In the U.S. and in Austin, LASIK is the most common refractive procedure performed today. The main reason LASIK is the most popular refractive procedure is because of two main advantages that it has over other procedures. The first advantage is that there is virtually no pain or discomfort experienced during and after the procedure. The second advantage is that the visual recovery is very rapid, in most cases patients can see very well the next day and patients are able to return to work the very next day!
LASIK laser eye surgery begins when the surgeon uses an instrument called a microkeratome to create a thin, circular flap on the cornea. This thin flap is lifted up and folded back by the surgeon. Next, the laser uses a beam of ultraviolet light to reshape the corneal surface by precisely removing microscopic amounts of corneal tissue. The corneal flap is then put back into place and smoothed out carefully with a small sponge.
As stated previously, this procedure is the most popular because of the minimal amount of pain or discomfort and its quick recovery time. However, LASIK is not always the best procedure for every patient. LASIK is sometimes too risky for patients who have thin or irregularly shaped corneas. It also presents an added risk for patients who have lifestyles that may put them at a higher risk for trauma after surgery.
For patient’s that are not good candidates for LASIK or who just want to reduce the risks associated with the corneal flap, LASEK or PRK may be better options.
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The first step for every patient should be a thorough and detailed consultation. This visit should include important tests necessary to determine if you are a good LASIK candidate (or other type of refractive surgery). Next, the doctor should review your candidacy with you and answer any of your questions. This visit can take anywhere from 20 minutes to 45 minutes depending on the range of questions and concerns that you have. If you wear contact lenses you should be informed how long you need to be out of your contact lenses before your pre-operative exam and laser procedure. The general rule is two weeks for soft lenses and one month for every decade of wear for RGP or hard lenses.
Pre-operative LASIK Exam
This is typically your next step after the initial consultation. At this visit, all of the necessary measurements and diagnostic tests that will be used for the surgery are performed. This visit will include measuring your optical prescription with your eyes non-dilated and also with them dilated. Your eyes will be thoroughly evaluated for general ocular health, diseases or abnormalities. This includes checking for cataracts, increased eye pressure, retinal problems, dry eyes and corneal disorders. Every patient should be evaluated with the Obscan IIz or Pentacam, the most advanced corneal mapping devices available. These two tests are vital to maximize each patient's outcome and safety. For patients having Custom Wavefront LASIK, highly specialized and detailed aberrometer/wavefront testing will also be performed at the pre-op exam.
Once your pre-operative exam and the necessary testing are complete, you are ready to undergo your refractive surgery on the scheduled day. You should arrive at the laser center prepared to spend approximately two and a half hours. Arrangements must be made for someone to drive you home. You will also need to dress comfortably (i.e. dress warm, the laser surgical suite ranges between 66-70 degrees F.). You should not bring young children with you as a consideration to other patients who will be anxiously anticipating their surgery.
Just prior to surgery, you will be given Valium to help reduce any anxiety and to help you relax. A staff member will also carefully review your post-operative instructions with you and answer any questions you have. You will then be escorted into the surgical suite. The laser suite is busy with activity as your surgeon and the technicians go about their work. Once you are in position on the laser bed, the technicians will administer the necessary topical anesthetic eye drops. There will not be any shots of any kind.
Your surgeon and the highly trained staff are focused on safety and performing their job to the best of their abilities. Every effort is made to keep you comfortable and informed before, during and after your LASIK procedure.
The following refers to LASIK with a Microkeratome created corneal flap, not to Intralase laser flaps:
A small retaining device is placed around the edges of your eyelid to keep them open and prevent blinking. During the creation of the flap it is normal for your vision to gray out or go dark, and you will also feel some pressure or a momentary dull ache which goes away in a few seconds. You should lie still and not talk as the surgeon guides you step by step through the rest of your procedure. The first step will be the creation of the corneal flap. The next step will be the actual laser treatment to reshape your cornea so that light will be focused properly thereafter. Finally, the corneal flap will be skillfully smoothed back into perfect position by your surgeon.
The laser's work is usually complete in a few minutes or considerably less time with the new Allegretto Wave laser. If you are having LASIK on both eyes, the procedure is repeated on the other eye. Throughout the entire process you are conscious of what is going on and are able to follow all events of the procedure. While you may feel differences in pressure, there is minimal if any discomfort. Your surgeon and attentive staff will talk you through every step of the procedure. The last step of the day will be for the doctor to view your eyes through a high powered microscope to make certain that your corneal flap(s) are perfectly in place and with no irregularities. Once this step is complete, you will be given your surgery packet of drops and written post-op instructions and are ready to leave.
After LASIK Surgery
We strongly recommend that you keep your eyes closed or sleep for much of the remainder of your surgery day. It is recommended that you do not watch TV, read, or do any extensive computer work on the day of your surgery. The natural position of your eyelids remaining closed helps the corneal flap to smoothly and permanently affix itself to your eye and to speed the normal healing process. You will also instill artificial tears and prescription eye drop medicine throughout the day.
You should expect to have blurred vision on the day of your LASIK procedure. By the next morning your vision will be quite improved and you should awake with a smile on your face as you view the alarm clock clearly without corrective lenses for the first time in years!
LASIK Post Operative Care
The first hours immediately following your LASIK procedure are the most critical for healing. You should keep your eyes well lubricated with tears and follow your post-operative instructions. The next day patients are able to return to almost all of their normal activities. Remember DO NOT RUB your eyes or do any forceful eyelid closures.
Post-operative care is an important part of your surgery. Make sure that you have good quality follow-up after your refractive surgery. Most patients should be checked at 1 day, 1 week, 1 month, 3 months, 6 months. This can vary based on your individual healing response. Close monitoring of the way you heal can make a difference in the way you ultimately see.