphones No Glasses after LASIK

LASIK

LASIK – Laser-Assisted In Situ Keratomileusis – is the most common refractive eye surgery today. As of 2011, over 11 million LASIK procedures have been performed in the United States and as of 2009 over 28 million have been performed worldwide.

LASIK, often referred to as laser eye surgery or laser vision correction, is a type of refractive surgery for the correction of myopia, hyperopia, and astigmatism. LASIK surgery is performed by an ophthalmologist who uses a laser to reshape the eye’s cornea in order to improve visual acuity. For most patients, LASIK provides a permanent alternative to eyeglasses or contact lenses.

LASIK is most similar to another surgical corrective procedure, photorefractive keratectomy (PRK), and both represent advances over radial keratotomy in the surgical treatment of refractive errors of vision. For patients with moderate to high myopia or thin corneas which cannot be treated with LASIK and PRK, the phakic intraocular lens is an alternative.

LASIK is the premier surgery for vision correction. It is quick, almost painless and there is little or no discomfort after the procedure. Vision recovery is rapid – patients report seeing 20/20 within 24 hours.

LASIK corrects nearsightedness, farsightedness and even astigmatism. With a technique called mono-vision, it can reduce the need for reading glasses among patients over age 40 who wear bifocals.

Who Are The Optimal LASIK Candidates?

The best candidate for LASIK is age 21+, has healthy eyes with adequate corneal thickness. This is necessary because LASIK procedure removes tissue from the cornea to reshape the eye.

Chronic dry eye, corneal disease or other abnormalities may disqualify a candidate from LASIK surgery. A comprehensive eye exam is required to be sure. For your convenience, we are happy to provide LASIK pre-operative exams and consultations at our practice.

Note that LASIK is an elective procedure and proper consideration must include the weight of personal needs, potential gain and willingness to accept the risks involved. There are no guarantees that LASIK will absolutely succeed to your expectations. The results are not always perfect vision. In some cases, your vision after LASIK may be permanently less clear than it was with glasses before LASIK. This outcome must be factored before deciding on LASIK surgery.

Certainly there is upside. In normal circumstances and conditions LASIK can reduce your dependence on glasses and almost always gives you the ability to function well without the need for glasses or contact lenses.

Specifics of The LASIK Procedure

LASIK is an ambulatory, two-step procedure. You walk into the surgery center, have the procedure and walk out about an hour later. The surgery event is about 15 minutes for both eyes, but allowances should accommodate for about at the surgery location, perhaps even a bit more.

First, the surgeon creates a thin, hinged flap of tissue on your cornea with an instrument called a laser. This flap is folded back so the laser reshaping of your eye can begin. After laser treatment, which lasts a minute or less, the flap is repositioned and the surgeon proceeds to your other eye.

What Is Wavefront LASIK?

Wavefront LASIK -wavefront-assisted, wavefront-guided or custom LASIK- uses laser treatment (ablation) mapped by computerized analysis. Wavefront-guided procedures are much more precise than ablations determined by using standard eyeglasses prescriptions. They can correct subtle optical imperfections of the eye called “higher-order aberrations” that regular ablations cannot treat. Studies prove wavefront-guided ablations provide sharper vision than conventional, non-wavefront LASIK and can improve night-vision, eliminating or reducing the risk of halos or glare.

After The Surgery

Following the LASIK procedure, you will use medicated eye drops and clear protective shields to cover your eyes. You can open your eyes and see well enough to walk without glasses, but you must not drive yourself home.

You will use medicated eye drops several times a day for a week or more to prevent infection and help the healing. You may also use artificial tears to keep your eyes moist and comfortable.

You should rest your eyes as much as possible the day of your surgery. You may find it more comfortable leaving the house lights on low dim.

The next day, you should see well enough to drive and resume your normal activities. Use care though not to rub your eyes until it is safe to do so. If you are currently using Latisse, discuss with your eye doctor how long after surgery to wait before re-starting the regimen.

You may be asked to return to visit your doctor the following day for an eye exam. They will want to check your vision and be sure your eyes appear to be healing as they should. You will be given any additional instructions necessary about eye drops and/or artificial tears, and you can ask the doctor any questions you may have.

Postoperative care may be performed by an eye doctor other than your LASIK surgeon. This is referred to as co-management. We are happy to provide post-operative care for you at our practice through a co-management agreement with your surgeon. Ask us for further details.

If My Vision Is Blurry After LASIK…

Though most patients see clearly within a day or so after LASIK, it can take several months before your eyes completely stabilize. Until then, improvements in your vision can still occur in fits and jumps. If several months pass and your vision is still blurred, be sure to communicate and visit with your LASIK surgeon. It may be appropriate to have a second LASIK surgery -an enhancement- to sharpen your eyesight further.

If an enhancement is not required, eyeglasses or contact lenses may be used to help. We will be happy to examine your eyes and discuss the options available to you.

After LASIK Eyewear

Even if your vision seems perfect after LASIK, you may still require or be more comfortable with eyewear.

When outdoors, it’s optimal and sometimes urgent to protect your eyes from the sun’s strong and sometimes harmful rays. Use sunglasses that provide 100% UV protection. For sports-sunglasses, the lenses need to have poly-carbonate for extra strength and protection. Anytime you work with power tools or do any activity where eye injury is possible, be sure to use safety glasses with poly-carbonate lenses.

If you’re over 40 (or close), it’s likely you’ll need reading glasses after LASIK. Many LASIK patients benefit from prescription eyeglasses for night driving. Even a mild prescription will make your vision sharper for added safety and comfort at night.

After LASIK Eye Care

Remember to continue to schedule routine eye exams post-LASIK. Even with perfect vision you still need to have your eyes examined for glaucoma and other potential problems on a regular basis. Routine exams will help insure that your vision remains stable after LASIK.

LASIK – How to Measure Success or Applicability

Is laser eye surgery for everyone?

Below are some guidelines to help you decide if LASIK is a good choice for you.

  • Vision stability: Young adults often experience annual changes in their prescription for eyeglasses or contact lenses. A 12-month period of maintaining the same prescription is highly recommended prior to LASIK. Otherwise there is a considerable risk of requiring repeated LASIK surgery in the future.
  • Healthy Eyes: Problems, diseases or conditions related to your eyes could cause increased risks to both the actual surgery and the healing process. If you have a condition that can be treated such as dry eyes, pink eye (conjunctivitis) or any eye injury speak to your doctor. It is probably best to wait until the condition is resolved to schedule your LASIK surgery. Conditions like cataracts, glaucoma, and other more serious conditions may disqualify you from LASIK altogether.
  • Age: 21 is the minimum age of consent for LASIK. Younger patients may be able to get special exemptions based on certain circumstances.
  • Vision prescription range: A very high degree of myopia may require removal of too much corneal tissue. This may exclude your candidacy for LASIK or make another refractive surgery a better option. For example, many surgeons conclude that a phakic IOL procedure provides better results and possesses less risk than LASIK for nearsighted prescriptions higher than -9.00 diopters.
  • Pregnancy: Normal hormonal changes of pregnancy may cause swelling of the cornea which can alter vision. Dry eye is also common during pregnancy. Additionally, medications (antibiotics or steroids) which are administered for LASIK could cause risk to the embryo or nursing infant. It is recommended to delay LASIK for several months after childbirth until the eyes stabilize and risks are reduced.
  • Systemic and autoimmune diseases such as rheumatoid arthritis, type 1 diabetes, HIV or AIDS may disqualify or delay candidacy for LASIK. If your body has trouble healing, your cornea may not heal properly after LASIK surgery. Opinions vary among professionals as far as which diseases automatically disqualify and which ones pose acceptable risks. Discuss this in depth with your doctor if applicable.

LASIK Risks and Complications

LASIK is the most common refractive eye surgery, partially due to the fact that the risks and complications are low. The majority of patients don’t experience any long term complications as a result of the surgery. Nevertheless, as with any surgical procedure there are some risks, however rare they are and it is important to know them and to discuss them with your eye doctor or surgeon prior to undergoing the surgery.

Side effects of LASIK

There are a number of side effects that are somewhat common immediately post-op and in some instances can last longer – sometimes indefinitely. Those include:

Dry Eyes

About half of LASIK patients experience dry eyes, which are usually a temporary side effect that resolves within 3-6 months after the surgery. Your doctor will likely prescribe artificial tears in the days and weeks following the surgery which should be continued as long as the symptoms persist. Because of this, it is usually recommended that patients with a history of chronic dry eyes opt for another type of refractive surgery such as PRK, another style of laser refractive surgery with reduced risk.

Eye Infection or Irritation

While not common due to the eye drops and checkups prescribed post surgery, there is a chance of developing an eye infection. If this does occur, it can be treated with antibiotic eye drops, anti-inflammatories or sometimes may require other treatment such as oral antibiotics. If you are experiencing symptoms of an eye infection such as redness, pain, discomfort, discharge or any change in vision, see your eye doctor immediately. As a precaution, it is imperative to follow your surgeon’s instructions for your post-operative care including prescription medications and doctor’s visits.

Vision Issues

Following surgery, you may experience certain vision issues such as such as poor night vision, double vision, halos around lights or glare. These side effects are common and can last up to a few weeks, but typically go away. Some patients report a lasting reduction in vision in low light conditions and may require vision aids for seeing better at night.

Other risks of LASIK include surgical errors, many of which can be corrected by a follow-up surgery. These include:

Overcorrection or Undercorrection

The key to vision improvement in LASIK is accurate reshaping of the corneal tissue. If too much is removed or not enough is removed, your vision will remain imperfect and when possible may require a follow up procedure to obtain the clear vision being sought.

Flap Complications

Perhaps the greatest risk involved in LASIK is the accurate creation and healing of the flap of the cornea that is lifted to reshape the underlying tissue and replaced after. If the flap in the cornea is not made accurately, cut too thick or too thin and not carefully replaced back on the eye, it can cause complications in the shape of the eye surface and therefore clear vision. Studies indicate that these complications occur usually in under 6% of cases and the experience and skill of the surgeon play a large role.

There can also be complications in the healing process of the flap which include infection or excessive eye tearing.

Vision Loss

There is a chance, albeit small that the surgery can result in a loss of vision or reduction in visual clarity due to complications with the surgery.

It is quite rare for any permanent damage or vision loss to occur as a result of LASIK and usually any vision problems can be corrected by a follow-up procedure. However, as with any surgical procedure, there are risks, so it is important to reduce your risks by finding an experienced surgeon and carefully considering your suitability for the surgery in the first place.

LASIK

LASIK or laser-assisted in situ keratomileusis is a refractive surgery that is used to correct myopia (nearsightedness), hyperopia (farsightedness) and astigmatism as an alternative to eyeglasses or contact lenses. LASIK is currently the most common of the refractive eye surgeries, largely because of the relatively low risk and the quick recovery and improvement in eyesight.

Also known as laser eye surgery or laser vision correction, LASIK uses a laser to reshape the cornea which is responsible for clear vision. The procedure is quick and relatively painless and eyesight is usually improved to 20/20 vision within one day of the surgery.

How Does LASIK Work?

LASIK is an outpatient procedure, which takes about 15 minutes for the actual surgery on both eyes and an hour total with recovery. A topical anesthetic drop is used and there is no need for bandaging or stitches following the procedure. The doctor will start by stabilizing the eye and then making a small flap in the outer layer of the cornea. Then with access to the underlying tissue, he uses a laser to reshape the corneal tissue and re-closes the flap, which will heal on its own. The nature of the corneal reshaping depends on the type of refractive error.

Wavefront LASIK

Wavefront LASIK uses computer mapping technology to guide the laser treatment based on the precise shape of the cornea. This can correct very precise issues, provide much sharper vision than non-wavefront LASIK and can reduce complications such as halos, glare and problems seeing at night.

What to Expect During and After LASIK?

During the procedure you may feel some pressure on your eye while the laser is working. Immediately following you will likely experience some blurriness and may feel burning or itching (be sure not to rub your eyes!). For your journey home you will be given protective shields to guard your eyes and will need someone to drive you. You will also be prescribed medicated eye drops for a week or so to aid in healing and prevent infection. Your doctor may also recommend artificial tears to moisten the eyes and keep them comfortable in the days following the procedure.

The day after the surgery you will be asked to visit your eye doctor (or the surgeon) for a checkup and to evaluate whether you are able to drive. Most people experience an improvement in vision by then, although for some it can take a few days or even a week. Your eyes may be sensitive to light for a day or two as well. You will likely be advised to rest for a day or two and to refrain from strenuous physical activity for about a week until further healing has taken place.

Most people achieve at least 20/20 vision following the surgery, although this can vary and there are cases where 20/40 vision is obtained or where people continue to wear glasses or contacts with a much lesser prescription. Some patients have light sensitivity, particularly when driving at night, also suffering from seeing halos around lights or glare. There are glasses and lenses available to reduce this glare and assist with night driving.

For some, it can take weeks or even months until the vision completely stabilizes. Occasionally, after a few months, patients who do not experience perfect results will schedule an enhancement or touch up surgery to correct the vision even further.

Am I a Candidate for LASIK?

The ideal LASIK candidate is a patient over 18 with generally healthy eyes. Since the procedure involves shaping the cornea by removing some of the tissue, it is not ideal for individuals with a thin cornea or any sort of corneal condition or disease. Patients with chronic dry eyes might also be disqualified as LASIK can often exacerbate these symptoms.

During a comprehensive eye exam your eye doctor will assess your eligibility by looking at the general health of your eye including your cornea, your pupil, the moisture in your eye, the type of refractive error you have and whether you have any other eye conditions of concern.

For the right candidate, LASIK can offer a lifestyle improvement in giving clear vision without the need for glasses or contact lenses, however, the results are not guaranteed. You and your eye doctor need to weigh the benefits and the potential risks based on your personal needs.