Since the Excimer Laser was approved for vision correction by the FDA in 1995, well over a million people worldwide every year have chosen to give up their glasses and/or contact lenses. Although every surgical procedure has risks, Laser Vision Correction has an amazingly low complication rate and exceptionally high satisfaction rate among those who have trusted their eyes to an ophthalmologist skilled in laser vision correction. One of the most important keys is to seek out an ophthalmologist who performs a lot of LASIK on an ongoing basis. The performance of LASIK surgery is a highly technical skill, and the best way for a surgeon to be good at it is to do a lot of them.
The eye is numbed with anesthetic drops. The eyelids are held open with a special retainer so the patient does not have to worry about blinking. Movement of the eye is usually not a problem because the patient is motivated to look at the fixation light in the laser, and most modern-day surgeons use state-of-the-art "tracking" technology. In LASIK, a protective flap is created in the front of the eye (cornea) with a microkeratome. The flap is then folded back to expose the central layers of the cornea. Laser treatment is then performed using the Excimer Laser on the inner layers to change the focal point of incoming light rays. The central cornea is flattened to correct nearsightedness, steepened for farsightedness and rounded for astigmatism. The flap is then repositioned and it adheres without the need for stitches. Antibiotic, anti-inflammatory and lubricating drops are used following the procedure.
In PRK, or its more modern version Epi-LASIK, no cutting is done. This procedure is truly “bladeless” and, unlike the Intralase procedure that uses a laser to cut a flap, in these “surface” procedures there really is no flap, making this type of surgical vision correction probably safer in both short and long run because there is no flap to create complications. After the surface layer is removed without cutting, the laser is used to reshape the cornea to create the new vision. The eye is dressed with a “bandage” contact lens, which is left in place from three to five days while the epithelium regenerates. This procedure is slightly more uncomfortable than LASIK and requires a slightly longer recovery period, but it is finding a resurgence in popularity, especially among those people who do not want to have their corneas cut.
Both types of surgery produce equally good visual results. Only the time and safety issues distinguish them. Surface procedures are more desirable for those people whose occupation or lifestyle involves activities in which the eye might receive a blow.
You will leave the clinic wearing sunglasses and go home to sleep for four to five hours. If you have had LASIK, it is during this time that the flap will begin to adhere in the correct position. You can expect very cloudy vision until after that nap. For most patients the excitement begins the next morning when they discover that they are fully capable of driving themselves to the post-op visit! The most typical reaction the first morning after surgery is: "I can't believe I can see the clock without glasses!" With Epi-LASIK, during that nap, the surface cells begin to regenerate, a process that takes an average of three days, during which time you can pursue most normal activities until the bandage contact lenses are removed between the third and fifth day post-operatively. The visual recovery with Epi-LASIK is somewhat slower than with LASIK.
Laser Vision Correction is brief and offers minimal discomfort. We recommend that patients take Valium before the procedure to achieve mild sedation. The Valium also helps patients sleep after the procedure.
The FDA’s Ophthalmic Devices Advisory Panel held a hearing on LASIK on April 25, 2008, prompted by 140 letters of complaint sent to the FDA between 1998 and 2006 (out of literally millions of cases). The chairman of the panel stated, “This has really been a referendum on the performance of LASIK by some surgeons who should be doing a better job.” Most of the public comment was made by LASIK patients and their families, sharing accounts of postoperative pain, visual distortion, even suicide. On the other hand, several surgeons presented scientific evidence of LASIK’s benefits, patients’ high rate of satisfaction and the rarity of severe postoperative dry eye.
One of the outcomes of the meeting was a prospective quality-of-life study to be conducted by the FDA, the National Eye Institute, the ASCRS and the AAO, scheduled to begin in 2009. The objectives of the study will include determining the change in patients’ quality of life after LASIK and the factors associated with their postoperative satisfaction or dissatisfaction. The panel rejected the request of numerous speakers for a moratorium on LASIK. “I think, instead, we need better screening and information and, in some cases, some better doctors,” said the chairman. Panel members advocated clarifying how often and how severely some patients are affected by side effects and complications of LASIK and proposed including information on conditions that should disqualify individuals from undergoing the surgery.
Dr. Jeffrey D. Gold is a board certified ophthalmologist with more than 30 years of experience in eye medicine and surgery with special expertise in laser technology. He began specializing in Laser Vision Correction in 1995 and has to date performed about 10,000 procedures, bringing happiness to thousands of people. For more information about laser vision correction and other eye care information, visit his website at www.libertyvision.net.
