Sure, most of us have heard of LASIK, and we know it has something to do with the eyes, but what is it really? What are the risks? Are you a candidate? Read ahead for some of what you should anticipate before jumping into LASIK—also, as with most medical procedures, it’s probably best to not just jump in.
What exactly is LASIK surgery?
First thing’s first, what does LASIK mean? Well, it’s an acronym, and it stands for laser-assisted in situ keratomileusis. To be fair, that probably doesn’t help clear up much of anything. FDA-approved near the end of the 20th century in 1998, LASIK is described by the American Academy of Ophthalmology (AAO) as “an outpatient refractive surgery procedure used to treat nearsightedness, farsightedness, and astigmatism.”
Astigmatism is defined by the AAO as “an imperfection in the curvature of your cornea”. There are two types of astigmatism—corneal and lenticular—though both result in “your vision for both near and far objects [appearing] blurry or distorted,” which the AAO equates to a fun house mirror.
Understandably, the procedure varies based on your reasoning for getting it. Basically, it utilizes a laser that will “reshape the cornea … to improve the way the eye focuses light rays onto the retina at the back of the eye.” Sounds like a piece of cake, right?
If you’re nearsighted, your cornea will need to be flattened, and if you’re farsighted, you’ll need your cornea to be steeper. It’s said to be able to rectify astigmatism through normalizing the shape of the cornea. One thing you shouldn’t count on LASIK fixing though, is “presbyopia, the age-related loss of close-up focusing power.”
According to the AAO, over 90 percent of LASIK patients are able to come away with vision that lands between 20/20 and 20/40 sans contacts or glasses. They stipulate that patients should also prepare in case they need a subsequent surgery, also known as an enhancement or retreatment, and that glasses might still be necessary for things like nighttime driving, as well as reading.
What makes a good candidate?
As with any surgery, there are certain factors that will determine whether or not the impending patient is truly a prime candidate for said procedure. If any of these apply to you, you might want to rethink LASIK: dry eye syndrome, thin corneas, keratoconus, or large pupil size. These are only a select few of the conditions listed, so be sure to check out the FDA’s own advice.
Insofar as dry eye is concerned, leaving it untreated before you get the surgery could affect your post-op results, though if “diagnosed and adequately treated before surgery, you will have the same chance of a successful outcome as a patient without pre-existing dry eye.” If your dry eye is severe though, you might want to rule out LASIK entirely. The risk for dry eye increases with age, particularly for post-menopausal women.
While thin corneas may render you a less-than-ideal candidate for LASIK, it doesn’t rule out the possibility of other similar surgeries. You can and should ensure that “the thickness of your cornea” is examined prior to any surgery.
Keratoconous, “a condition in which the clear tissue on the front of the eye (cornea) bulges outward,” is something that your doctor should ensure that you don’t have, prior to the procedure. It’s always better to take precaution, after all.
In terms of your pupil size, which will be determined during your pre-LASIK exam, a large pupil “has been thought to be a factor in undesirable side effects such as ‘glare’ and ‘halos.’” As it happens, “the relationship between pupil size in low light and these disturbing visual symptoms” isn’t entirely clear.
According to Paula Cofer, who underwent LASIK only to have her eyes forever changed—and not for the better—says she was never briefed about the issues she might later encounter, as she should have never ben a candidate, given her large pupils and propensity for severe dry eye. Back in 2010, a decade after her surgery, Cofer not only continued to endure “severe dry eyes and blurry vision,” but she noted that her eyes were always burning, and she even had to use a slew of products for them, such as eye rinses, drops, a mask to help with dry air, and more. She was also wearing goggles to help maintain moisture, which she said made her resemble a fly, and she called them “very unattractive.”
What sort of preparations should be made prior to surgery?
In addition to speaking with your doctor and ensuring you don’t have any of the aforementioned conditions, as well as the others listed in the links above, there are still plenty of things you should be doing to prepare yourself, some of which vary depending on whether you wear glasses or contacts. For the latter, you should “stop wearing them before your baseline evaluation and switch to wearing your glasses full-time.” Though how far in advance you should stop wearing them varies, based on the type of contacts you wear—soft, toric soft or RGP, or hard—as they can alter the shape of the cornea.
Make sure you disclose any medical or eye-related conditions to your doctor, regardless of whether the condition is a current or past one, as well as any medications you’re currently taking or could possibly be allergic to.
During an eye exam prior to your surgery, ensure that your doctor covers “the risks, benefits, and alternatives of the surgery,” what to anticipate, what sort of candidate you are, and “what your responsibilities will be before, during, and after surgery.” Don’t forget to ask any and all questions you have regarding the surgery so you can make an educated decision about how to proceed.
The day before your surgery is scheduled, the FDA recommends that you stop using perfumes and cosmetics, as well as lotions and creams, as any of these could pose an increased risk regarding possible infections.
You should ensure you have a ride to and from the procedure, as well as to your first post-op visit. Aside from possible blurry vision, the medicine you’ll have “impairs your ability to drive.”
What can be expected during the procedure?
Referred to by the American Refractive Surgery Council (ARSC) as “quick and virtually painless,” a LASIK procedure should actually only take up about a half hour of your time, says the FDA, if not less. It sounds like a pretty comfortable setup, especially for a doctor’s office, as you get to lie down in a reclining chair.
The procedure begins with a topical anesthetic, says the AAO, and that’s meant to numb the eye, after which the area surrounding your eye is going to be cleaned. Just like those tools the dentist uses to keep your mouth wide open, something similar will occur here with your eyes. Get ready for the lid speculum.
If you want to read a more detailed and in-depth description of what exactly the procedure entails, the FDA provides a description on their site, as does the AAO. One thing you should be aware of is that you won’t need stitches after, but you will need to use some sort of shield to protect your eye. This will “prevent you from rubbing your eye and putting pressure on your eye while you sleep, and to protect your eye from accidentally being hit or poked.” This is something you will need to continue wearing until you’re all healed.
According to the ARSC, given the technological developments since LASIK was first approved, there are additional technologies now used in the procedure. Excimer lasers, whether wavefront-guided or optimized, are one such example, as is 3D digital mapping of your eye. The ARSC points out that these help to increase the safety and accuracy to patients, “enabling surgeons to customize procedures for the patient and better visual outcomes.”
What other normal activities should be avoided, when can they be resumed, and are there other things to watch out for?
If you’re used to an active lifestyle, LASIK might pose a bit of a problem for you. Granted, for non-contact sports, it’s only advised that you wait one to three days after your operation to resume these—though it’s dependent “on the amount of activity required, how you feel, and your doctor’s instructions.” For contact sports, it’s not quite so lenient, as you should not be participating in any of these for a minimum of four weeks following your procedure. These sports include, but are not limited to, karate, boxing, and football.
Regarding the creams, lotions, and other cosmetics that you were supposed to stop using prior to getting LASIK, you shouldn’t resume using them just yet. In fact, the FDA suggests that, “To prevent infection, you may need to wait for up to two weeks after surgery or until your doctor advises you otherwise.”
Be aware that your vision is prone to changing over the course of the months following your operation. For instance, it could take “three to six months for your vision to stabilize after surgery,” which sounds like a lot if you’re not prepared, but this is why you should know all the facts going in. During these months, it’s possible that symptoms such as “glare, haloes, difficulty driving at night, and other visual symptoms may also persist.” If you do happen to need enhancement, you’re advised to “wait until your eye measurements are consistent for two consecutive visits at least 3 months apart before re-operation.”
While distance-related vision has the propensity to improve after a subsequent operation, glare or haloes likely won’t, so keep that in mind. No matter what, if you find yourself having new or unusual symptoms, or anything is, again, turning worse rather than better, reach out to your doctor right away.
Are there alternative procedures? If so, what?
As mentioned above, it’s possible that you might have some underlying conditions that would mean you’re not a prime candidate for LASIK. Don’t give up hope though, there are other refractive surgeries you might be eligible for. One such procedure is called Wavefront-Guided LASIK, in which “computer imaging technology creates a very detailed three-dimensional ‘map’ of the patient’s cornea that looks a bit like a miniature mountain range. …Wavefront technology can measure very subtle abnormalities in the surface of the cornea, enabling wavefront-guided LASIK to achieve vision correction beyond what is possible with glasses or conventional LASIK.” This type of operation has, according to studies, also proved to “reduce side effects, such as problems with night vision and contrast sensitivity (the ability to clearly see objects against a background, such as black letters on a white page), and also to increase the percentage of patients who achieve 20/20 vision.”
Photo refractive keratectomy, also known as PRK, is another alternative, utilizing an excimer laser, as LASIK does. According to the AAO, the results for a patient’s vision correction are pretty comparable, though PRK doesn’t have anything to do with a flap. Apparently, it can take “a few days before vision stabilizes for PRK patients.” There’s also wavefront-guided PRK, though, as, “the FDA approval process has not yet taken place … wavefront-guided PRK is considered an ‘off-label’ use of the technology.”
Other options include LASEK and EpiLasik; in both procedures, the epithelial layer tends to take around four days to heal. Alternative surgeries you might prefer include Conductive Keratoplasty (CK), Phakic Intraocular Lenses, also known as IOLs, and Refractive Lens Exchange, also referred to as Clear Lens Extraction.
What are the extreme risks?
In addition to the risks mentioned above, you should be wary of both undercorrections and overcorrections, according to the Mayo Clinic. Undercorrections occur when “the laser removes too little tissue from your eye.” This then results in your post-op vision not being as clear as you might have been aiming for, though this is a more prevalent issue with nearsighted patients. If this occurs, you could need one of those enhancement surgeries previously noted, to get the rest of the necessary tissue. As with many things though, “Less is,” as the old adage says, “More.” In this sense, it’s much less of a hassle to be saddled with undercorrections than overcorrections—“a complication of refractive surgery where the achieved amount of correction is more than desired,” as defined by the FDA. As the Mayo Clinic says, this “may be more difficult to fix than undercorrections,” as it means too much tissue was removed.
You also run the risk of eventually regressing back to your “pre-surgery vision,” which, according to the Mayo Clinic, could occur because of “abnormal wound healing, hormonal imbalances or pregnancy.”
Oh, and remember when we told you LASIK can sometimes help your Astigmatism? Well, it can also cause it, if there’s “uneven tissue removal. It may require additional surgery, glasses or contact lenses.” That sort of defeats the purpose, doesn’t it?
You might also recall us mentioning that people with severe dry eye probably shouldn’t get the procedure. Well, the Mayo Clinic says that, “LASIK causes a temporary decrease in tear production.” If this is the case, you’re able to get an additional “procedure to get special plugs to put in your tear ducts to prevent your tears from draining away from the surface of your eyes.”
Remember, these aren’t the only risks, you can check out this link for more information.
What should you ask your doctor?
As is emphasized throughout this piece, there are certain things you and your doctor really need to go over before you decide to get LASIK. You should, as a precaution, ask these regardless of which refractive surgery piques your interest. Here are some of the things you should be asking, based on points made above.
Ask about the range in which your refractive error falls, and if it’s “within the approved range,” as “LASIK is approved by the FDA to treat certain degrees of nearsightedness, farsightedness and certain types and degrees of astigmatism, alone or in combination with near- or farsightedness.” As AAO says, if your refractive error is severe, it “reduces the chance of success and increases the chance that pretreatment may be needed.”
Ask if your current age and “life-stage” are ideal for you to undergo the procedure. Ask if, over the past 12 months or so, your eyes have constituted as “relatively stable,” which can be proven by your glasses and contact prescription. Inquire if and how LASIK will fit into your lifestyle. You should ask your doctor what retreatment could consist of, should you get it. Make sure you ask how other health conditions—be they related to your eyes or not—could affect your eligibility for LASIK, and whether they need to be taken care of prior to the procedure. Some of these could be diabetes, glaucoma, and autoimmune diseases.
Don’t forget to ask about the cost of the surgery and anything related to it, like subsequent treatments—should you need any of that.
Of course, these questions aren’t the only ones you should be asking, but they are a good place to start.