LASIK Surgery : Need It Or Not?

What is LASIK?

LASIK stands for laser in situ keratomileusis, which means using a laser underneath a corneal flap (in situ) to reshape the cornea (keratomileusis). This procedure utilizes a highly specialized laser (excimer laser) designed to treat refractive errors, improve vision, and reduce or eliminate the need for glasses or contact lenses. This laser procedure alters the shape of the cornea, which is the transparent front covering of the eye. Though the excimer laser had been used for many years before, the development of LASIK is generally credited to Ioannis Pallikaris from Greece around 1991.With nearsighted people, the goal of LASIK is to flatten the too-steep cornea; with farsighted people, a steeper cornea is desired. LASIK can also correct astigmatism by smoothing an irregular cornea into a more normal shape.

If you are considering LASIK eye surgery, your first step is to choose a good LASIK surgeon who can evaluate whether LASIK is right for you. Your LASIK surgeon will examine your eyes to determine their health, what kind of vision correction you need, and how much laser ablation (corneal tissue removal) is required. The doctor will also ask about any health conditions that may disqualify you altogether for LASIK surgery.

If you're not a candidate for LASIK, you may qualify for another laser eye surgery such as PRK (similar to LASIK but without the flap), LASEK, or epi-LASIK. There are also non-laser vision correction procedures. Your prescription and eye structure will be considered to help determine which procedure is best for you.

LASIK is an outpatient procedure, so you don't have to stay at the surgery center overnight. The LASIK surgeon uses a computer to adjust the laser for your particular prescription. You will be asked to look at a target light for a short time while the laser sends pulses of light to painlessly reshape your cornea. The actual LASIK surgery usually takes less than ten minutes.

How does LASIK work?

During the LASIK procedure, a specially trained eye surgeon first creates a precise, thin hinged corneal flap using a microkeratome. The surgeon then pulls back the flap to expose the underlying corneal tissue, and then the excimer laser ablates (reshapes) the cornea in a unique pre-specified pattern for each patient. The flap is then gently repositioned onto the underlying cornea without sutures.

How do glasses or contacts improve vision in people with refractive errors?

Glasses or contact lenses are used to compensate for the eye's refractive error by bending light rays in a way that complements the eye's specific refractive error. In contrast, LASIK and other forms of refractive surgery are intended to correct the eye's refractive error to reduce the need for other visual aids.

What are the risks of LASIK?

LASIK has been shown to be a very effective procedure, and most patients are very happy with their vision following the procedure. However, like any surgical procedure, LASIK does come with some risks. In order for you to decide whether LASIK surgery is right for you, you need to be aware of potential risks and complications and weigh these carefully before proceeding with surgery.

1. You may be over-corrected or under-corrected. Most patients are satisfied with their vision after a single treatment, but in some cases, you may not achieve quality vision initially and need a second surgery, called an enhancement, to sharpen your vision. Patients with more extreme prescriptions are at higher risk for needing an enhancement. This enhancement cannot be performed for many months after your initial surgery to allow for your eyes to heal appropriately from the first surgery and for your eyeglass prescription to stabilize. In some rare cases, you may not be able to have an enhancement if your corneas are too thin or abnormally shaped after surgery.

2. You may still need glasses or contact lenses after surgery to achieve your best vision. This is extremely rare for the average person; however, it is something you should discuss with your surgeon. In addition, if both of your eyes are corrected for good distance vision, you will still need glasses for close work when presbyopia develops as a part of normal aging process.

3. Your results may not be permanent. Although uncommon, some patients do experience a regression of their desired treatment effect many years after the surgery. This is more common in patients with hyperopia, or farsightedness. Those who need reading glasses are especially prone to having changes in their vision after LASIK surgery. If regression does occur, it may be possible for you to have an additional surgery many years after your initial LASIK.

4. You may experience visual aberrations, especially in low light. Visual effects that can occur with LASIK and decrease visual quality include: anisometropia (difference in refractive power between the two eyes), aniseikonia (difference in image size between the two eyes), double vision, hazy vision, fluctuating vision during the day and from day to day, increased sensitivity to light, glare, shadows, and seeing halos around lights. These visual aberrations are extremely unusual; however, they may be incapacitating for some time and may not ever go away completely.

5. Dry eye symptoms may persist or get worse. Most people experience some dry-eye symptoms immediately after surgery. In some cases, people may develop worsening of dry-eye symptoms, such as burning and redness, or even decreased vision, after surgery. This condition is occasionally permanent and may require medication to improve tear production or punctal plugs, which temporarily close off the drainage system for tears.

6. You may lose vision. Rarely, LASIK may result in worse vision that cannot be corrected with glasses or contact lenses. This could result from flap-related complications, equipment malfunction, infection, scarring, or extreme changes in corneal shape postoperatively.

What are the advantages of LASIK surgery?

In summary, despite the risks outlined above, LASIK has been proven to be safe and effective for most people. With careful patient screening and selection, reasonable expectations, and in the care of an experienced surgeon, most patients will be very pleased with their results. 

These are some of the other advantages of LASIK:

• LASIK is able to accurately correct most levels of myopia (nearsightedness), hyperopia (farsightedness), and astigmatism.
• The procedure is fast, usually lasting only five to 10 minutes, and is generally painless.
• Because the laser is guided by a computer, it is very precise and results are very accurate.
• In most cases, a single treatment will achieve the desired outcome; however, enhancements are possible if needed, even many years after the initial surgery.

What are the disadvantages of LASIK surgery?

Because each patient will heal slightly differently, results may vary from patient to patient.

• LASIK could make some aspects of your vision worse, including night vision with glare and halos.
• LASIK may make dry-eye symptoms worse in certain individuals.
• In rare circumstances, LASIK can make your vision worse and not correctable with regular glasses or contact lenses.