LASIK - Laser Eye Surgery

• In their early 20's and younger.
• Diabetic and are susceptible to other diseases that lead to fluctuating hormones.
• Are pregnant or breastfeeding.
• On medications that cause fluctuations in vision.

• Herpes simplex or shingles involving the eye area.
• Glaucoma, glaucoma suspect, or ocular hypertension.
• Eye diseases, such as uveitis/iritis (inflammations of the eye).
• Eye injuries or previous eye surgeries.
• Keratoconus.

• Blepharitis. Inflammation of the eyelids with crusting of the eyelashes, that may increase the risk of infection or inflammation of the cornea after LASIK.
• Large pupils. It is common for many people to have large pupils, younger patients and patients on certain medications may be particularly prone to having large pupils under dim lighting conditions. This can cause symptoms such as glare, halos, starbursts, and double vision after surgery. In some patients these symptoms may be overall detrimental; a patient may no longer be able to drive a car at night or in certain weather conditions.
• Thin Corneas. The cornea is the thin clear covering of the eye that is over the iris; the colored part of the eye. LASIK changes the eye’s focusing power by reshaping the cornea. Performing a refractive procedure on a cornea that is too thin may result in blinding complications.
• Previous refractive surgery such as RK, PRK and LASIK. Additional LASIK may not be recommended. The decision to have additional LASIK must be made in consultation with your doctor after careful consideration of your unique situation.
• Dry Eyes. LASIK can aggravate this condition.

• Some patients lose vision.
• Some patients can develop glare, halos, or double vision that can greatly impair vision at night.
• It is possible that full vision will not be restored. Some patients still need reading glasses or weak prescription lenses.
• Some patients report severe cases of dry eyes after surgery.
• Results generally depend on the severity of the eyesight. It is possible that a person with severe eyesight to not gain 20/20 vision after surgery.
• Some farsighted patients may experience diminishing eyesight with age.
• LASIK is a new technology. There is no long term data.

• Monovision
  Monovision is a technique used to deal with presbyopia; when the eye gradually loses the ability to change focus from far to close up – usually a result of aging. The idea behind monovision is for the presbyopic patient to use one eye for viewing distances and the other eye for viewing close up. Since one eye is corrected for viewing far and the other eye is corrected for viewing close up, the two eyes no longer work in unison. The results are poor vision quality and decreased depth perception. Monovision is most noticeable in low light and tasks that require sharp vision. In most cases, you will need to wear glasses or contact lenses to fully correct both eyes for viewing far distances or close up when performing tasks that require a sharp eye, such as driving at night, operating machinery, or performing tasks that require sharp vision.
  
  Most patients have a hard time with having one eye blurred at all times. If you are considering monovision with LASIK, it is highly recommended that you go through a trial period with contact lenses to see if monovision can be tolerated. Different states also have specific requirements for driving with monovision.
  
  Another thing to consider is how much your presbyopia is expected to increase over time. Your doctor should be able to tell you when you can expect your monovision surgery to no longer be enough for you to see near-by objects effectively without the aid of glasses or contacts, or when a second surgery might be required to further correct your near vision.
• Bilateral Simultaneous Treatment
  In most cases patients choose to have surgery on both eyes at the same time, however the practice of having surgery on both eyes is actually riskier.
  
  The advantage of having surgery on one eye at a time is to see how effective the surgery is on the eye and the resulting vision. Also by doing both eyes simultaneously there’s a chance that vision in both eyes will be blurry during recovery and may not be able to see for a few days until both eyes heal.

• Compare.
  Always get a second opinion. Some doctors have more or less experience with newer and older technologies. The results from LASIK vary with every little detail, from the individual patient, to the doctor, to the procedure being performed and even the equipment being used.

• Never compromise your health and well being over cost. This applies across the board with all medical related procedures. Eye surgery is permanent and irreversible.
• No Guarantees. Be aware of false advertising, faulty promises or package deals. There are never any guarantees in medicine. Do your research.

• Make sure you have a consultation and evaluation with your doctor first.
• It is recommended that you stop wearing contact lenses before your evaluation and switch to wearing your glasses full-time. Contact lenses can change the shape of your cornea for weeks after you have stopped using them depending on the type of contact lenses you wear. If your cornea does not assume its natural state before surgery it can lead to negative consequences; including inaccurate measurements and surgical plan, resulting in poor vision after surgery. These measurements, which determine how much corneal tissue to remove, may need to be repeated at least a week after your initial evaluation and before surgery to make sure they have not changed. This is especially true for those who wear RGP or hard lenses.
• Soft contact lenses should not be worn 2 weeks before the initial evaluation.
• Toric soft lenses or Rigid Gas Permeable (RGP) lenses should not be worn for at least 3 weeks before the initial evaluation.
• Hard lenses should not be worn for at least 4 weeks before the initial evaluation.
• You should tell your doctor:
  - about any current or past medical and eye conditions
  - about any medications being taken, including over-the-counter medications and any medications you may be allergic to
• Your doctor should perform a thorough eye exam and discuss:
  - whether you are a good candidate
  - what the risks, benefits, and alternatives of the surgery are
  - what you should expect before, during, and after surgery
  - what your responsibilities will be before, during, and after surgery
• During the consultation you should ask your doctor all the questions you feel you need to ask. Discuss the risks and benefits, review any informational literature provided by your doctor, and make sure all your questions are answered before signing anything.
• You should never feel pressured by your doctor, family, friends, or anyone else to make a decision about having surgery. It is your health and well being. It is your decision.
• The day before surgery, you should stop using creams, lotions, makeup, and perfumes. These products along with other debris on the eyelashes can increase the risk of infection during and after surgery.
• Arrange for transportation to and from your surgery and your first follow-up visit. On the day of surgery, your doctor may give you medication that may impair your ability to drive and see clearly.

• The surgery is generally no more than 30 minutes. The surgery takes place in a reclining chair in an exam room where the laser is housed.
• Anesthetic eye drops will be placed in your eye and the area around your eye will be cleaned while the lid speculum holds your eyelids open. A ring is then placed on your eye and suction will be applied to the cornea. During suction your vision will dim and you may feel pressure and experience some discomfort. A cutting instrument called the microkeratome, is then attached to the suction ring and the doctor will cut a flap in your cornea.
• Afterwards the microkeratome and the suction ring are removed. At this point you will experience fluctuating degrees of blurred vision during the rest of the procedure. The doctor will then lift the flap and fold it back on its hinge, and dry the exposed tissue.
• Once the laser is positioned over the eye, you will be asked to stare at a light. The light is not the laser; it’s to help you keep your eye fixed in one position so the laser can do its job. If you are unable to stare on a fixed point for no more than 60 seconds you may not be a good candidate for LASIK.
• The pulse of the laser makes a ticking, or crackling sound. As the laser removes corneal tissue, you may experience a burning smell. Once the laser is done removing tissue the corneal flap is put back into place.
• Your doctor should provide you with a shield to be placed over your eye at the end of the procedure as protection; since there are no stitches used to hold the flap in place. This shield should be worn at night especially to prevent rubbing or putting any kind of pressure on your eye during sleep. You don’t want to accidentally hit or poke the flap while it’s still healing.

• Following the procedure you may experience burning, itching and discomfort as well as mild pain. Your eyes may tear or water and in most cases your vision will be a bit blurry. Remember not to rub your eye, you might move the corneal flap before it heals which will lead to further treatment. You may also experience sensitivity to light, see glare and halos around lights. However in most cases these symptoms improve a few days after surgery. If you work, you should plan on taking a few days off, the recovery time may impair tasks. If you experience severe pain or your vision gets worse, you should immediately see your doctor.
• Your first visit to the doctor after surgery should be within the next 24 to 48 hours and at regular intervals afterwards for the next six months. At the first post operative visit your doctor will remove the eye shield, test your vision and examine your eye. At this time your doctor may give you one or more different kinds of eye drops to take home to help prevent infection and inflammation.
• Your doctor will advise you to stay away from lotions, creams and make-up around the eye for a few weeks, along with continued scrubbing of your eyelashes. For continued safety, swimming, hot tubs and contact sports should be refrained from for a few months, it is very important to keep your eye safe from any kind of collision. Your doctor should be able to tell you when it is safe to resume these activities.
• During the first few months after surgery, your vision may fluctuate. It may take up to anywhere between three to six months for your vision to stabilize after surgery. Glare, halos, difficulty driving at night, and other visual symptoms may also persist during this stabilization period.
• Immediately contact your eye doctor if you develop any new, unusual or worsening symptoms at any point after surgery. Such symptoms could signal a problem that may lead to a loss of vision.

• Know what makes you a poor candidate
• Career impact - does your job prohibit LASIK?
• Cost - can you realistically afford this procedure?
• Medical conditions - do you have an autoimmune disease or other major illness? Do you have a chronic illness that might slow or alter healing?
• Eye conditions - do you have or have you ever had problems with your eyes other than needing glasses or contacts?
• Medications - do you take steroids or other drugs that might prevent healing?
• Stable refraction - has your prescription changed in the last year?
• High or Low refractive error - do you use glasses/contacts only some of the time? Do you need an unusually strong prescription?
• Pupil size - are your pupils extra large in dim conditions?
• Corneal thickness - do you have thin corneas?
• Tear production - do you have dry eyes?
• Know all the risks and procedure limitations
• Overtreatment or undertreatment - are you willing and able to have more than one surgery to get the desired result?
• May still need reading glasses - do you have presbyopia?
• Results may not be lasting - do you think this is the last correction you will ever need? Do you realize that long-term results are not known?
• May permanently lose vision - do you know some patients may lose some vision or experience blindness?
• Dry eyes – do you know that if you have dry eyes they could become worse, or if you don’t have dry eyes before you could develop chronic dry eyes as a result of surgery?
• Development of visual symptoms - do you know about glare, halos, starbursts, etc. and that night driving might be difficult?
• Contrast sensitivity - do you know your vision could be significantly reduced in dim light conditions?
• Bilateral treatment - do you know the additional risks of having both eyes treated at the same time?
• Patient information - have you read the patient information booklet about the laser being used for your procedure?
• Know how to find the right doctor
• Experienced - how many eyes has your doctor performed LASIK surgery on with the same laser?
• Equipment - does your doctor use an FDA-approved laser for the procedure you need? Does your doctor use each microkeratome blade only once?
• Informative - is your doctor willing to spend the time to answer all your questions?
• Long-term Care - does your doctor encourage follow-up and management of you as a patient? Your preop and postop care may be provided by a doctor other than the surgeon.
• Be Comfortable - do you feel you know your doctor and are comfortable with an equal exchange of information?
• Know preoperative, operative, and postoperative expectations
• No contact lenses prior to evaluation and surgery - can you go for an extended period of time without wearing contact lenses?
• Have a thorough exam - have you arranged not to drive or work after the exam?
• Read and understand the informed consent - has your doctor given you an informed consent form to take home and answered all your questions?
• No makeup before surgery - can you go 24-36 hours without makeup prior to surgery?
• Arrange for transportation - can someone drive you home after surgery?
• Plan to take a few days to recover - can you take time off to take it easy for a couple of days if necessary?
• Expect not to see clearly for a few days - do you know you will not see clearly immediately?
• Know sights, smells, sounds of surgery - has your doctor made you feel comfortable with the actual steps of the procedure?
• Be prepared to take drops/medications- are you willing and able to put drops in your eyes at regular intervals?
• Be prepared to wear an eye shield - do you know you need to protect the eye for a period of time after surgery to avoid injury?
• Expect some pain/discomfort - do you know how much pain to expect?
• Know when to seek help - do you understand what problems could occur and when to seek medical intervention?
• Know when to expect your vision to stop changing - are you aware that final results could take months?
• Make sure your refraction is stable before any further surgery - if you don't get the desired result, do you know not to have an enhancement until the prescription stops changing?