LASIK - laser vision correction, is a procedure for the correction of moderate to high degrees of myopia (nearsightedness). LASIK will also correct low to moderate degrees of hyperopia (farsightedness) and astigmatism associated with myopia.

In order to really understand the LASIK procedure, the patient must have a working knowledge of the Cornea. The Cornea is a clear window to the eye and is transparent tissue. Generally, the cornea is 11.5mm in horizontal diameter, which is roughly ½ inch. The center most portion of the cornea is about 500 microns thick.

The day of the procedure begins with the arrival at the center of choice. Of course, the first matter at hand is collection of payment and consent forms. Oral Valium, in most cases, is dispensed to relax the patient. Pre-operative topical antibiotic, anti-inflammatory and anesthetic drops are given.

The patient will be escorted into the surgery suite. The surgeon will then examine the eye under the slit lamp and will apply a gentian violet dye to the pupil. These markings give orientation for astigmatism, when patients lie down their eyes tend to roll slightly; therefore, these marks allow for a perfect line up. Also in the case of a “free flap”, the mark would allow proper orientation of the cap back on the eye.

The patient is now ready to be placed in position in a reclining surgical chair. Eyelashes are covered with a plastic drape and a speculum, lid holder, is inserted to hold your eyelids open. The opposing eye is patched closed. LASIK is most commonly performed bilaterally (both eyes on the same day). Patients remain awake during the procedure, and the eye is numbed with drops. There is no discomfort during the procedure.

The patient will be asked to focus on a light, most surgeons provide a coach or hand holder to assist the patient through the process. The coach’s job is to tell the patient everything that is going to happen before it happens. Patients will also be reminded to focus on the light, keep still, and breathe normally.

The surgeon will begin the placement of the suction ring (the microkeratome blade will attach to this), once good positioning is obtained, suction is applied. The patient will generally feel pressure and vision will go dark; however, there is no pain involved. The microkeratome will be placed on its track, after an adequate amount of pressure is fulfilled. The surgeon will then start the microkeratome blade across the cornea creating the flap. The flap is left attached to the cornea by a hinge, which is made by having the microkeratome stop before it fully traverses the diameter of the cornea, leaving an uncut portion. The flap is 160-180 (about 4 human hairs) of the 500 microns. The patient will hear a buzzing sound and feel a mild vibration. Once the flap is complete, the suction ring and the microkeratome are removed.

The flap is then lifted by the surgeon, and folded back out of the way. Then the excimer laser is used to reshape the remaining surface of the cornea. The laser treatment typically lasts less than one minute. During the laser treatment, the patient will hear the click sound of the laser and might also smell a slight burning odor. The treatment will last from 30 to 90 seconds. One diopter of correction will take approximately 8 seconds. The surgeon has control of the treatment at all times. Should the eye move off center, the surgeon could stop and then restart the laser treatment. The amount of laser treatment necessary is based on the patient’s particular prescription. This information was programmed into the laser prior to arrival for surgery.

Once the laser treatment is complete, the surgeon will irrigate the treated area and lay the flap back into its original place where it will adhere to the eye without the need for sutures. Topical drops will be applied and the area will be smoothed. Most surgeons wait 1 to 3 minutes to insure the corneal flap has fully re-adhered. At this point, patients can blink normally and the corneal flap remains secured in position by the natural suction within the cornea. While it is possible to dislodge the corneal flap during the first day or two by physically rubbing the eye, this event is actually quite rare. Before the patient leaves, the surgeon will examine both eyes to insure that the flap is still in position.

Since the protective layer remains intact with LASIK, patients are only placed on an antibiotic and anti-inflammatory drop for about a week. Preservative Free artificial tears are used initially for dryness. Vision is usually quite good the following day with LASIK.

LASIK patients are instructed to wear protective eye shields while sleeping the first night to prevent accidental trauma to the cornea flap during the early healing period. The excimer laser is an ultraviolet laser, which utilizes Argon and Fluorine gas to create a non-thermal, or cool beam, of laser light, which can break molecular bonds in a process commonly, referred to as “photoablation”. A simple way to imagine how the laser works is to think of it as placing the curvature from your glasses or contact lenses onto the front surface of your eye, allowing you to see without corrective eyewear.

There are many resources available to explain the LASIK procedure; however, very few detail the testing necessary leading up to the procedure. These tests can be seemingly overwhelming and technical. Some of the testing could have been done at an initial consultation, though, some tests may need to be repeated. Each test has a specific purpose to assist the surgeon in obtaining the best results possible.

The first step is to determine the uncorrected visual acuity, which is vision without glasses or corrective lenses. This raises the question of “What does 20/20 mean?” In the U.S. vision is recorded on a chart with standardized letters calibrated to be read at 20 feet away. The fraction that describes vision, for instance, 20/20, 20/40, compares the smallest letters that a person with perfect vision can see at 20 feet to your vision at 20 feet. If you are only capable of seeing larger letters on the chart that can be seen by a normal person standing back 40 feet from it, then your vision is 20/40. 20/400, means at twenty feet from the chart you can only distinguish the giant E on top, which could be seen by a normal person from 400 feet away.

Some visual acuity levels bear special legal significance. For example, you must be able to see the 20/40 line of letters, or smaller, in order to drive without glasses in the U.S. For this reason, statistics for laser vision correction are often quoted in relation to the percent of patients receiving 20/40 vision or better. If the best vision a person can see with corrective lenses is 20/200 in both eyes, that person is legally blind.

Next, best-corrected visual acuity must be determined. Refractive error or acuity is measured one eye at a time, covering the other eye with an occluder. Refractive error is the state of the eye for which a prescription is normally given for glasses or contacts. Generally two refractions are completed on a person considering LASIK surgery. The first refraction is called a manifest refraction. A determination of the refractive error is the “dry” or undilated state. The second is a cycloplegic refraction. This is similar to a manifest refraction except it is completed while your eyes are dilated. The reason for the cycloplegic refraction is to insure that the manifest is correct. When your eyes are dilated, you are unable to accommodate (focus up close) during the test.

Once your visual acuity has been determined, the results will be compared to your previous prescription to assure stability in refractive error. There should not be more than a half a diopter change in the past two years.

The next eye examination is performed with an instrument known as a slit lamp microscope that allows a binocular, high magnification view of the eye. This examination is used to rule out the presence of disease.

Keratometry is used to measure corneal curvature and is completed with a keratometer. This measures the shape of your cornea. Many surgeons have sophisticated topography equipment that obtains these measurements.

An Opthalmoscope is used to examine the back of the eye or “retina” to exclude any tears, detachment or predisposing conditions. The optic nerve that carries vision from the retina to the brain is also observed for signs of glaucoma.

LASIK surgery; nevertheless, it is always best to consult with an ophthalmologist with regards to specific circumstances.

Most patients who are able to successfully wear glasses and contacts and are able to see with corrective lenses will be a candidate for LASIK. However, there are several conditions that can prohibit you from having LASIK surgery and risks that may cause you to have a poor result.

First, begin with what type of vision can be corrected with LASIK surgery. A person who needs glasses or contacts has a “refractive error”. There are four types of refractive error myopia, hyperopia, astigmatism and presbyopia. A person who has perfect eyesight and lacks a refractive error is called “emmetropic”.

In an eye without a refractive error, light rays enter through the cornea and focus directly on the retina at the back of the eye.

In the myopic eye, the cornea is often steep and light rays focus in front of the retina, causing distant objects to appear blurred.

In the hyperopic eye, the cornea is not steep enough and light rays focus behind the retina.

With astigmatism, the cornea has an irregular shape, which scatters light rays and causes both close-up and distant objects to appear blurred.

Presbyopia is a condition where a person progressively loses their lens elasticity and ability to accommodate (focus up close). This condition affects the ability to read at close ranges. The necessary corrective lenses are called reading glasses. Even people who have had perfect vision all of their lives will develop presbyopia in their mid-forties. The excimer laser has no effect on your focusing muscles. The excimer laser cannot help patients who are experiencing the effects of presbyopia, however, there are new techniques being developed for this condition. Ask your doctor if you are a candidate for these new procedures.

Some of the contraindications, or conditions, for which the surgery should be avoided:

Keratoconus - genetically cone-shaped cornea.

Pregnancy or lactation

Progressive myopia - vision should be stable at least one year prior to having lasik surgery.

Keloid formers or people with autoimmune or immunodeficient diseases.
Presence of cataracts.

You must be 18 years or older to have lasik surgery, under present FDA guidelines.

There are other conditions, which may affect the results of your surgery. Should you suspect you have any of these conditions, consult your doctor.

Corneal scars from previous injuries or surgeries (i.e. radial keratotomy)
Diabetes can cause abnormal healing; however, many diabetics have had laser vision surgery with results comparable to those of non-diabetics.

Use of medications. There are medicines that can cause corneal scarring, infiltrates, and some interfere with healing. Consult your doctor, he/she can tell you if you should discontinue medications prior to your procedure and resume shortly after surgery.

Large pupils 8mm or greater, this can cause significant night glare.
Before undergoing an eye examination for refractive surgery, you must be out of your contact lenses. Contact lenses alter the shape of your cornea and can affect the measurements necessary for having LASIK surgery. Patients wearing soft contact lenses should be out of their lenses for three to seven days. Soft-toric, Gas-permeable, and hard contact lens wearers, in contrast, take at least two to three weeks to stabilize the cornea. Talk to your doctor about your specific lenses and cornea shape.

With LASIK, is it important to have an adequate amount of tissue for removal for full correction. Excessive tissue removal can result in severe corneal instability in patients with thin corneas or those with normal thickness corneas with disproportionately high prescriptions. It may be best to under-treat and be left with some residual myopia rather than be fully treated with a small optical zone. It is important to understand the limitations of these procedures based upon your own prescription and eye characteristics.

Laser correction of certain visual problems is the most technologically advanced method available today for reducing your dependence on glasses and contact lenses. The outpatient procedure can correct nearsightedness, farsightedness, and astigmatism by gently reshaping the cornea of your eye with a cool, ultraviolet beam of laser light.
It is estimated that over one million laser procedures have been performed in 52 countries around the world. In fact, vision correction by laser is expected to become the most common procedure performed worldwide within the next five years.

Vision correction using the excimer laser can also dramatically improve your quality of life. From the simple pleasure of being able to see the alarm clock in the morning, to playing sports, and pursuing career-related opportunities, many patients are able to enjoy life with improved self-confidence and renewed enthusiasm.

A refractive procedure attempts to re-shape the cornea to allow light rays to focus directly on the retina. Myopia, hyperopia, and astigmatism all relate to the shape of the surface of the cornea and are therefore correctable with Laser Vision Correction - LASIK.

The reasons a person may not be a candidate to have LASIK vary greatly; however, most doctors offer a complimentary consultation to determine your candidacy for LASIK. Your doctor is the best person to determine if you are a good candidate Laser Vision Correction - LASIK.

The subject of LASIK is a very interesting one. There is a lot to investigate and understand about the process of getting your vision corrected through laser surgery. I hope this article helps to point you where you need to go to do the best research. There are both pros and cons to consider before submitting to this type of surgery.

First, if you are already firmly set in your decision to have LASIK, read these pointers:

1. Make sure you go to a doctor who uses the new Interlase laser for making the corneal flap.

Why? Because the Interlase is 100 times more precise than the “old fashioned” method of using a microkeratome to cut the initial flap. Many speculate that most of the problems that come from LASIK surgery have been due to the impreciseness of the microkeratome device used to cut the cornea.

2. Most definitely insist on a custom wavefront laser to do the actual reshaping of the cornea.

Why? Because the custom wavefront can get rid of what is called higher order aberrations.

What does this mean to you? It means much sharper vision after the surgery and a significantly reduced chance of having halos, starburst and other “complications” from LASIK.

Repeating: Make sure you go to a surgeon who is using both Interlase and Custom Wavefront technology to do LASIK surgery. Relatively few practices have these new technologies. Consider that surgeons who invest in these technologies may have more of your interests at heart.

One of the top 5 LASIK surgeons lives in Kansas City. Check out his site: durrievision.com Look at the information on his site including the videos where he explains what LASIK is all about. Compare your perspective surgeons website to his and you may detect a difference.

Next, you should be aware of the potential problems of LASIK surgery as you review www.surgicaleyes.com - you may find that these horror stories came from procedures that didnt use interlase and custom wavefront technology together. See-there is a reason to go with the newer technologies. You can email the people on this site and ask them questions about their procedures and the complications that they faced or are still facing.

One of the problems with LASIK, has been the LASIK 20/20 phenomenon. Some people do technically see 20/20 after the procedure but it is not normal. Instead, it is hazy or blurred. This is probably due to the higher order aberrations mentioned earlier. That is why it is important to get custom LASIK done. The custom wave front lasers can remove those aberrations, hopefully allowing you avoid the LASIK 20/20 phenomenon.

If your doctor says that you dont need the custom treatment, I would ask him if he has a custom wave front machine. There may be a few legitimate reasons to not have the custom procedure done, but I seriously doubt there are many.

If he doesnt have such a machine, I would wonder if his recommendation is based on the best thing for you as the patient. It always pays to get a second opinion anyway and in this case, you should.

These are your eyes that we are talking about and you owe it to yourself to get educated on every aspect of this surgery before undergoing treatment. The surgical eyes web site mentioned above is worth investigating. You need to know what could go wrong and how to choose a doctor and equipment that will allow you to avoid problems.

I will say it again. Try to go with Interlase to cut the corneal flap and try to go with a custom wavefront laser to reduce your risk of complications! I cannot stress this enough.

I went through a screening process to get LASIK done and was categorized as an excellent candidate. They even wanted me to participate in a study program that would save me about $600. I still turned it down. In the end, I decided that I didnt want to get my eyes lasered.

Of course, there is something to be said about not wearing glasses or contacts anymore and there are many happy patients out there. I just want you to be aware of both the pros and the cons.

Do you really need to have LASIK done? I think its worth it to investigate natural vision therapy and see what you can do about correcting your vision naturally before permanently etching your current prescription into your cornea.

Many people have gotten results from vision therapy. A few have even gotten rid of their glasses and /or contacts forever. An industry insider has informed me that this does happen but not very often.

There are a couple of books to check out on natural vision improvement if you are interested in that alternative. Relearning to See by Thomas Quakenbush is one that comes to mind.

The original pioneer in vision improvement was Dr. Bates. He was an early 20th century ophthalmologist who really stuck his neck out to go against the prevailing theories of the day (that still persist). Many of the people who he helped were very grateful, Im sure.

I have dabbled with naturally improving my vision. I have experienced a decrease of tension, but I have not recovered 20/20 vision. This type of improvement does take work and determination.

That is why there is LASIK today; everyone is different in their wishes and expectations. If you are in a hurry and you dont mind the permanent etching of a prescription in your cornea, LASIK might be for you.

I hope this helps you on your quest to learn more about LASIK Surgery and point you in the right directions to gain more information so that you can make an informed decision before deciding to undergo this often expensive elective procedure.

This article is for informational purposes only and is not meant to diagnose or suggest treatment for any health condition. Please consult a health care professional if you have or suspect you have any health related problem for proper diagnoses and treatment

As with any surgical procedures, there are benefits as well as possible risks of LASIK eye surgery done to your eyesight. You should therefore, carefully consider all the aspects of the risks of LASIK eye surgery, before making a decision.

To make this informed decision, you’ll need to learn the facts about LASIK eye surgery. You’ll have to understand how the eye works and learn pertinent details about the cornea. After which, you should take time to look for a good eye surgeon. One way to minimize the risks of LASIK eye surgery is to have a skilled and experienced eye surgeon, as this is a surgeon dependent procedure.

What is LASIK? LASIK is the acronym for Laser-Assisted In Situ Keratomileusis and is laser eye surgical technique permanently corrects vision. This procedure works best on people who have the following conditions, from moderate to high degrees of myopia (nearsightedness), low to moderate degrees of hyperopia (farsightedness) and astigmatism associated with myopia, and have thick corneas.

People with normal eye sight see objects clearly, for the lights and shadows these cast are brought into a focus point by the cornea and lens of the eye. Ideally, the cornea’s curvature is evenly matched to its length in a normal eye. But people with astigmatism, myopia or hyperopia, have irregularly shaped corneas, so the objects seen are blurred or distorted.

LASIK aims to change the shape of the corneas by a precise removal of corneal tissue, and by doing so correct the eyes’ focusing power. What are the risks of LASIK eye surgery?

Risks of LASIK eye surgery
One of the palpable risks of LASIK eye surgery is totally losing your vision. This could happen if you were misdiagnosed and shouldn’t have had the eye surgery in the first place because you had a serious medical condition. For instance, you could be pregnant, or have cataracts, arthritis, diabetes, glaucoma, and lupus and still undertook the procedure.

Another one of the serious risks of LASIK eye surgery is you’ll lose acuity, because you had large pupils, and extremely poor eyesight.

Do you have dry eye syndrome? One of the risks of LASIK eye surgery, is it will aggravate this condition.

One of the risks of LASIK eye surgery is you’ll permanently suffer from seeing ghost images, have fuzzy vision and diminished contrast.

FDA has approved the use of LASIK laser eye surgery procedure since 1998. While there are a lot of satisfied patients, there are still no long term studies about its effects. Understand the limitations and the risks of LASIK eye surgery, to help you get the best out of the procedure.