How The LASIK Procedure Works
LASIK is performed in an outpatient suite in a laser center. In readiness for the procedure, you will be comfortably reclined under a pain free laser. Although you can resume most normal activities the next day, it usually takes three to six months after the LASIK procedure for improvements in a person’s vision to fully stabilize.
First, the eye is numbed with a few drops of topical anesthetic. An eyelid holder is placed between the eyelids to keep them open and prevent the patient from blinking. The other eye is immobilized. A suction ring is then placed on the eye which lifts and flattens the cornea and helps keep the eye from moving. You may feel pressure from the eyelid holder and suction ring, just like you would if a finger is pressed firmly on your eyelid.
Vision will appear dim or go black as the suction ring is placed on the eye and will return when it is removed a minute or less later. Once the cornea is flattened, a hinged flap of corneal tissue is created using a painless, blade free automaed laser. This corneal flap is gently lifted and folded back. Then the preprogrammed excimer laser with your unique eye measurements is centered above the eye.
The laser is positioned correctly while you look at a special pinpoint light called a fixation and tracking light. The excimer laser then sculpts the corneal tissue to your prescription. Then the flap is replaced into the exact previous position. The corneal flap sticks to the underlying corneal tissue within two to five minutes, and stitches are not needed.
You should make arrangements for someone to drive you home after the procedure and then take a nap or just relax. Often times you may need to wear a shield to protect the eyes when sleeping. The surgeon will also provide eye drops to help the eye heal quickly and relieve dryness.
What to Expect Before, During, and After Surgery
A complete eye examination will be required by Dr. DeCanio. You are also required to bring your most recent eye prescription and/or your eyeglasses with you to the initial exam. You will then need to stop wearing contact lenses a week or more before your final pre-operative evaluation. At this visit, Dr. DeCanio will dilate your pupils to fine-tune your prescription, examine your eyes to ensure they’re healthy, including testing you for glaucoma, performing a retinal exam, and assessing for dry eye
The curvature of your cornea and your pupils will also be measured, alongside the corneal topography of your eyes; just to ensure you do not have conditions that may disqualify your candidacy. The thickness of your cornea will also be evaluated to confirm you have enough tissue to perform the procedure safely.
You will be asked to sign an informed consent form after a thorough discussion of the risks, benefits, options, and possible complications of LASIK. It is important to review the form carefully and understand everything in it.
LASIK is an outpatient procedure. They begin by applying an eye drop that numbs the surface of the eye. The procedure takes about 10 minutes for each eye.
The Procedure: The eye is moistened. A specialized device is positioned to keep the eye from moving, placing the central cornea in the correct position. Then a special laser, called a femtosecond laser, creates a hinged flap of thin corneal tissue, at which time the flap is lifted. A special second laser, called the excimer laser, gently reshapes the underlying corneal tissue, and then the corneal flap is precisely repositioned and quickly adheres to the eye with no stitches.
The healing process is relatively quick. You can resume most normal activities the next day; however, you may wish to take a few days off from work and other activities. Do not engage in moving sports activities for a week after the procedure. Impact sports or similar activities may have to wait for as long as four weeks. Be aware that you may experience a mild burning sensation for a few hours after the procedure. Do not rub your eye for at least six months. The day of procedure is a day of no expectation and blurry vision is normal. You can expect a considerable improvement by the next day as you return for your follow up evaluation. Report any unusual or aggravating side effects immediately. Do not drive until your vision has improved comfortably. Avoid swimming, hot tubs, and whirlpools for at least two weeks after the procedure.
LASIK Risks And Side Effects
LASIK, like any procedure, has potential risks and complications that should be carefully considered. Since it was approved by the FDA in 1996, LASIK has become a very popular treatment in the United States and the overall complication rate is exceedingly low. Infection is rare as with any procedure and can be well treated.
For regular LASIK, side effects usually disappear over time. These side effects may include hazy or blurry vision; difficulty with night vision and/or driving at night; scratchiness, dryness and other symptoms of the condition called "dry eye"; glare, light sensitivity; halos or starbursts around lights; discomfort or pain; or small pink or red patches on the white of the eye. Our advanced laser vision technology has an excellent track record of minimizing or eliminating reported side effects or complications.
In rare cases, a second procedure, called a retreatment or enhancement, may be indicated in order to achieve the optimum desired visual outcome. This is more likely for people who have extreme cases of nearsightedness, farsightedness, or had higher astigmatism before LASIK — those whose vision originally needed more intensive correction.
At the May 2016 annual meeting of the American Society for Cataract and Refractive Surgery – the medical organization of surgeons specializing in vision correction and cataract surgeries – updates of several high-profile research studies of LASIK safety and performance, including the FDA PROWL study, were presented showing impressively and consistently high marks for safety, outcomes, as well as patient satisfaction.
Ultimately, these studies support the overwhelming body of clinical evidence proving LASIK is a safe and effective vision correction option for those who qualify. Remarkably, these studies report the procedure is more likely to help symptoms of dry eye, glare, halo, starbursts and ghosting than it is to cause symptoms. Especially, noteworthy for those who previously wore contact lenses.
Two results of two studies in particular, the U.S. Food and Drug Administration-sponsored “Patient Reported Outcomes with LASIK (PROWL)” and an evaluation of the available scientific literature worldwide on advanced LASIK entitled, “Modern LASIK Outcomes: A Review,” conducted by ASCRS president Kerry D. Solomon, M.D., have been much anticipated by vision correction surgeons.
“Although each take a different investigative approach, these studies provide some of the best data and insights into LASIK, particularly from the patient’s perspective,” said Daniel S. Durrie, M.D. and one of the clinical investigators for the FDA PROWL study. “One of the key findings, from both studies, is with modern equipment, modern techniques and well-selected patients; good surgeons can deliver terrific results with a high degree of safety. LASIK is a great procedure.”
The FDA PROWL research was conducted as prospective, post-market, observational studies designed to develop and evaluate a patient reported outcome questionnaire for use post-LASIK. Approximately 574 subjects (262 active duty military personnel, 312 civilians from 5 investigational sites) were enrolled and asked to fill out an online questionnaire before LASIK and 3-months after LASIK.
The “Modern LASIK Outcomes: A Review” updated the work from the “LASIK World Literature Review: Quality of Life and Patient Satisfaction published in 2009 by analyzing the impact of advanced treatment profiles in LASIK (employing femtosecond laser keratomes and wavefront diagnostic/guidance). In the current work, nearly 4500 clinical study papers on the topic of LASIK were evaluated for relevancy and authority. The final data set included 97 high-quality studies that combined represented 67,893 procedures.
These substantial studies made fresh inquiries into the basics of LASIK: Is it safe? Does the procedure improve vision? What is the potential for side effects? The findings from these studies affirmed the consensus of previous research into LASIK performance:
- Patient satisfaction rate of up to 98 percent.
- Nearly 100 percent of patients achieving at least 20/40 vision, with more than 90 percent achieving 20/20 vision.
- Less than 1 percent of patients lost two or more lines (on the eye chart) of best corrected visual acuity (BCVA).
There was particularly good news out of the FDA PROWL study about the potential for side effects, including dry eye and other visual symptoms such as glare, starbursts, ghosting and halos, post LASIK.
For dry eye, more than half of patients (59%) with dry eye symptoms before surgery reported having no symptoms of dry eye 3-months after LASIK. For those reporting residual dry eye symptoms, there were statistically significant decreases in the severity of symptoms at 3 months post LASIK
For those patients with no symptoms of dry eye prior to surgery, approximately 30 percent reported experiencing symptoms at 3 months after LASIK. The typical clinical experience with dry eye post LASIK is a gradual improvement of symptoms throughout the healing process, up to one year after surgery.
LASIK also benefited those with visual symptoms (glare, starbursts, ghosting and halos) before surgery. More than twice the number of patients reported their pre-operative visual symptoms were gone at 3-months than those who reported an increase in symptoms at 3-months.
While a small percentage of patients may experience symptoms during the healing process, by working closely with your surgeon your symptoms can be managed and, if needed, treated to help you achieve your vision goal.
The results of these studies are consistent with the clinical experience of LASIK and underscore the commitment of surgeons and researchers to continually investigate the potential of this valuable option in vision correction. Through efforts such as these, clinicians are able to find ways to improve the technology, technique and overall patient experience with LASIK, making an already good procedure even better.
Culled from American Refractive Surgery Council https://americanrefractivesurgerycouncil.org/new-research-lasik-safety-performance-continue-to-impress/
American Academy of Ophthalmology https://www.aao.org/eye-health/treatments/lasik
Federal Trade Commission consumer information https://www.consumer.ftc.gov/articles/0062-basics-lasik-eye-surgeryAmerican Refractive Surgery Council https://americanrefractivesurgerycouncil.org/new-research-lasik-safety-performance-continue-to-impress/
US National Library of Medicine https://medlineplus.gov/lasereyesurgery.html