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LASIK, or Laser In-Situ Keratomileusis, is a surgical procedure in which an excimer laser is used to improve vision through the reshaping of the cornea. The procedure can treat myopia (nearsightedness), hyperopia (farsightedness), and astigmatism, and it can reduce patients' dependency on glasses and contact lenses. LASIK was first performed in clinical trials in the United States in 1991, and the excimer laser was approved for use in the procedure by the U.S. Food and Drug Administration in 1998. Since then, LASIK has soared in popularity, with nearly 20 million Americans having undergone the procedure through 2013. Today, LASIK is safer and more effective than ever.
Individuals who suffer from vision impairment can benefit tremendously from LASIK, but the procedure is not for everyone. A good LASIK candidate should meet the general requirements and understand the risks and possible side effects of treatment. LASIK surgeons carefully screen potential candidates for the procedure in order to help ensure the best possible results. Your ophthalmologist can evaluate your vision and determine whether you would be a suitable candidate for LASIK.
The cost of LASIK eye surgery continues to drop as surgical techniques are further refined and technology advances. On average, surgery costs about $1,000 to $2,000 per eye. However, the final price of the treatment can vary, based on several factors. These include:
- Type of LASIK: LASIK technology has progressed rapidly over the past two decades. New techniques, such as bladeless LASIK and custom wavefront LASIK, have made the treatment safer and more accurate than ever before. Although these treatments do cost more than traditional laser vision correction, many patients are willing to pay the slight upcharge to achieve optimal results.
- Geographic location: Like most things, the cost of medical treatment varies in different parts of the country. In general, LASIK surgery will cost more in larger cities and on the East and West coasts.
- Surgical facilities: If a doctor does not have his or her own operating facility, the procedure will take place at an ambulatory surgical center. These locations will charge their own fee. Again, this will vary, depending on geographic location and the reputation of the facility. Noted facilities may charge a slightly higher fee.
- Medication: Following LASIK treatment, patients require eye drops and, sometimes, additional medications. These treatments will have different prices, and doctors often do not include them in the initial treatment estimate.
- Follow-up procedures: If patients do not achieve their desired results, they may require secondary LASIK. The costs of these surgeries are then added on to the initial cost of treatment.
An Investment in the Future
In their quest for a bargain, some patients may select a less qualified surgeon or choose a less advanced form of surgery. It is important for them to remember that LASIK represents an important investment in themselves and their futures, and their decisions will affect their quality of life for years to come. Additionally, choosing an inexperienced doctor or a dubious clinic can cost more in the long run, if patients require corrective surgery or additional medical treatment.
LASIK is an elective treatment, and, therefore, it is not usually covered by conventional health insurance plans. However, a select few patients may qualify for coverage. These individuals could include:
- Military personnel
- Those who rely on good vision for their work (e.g., police officers, firefighters, athletes)
- Individuals with severe intolerance for contact lenses
- Individuals with dry eye syndrome or allergies, who find it difficult to wear corrective lenses
Unfortunately, it can often be difficult to prove eligibility for insurance. If you think you may qualify, you will need to file several forms from your doctor and employers. The administrative staff at your surgeon's office will usually assist with this process and help you make the most of your health care benefits.
In-House Payment Plans
Because most patients do not qualify for insurance coverage, many doctors offer their own financing opportunities. For example, you may be able to pay for your surgery in small monthly installments, often with low, fixed, or even no-interest rates. Some doctors may offer discounts if you pay for your procedure in full beforehand. You should inquire about these financing options at your initial consultation.
Third Party Financing
When researching payment options, you should also consider third party options such as Compassionate Finance®. These medical financing companies frequently offer fixed-interest and low-interest payment plans with approved credit. You may even qualify for a no-interest plan if you pay for your LASIK surgery within a certain time frame. Additionally, some banks and other lenders are willing to finance elective medical procedures for a low rate. Often, the office team at your doctor's office can guide you in determining the right repayment plan for your needs.
How to Choose a LASIK Surgeon
Selecting a qualified LASIK surgeon is perhaps the most important step to ensuring positive results. When choosing a surgeon, your decision should not be based solely on the cost of surgery or office location. Selecting an experienced, reputable, and qualified physician is an important factor in your outcome. If possible, talk to several doctors before making your final decision. For further help, check out DocShop's database of qualified LASIK surgeons in your area.
The ABO requires doctors to complete ongoing training and education.
Affiliations and Accreditations
When researching doctors, look at each practitioner's memberships and accreditations. You should select someone who is certified by the state medical board, as well as the American Board of Ophthalmology (ABO). The ABO requires doctors to complete ongoing training and education, so you can be sure that your doctor is aware of the latest innovations and discoveries regarding laser eye surgery. Finally, select a doctor who is a member of the American Academy of Ophthalmology (AAO). Additional training, teaching credits, and volunteer work are also good indications of a doctor's expertise.
For your safety and to ensure good final results, it is important to find a doctor who has performed many LASIK procedures successfully. If you are interested in an advanced technique, such as iLASIK, you should look for a practitioner who is familiar with these new technologies.
Choose a LASIK surgeon who is known for his or her skill and patient satisfaction rate. Every state medical board is required to release information regarding a doctor's past infractions, complaints, and lawsuits. Check with your local institution to learn more about the practitioner you are considering. In many states, these records are available online, but in some places, you may have to request them through the mail.
If your doctor does not have his or her own operating facility, research the place where your procedure will take place. Make sure that the center has been certified by the American Associations for Accreditation of Ambulatory Surgery Centers. This will ensure that the staff maintains proper safety, hygiene, and ethical standards.
Finally, it is important to find a doctor with whom you feel comfortable. Choose a surgeon who listens to your concerns and takes the time to answer your questions. Although LASIK is an extremely safe procedure, it is normal to feel a bit nervous before any surgery. Therefore, it is important to select a doctor who will put your mind at ease and be a good guide throughout the process.
The Initial Consultation
After you select the right doctor for your needs, you will have a complete evaluation. This will give you and your doctor a chance to get to know one another and begin creating your individual treatment plan. If you wear contacts, your doctor may ask you to leave them out for a few weeks before this consultation. Contact lenses can distort the shape of your cornea and prevent the doctor from obtaining an accurate assessment of your eye health and structure.
Determining Your Candidacy
First, your doctor will need to ascertain whether LASIK surgery is right for you. You will discuss your medical history, current glasses prescription, and any medications you are taking. Because some medicines can affect your candidacy for LASIK, your doctor may recommend that you stop taking them for a few weeks leading up to your surgery. He or she may also prescribe an alternative.
To determine conclusively that LASIK is a good fit for you, your doctor will conduct a thorough eye exam. In addition to a routine vision test, the doctor will perform a variety of other tests, including:
- Dilated eye exam
- Corneal topography tests
- Tear-film test to check for dry eyes
These tests are quick and involve minimal discomfort.
Planning Your Procedure
Armed with the information gathered in your comprehensive exam, your surgeon can begin planning out your individual treatment. You should be an active participant in this process. If you are interested in a certain technique, bring this up at the initial consultation. Your doctor will also explain the probable results of your treatment and make sure that you have reasonable expectations.
Types of LASIK
Due to advances in LASIK technology, there are several variations of the procedure. Each of these advanced types offers unique advantages over LASIK as it existed at its inception. When you are planning out your treatment with your doctor, you may be able to choose from among several different types of surgery.
Custom (Wavefront) LASIK Procedure
Custom LASIK surgery uses advanced wavefront technology to correct visual flaws not addressed by traditional LASIK. This type of eye surgery is very similar to earlier versions of the procedure, but it is fully personalized and guided by a detailed wavefront map of your eyes.
In the past, LASIK eye surgery was simply based on your prescription. A doctor would determine whether you were nearsighted, farsighted, or astigmatic, and he would look at the severity of your vision aberration. However, your sight can also be compromised by higher-order aberrations. These imperfections are more complicated and personalized vision abnormalities that affect the crispness and clarity of your eyesight. New custom LASIK technology is able to diagnose and treat these visual imperfections like never before.
IntraLASIK (All-Laser Bladeless LASIK)
To perform LASIK, a surgeon must create a flap in the surface of your cornea, creating access to the underlying tissues. During traditional LASIK surgery, the surgeon makes the flap with a microkeratome blade. The IntraLase® laser is the first and only laser technology approved for use in this first step of the LASIK procedure. With this technology, the surgeon can program the desired depth and position of the corneal flap into a computer system prior to actual surgery, making the creation of the flap an incredibly safe and accurate procedure. Bladeless LASIK delivers a level of safety and precision that has revolutionized laser vision correction.
LASIK with the IntraLase® laser was approved by the Food and Drug Administration in 2001. Though it is a relatively new procedure, as of 2005, it had already been used on more than 250,000 eyes.[i] Since gaining FDA approval, surgeons have gained invaluable experience in the use of the IntraLase® laser and have further refined their methods to fully benefit their myopic, hyperopic, and astigmatic patients. All LASIK surgeries use a laser to reshape the lower levels of the cornea. However, only procedures that use the IntraLase® laser for creating the corneal flap can be considered all-laser LASIK.
- Reduced Complications: The use of the microkeratome is associated with the majority of LASIK complications. The most common complications include buttonhole cuts, partial or improperly formed flaps, free caps, invasive corneal incisions, corneal abrasions, and subsequently blurred vision. With the high level of laser precision, the doctor can virtually eliminate these risks.
- Can Treat a Wider Range of Patients: Bladeless LASIK is particularly beneficial for patients with thin or thick corneas, factors that might otherwise disqualify them for traditional laser vision correction.
- Quick: The entire process of creating the corneal flap with all-laser LASIK takes about 30 seconds. After making the flap, the surgeon lifts the tissues to reveal a pristine corneal surface.
iLASIK combines IntraLase® and wavefront technology to form the most precise type of laser eye surgery available. With custom LASIK systems, doctors can correct both lower and higher-order aberrations. The doctor will first create a digital map of your eye using the laser wavefront imaging system. As it scans your eye, the laser will also register the depth of your cornea. The doctor will then calibrate the Intralase laser using these dimensions. In this way, he or she can create an extremely precise corneal flap and tailor your treatment based on the smallest variations in the structure of your eye. These new technologies are designed with one goal in mind: a more rewarding patient experience and superior results.
The various types of LASIK can be divided into two primary categories: bladed and blade-free LASIK. With bladed LASIK, your doctor will use a microkeratome blade to create the corneal flap. Although this may sound alarming to some patients, the procedure is quite safe. Additionally, thanks to recent innovations, today's microkeratomes are more precise than ever before. Blade-free LASIK uses a femtosecond laser to create tiny bubbles under the top layer of the cornea. When enough of these bubbles have formed, the surgeon can easily lift the top tissues from the underlying layers of the cornea. Blade-free LASIK is sometimes referred to as SBK, or Sub-Bowman's Keratomileusis.
Choosing the Right Technique
Both bladed and blade-free LASIK are quite effective, and each method has its own advantages. The benefits of bladed LASIK include:
- A quicker procedure
- The doctor will only need to apply suction to your eye for about three seconds (versus fifteen or twenty for blade-free LASIK).
- Decreased risk for edema, or swelling of the corneal flap
- May be more suitable for patients who have had previous LASIK surgery
In comparison, the advantages of blade-free LASIK include:
- Reduced risk for unattached, partial, and improperly formed flaps
- Uniform thickness across the entire corneal flap
- Reduced likelihood of induced higher-order vision aberrations
Your doctor will further explain the benefits and risks of each technique. Together you can choose the right one for your needs.
Conventional LASIK is performed with a microkeratome, a precise, hand-held surgical instrument with an oscillating metal blade. It is used to separate the surface layers of the cornea and create a flap during the first step of LASIK surgery.
First, the microkeratome is placed over the eye. Then the doctor gently applies suction so that the microkeratome is held perfectly still during the procedure. The blade creates a hinged flap, which the doctor folds back as the excimer laser sculpts the cornea into the optimal shape. Once the re-shaping process is complete, the doctor carefully repositions the tissues, and the eye heals on its own.
What Qualities Make a Good Microkeratome?
The factors that determine the quality of a microkeratome are related to its stability and consistency in creating the corneal flap. The newest and best microkeratomes can create flaps that are uniform in thickness, with proper suction maintained throughout the procedure. The following are two of the most advanced models available today:
- Moria M2: The Moria M2 microkeratome has an innovative design that allows the surgeon to view the flap as it is being created, providing greater accuracy. In addition, the quality of the cut and the predictability of flap thickness are proven to be better and more consistent than the flaps created by other microkeratomes. The Moria M2 also offers the surgeon greater control over the flap and hinge size.
- Hansatome™: The Hansatome™ has fewer gears, which reduces the risk of an incomplete flap. The Hansatome™ blade can lower your risk for additional flap complications, such as partial flaps, free caps (unattached flaps), and buttonholes (improperly formed flaps).
The IntraLase® Laser
The introduction of the IntraLase® laser has redefined the landscape of laser vision correction. Rather than creating a flap with a blade, IntraLase® uses laser energy to make a quick, painless incision. The computer-guided IntraLase® laser quickly pulses light through the outer layers of the cornea as it moves back and forth across the eye. In this way, it creates microscopic bubbles at a specified depth in the eye. The bubbles under the cornea eventually create a perforation, and the doctor can easily fold back the flap to access the lower levels of the cornea. The computer-guided laser allows surgeons to program the laser to create a precise flap diameter, depth, hinge location and width.
Wavefront mapping is able to detect and measure optical imperfections 25 times more precisely than standard methods.
Wavefront LASIK Technology
Wavefront mapping for LASIK eye surgery is able to detect and measure optical imperfections 25 times more precisely than standard methods. To generate a wavefront map, the doctor shines a beam of light through the eye. The light is comprised of flat sheets, known as wavefronts. As the light passes through the eye's optical system (the cornea, lens, and retina), it reflects back. Then the wavefront diagnostic machine captures and measures the precise dimensions of the eye. In eyes with no vision abnormalities, the rays of light exit just as they entered the eye - as flat sheets. However, if an eye has any lower-order or higher-order aberrations, the ray becomes distorted. Translating this distorted light into a wavefront map of the eye's imperfections is the basis of custom LASIK.
Once a wavefront LASIK sensor has identified, measured, and mapped the eye's specific irregularities, special software converts these data points into a mathematical algorithm. This algorithm guides the excimer laser used in the reshaping procedure. Today's best wavefront sensors are seamlessly integrated with excimer laser eye surgery systems. Such integrated technology ensures that unique visual challenges are accurately diagnosed, measured, and treated.
Visual Errors LASIK Can Address
With ever advancing technology, LASIK can correct a range of vision conditions, meaning more patients can now enjoy clear vision and a reduced dependence on corrective lenses.
Nearsightedness, or myopia, is one of the most common lower-order vision aberrations. This condition affects patients who have unusually long corneas. As the light passes through the eye, it focuses in front of the retina, rather than on the retina itself. This causes the optic nerve to send a distorted image to the brain. Nearsighted patients may be able to read and do close-up work without difficulty, even if they rely on glasses for distance vision. By removing some of the excess corneal tissue, a doctor can correct the refraction of light so that it focuses properly on the center of the retina.
Patients who suffer from farsightedness, or hyperopia, have unusually short eyes and flat corneas. This means that as light passes through the eyes, it focuses behind the retina. Farsighted patients can see far away objects clearly, but they may have difficulties reading and doing close, detailed work. To correct hyperopia, a surgeon will move the femtosecond laser in a circular pattern around the patient's cornea. This makes the cornea steeper so that light refracts correctly on the retina.
Astigmatism is another common vision aberration. Normally, the cornea should be completely spherical. When patients have asymmetrical or oddly shaped corneas, light is distorted as it passes through the eye. Therefore, astigmatic patients have moderate to severely blurred vision at all distances.
Regular astigmatism is the most common type of astigmatism, and the exact causes are unknown. Irregular astigmatism is caused by eye injuries or certain diseases. In most mild to moderate cases, LASIK can correct both types of astigmatism. To perform the procedure, a doctor will flatten certain areas of the cornea and steepen others to give the tissues a more spherical shape.
Presbyopia is an age-related condition. As people get older, the natural lenses in their eyes begin to lose flexibility, and they are not able to adjust quickly to varying distances. Although LASIK cannot cure presbyopia, a doctor may be able to improve a patient's vision through a technique called monovision. During this treatment, the surgeon will correct one eye for distance vision and the other eye for close-up vision. The patient will naturally adjust to this new way of seeing, so that he or she can easily observe objects at all distances.
While this can be a highly effective treatment for some, it is not right for everyone. Because the eyes no longer work together, some people's brains may never be able to adjust properly. Typically, if someone is considering monovision, a doctor will suggest trying the method with contact lenses. If the patient can get used to seeing this way, the surgeon will proceed with LASIK.
Higher-Order Vision Aberrations
In the past, doctors could only use LASIK to correct the lower-order vision aberrations listed above. However, with the introduction of advanced custom LASIK, doctors can now identify and treat many higher order vision aberrations. Wavefront technology will create a digital map of the eye, which identifies even the smallest structural abnormalities. By calibrating the femtosecond laser according to this map, a doctor can make minute adjustments to meet patient's individual needs.
Custom wavefront LASIK can correct many of the symptoms associated with higher-order aberrations. These include:
- Blurred vision
- Difficulties with night vision
- Decreased contrast sensitivity
- Double vision
Before LASIK Surgery
LASIK is a quick and easy procedure that involves little preparation. However, there are a few things you can do to reduce your risk for complications and mentally prepare yourself for treatment.
Learn about Your Procedure
Before undergoing laser vision correction, you should be well-informed about the treatment, including any potential risks. Your doctor will be able to answer your questions and help to put your mind at ease. LASIK is extremely safe and virtually discomfort-free. However, like many patients, you may suffer some anxiety as you prepare for your surgery. In many cases, your doctor can prescribe an anti-anxiety medication to help you relax during treatment.
Eye Hygiene and Contacts
A few weeks before your LASIK surgery, you will need to stop wearing your contacts. The lenses can distort the shape of your cornea, so that your doctor cannot accurately gauge the degree of correction you require. Additionally, you should stop wearing eye makeup and facial lotion for two days before your treatment. These things can cause contaminants to get in your eyes during the surgery, increasing your risk for infection and other complications. To further lower your risks, thoroughly wash your eyes the three nights leading up to your surgery. Be sure to get a good night's sleep the night immediately preceding the treatment.
Prepare for Recovery
Although LASIK involves minimal recovery, you will need to arrange for a ride home from the surgical facility. Many patients are able to return to work the next day. However, you may prefer to take a few days off from work, especially if your job requires extensive computer use or fine, close-up work.
The Surgical Procedure
After you have finished preparing for laser vision correction, your surgeon will perform another eye exam. He or she will measure your eyes, review the procedure, answer your questions, and address any lingering concerns you may have. The data gathered in this preliminary exam will allow your doctor to customize your treatment to meet your unique needs. The procedure itself takes less than 15 minutes, although the length of pre- and post-operative examinations varies depending on the doctor and your individual case. The procedure is broken down into four steps.
1. Refractive Error Measurement
If you choose to undergo custom LASIK vision correction, rather than traditional LASIK, your doctor will first make a map of your eyes using wavefront technology. This allows for the most accurate correction of visual impairments. The treatment then proceeds in a similar manner to traditional LASIK.
2. Creating the Corneal Flap for LASIK Surgery
To begin the traditional procedure, the doctor will anesthetize your eye with topical eye drops. Then you will lie on a table with laser equipment mounted above it. The doctor will use a special instrument called a speculum to hold your eye open. A shield will protect your other eye. As you focus on a small blinking light above your head, your surgeon will use a microkeratome (a precise, computer operated surgical blade) or an IntraLase® laser to create a hinged corneal flap on the outer layer of your eye.
3. Reshaping the Cornea
The doctor will then use an excimer laser to remove the precise amount of corneal tissue needed to correct your refractive error. As you continue to look at the blinking light, the surgeon will apply very small, rapid bursts of laser energy, which will obliterate the unwanted corneal tissues. Each pulse of the laser removes 39 millionths of an inch of tissue, meaning your doctor can make incredibly precise alterations to the shape of your cornea. This portion of the procedure only takes about 15 seconds per eye, and it is discomfort-free.
4. Replacing the Flap
After removing all necessary tissues, the doctor will replace the flap. Your eye will heal by itself, and no stitches are necessary. After the procedure is complete, you may experience immediate improved vision, although it can take up to six months for your eyesight to stabilize. You should expect a brief recovery period but there is usually little to no discomfort following the procedure. You should make follow-up exams with your doctor to ensure proper healing.
After LASIK Surgery
Following your surgery, you may experience some eye sensitivity and a feeling of something in your eye. Like many patients, you may notice an immediate improvement in your vision. Alternatively, you may have some blurring, which will typically dissipate within a few days.
During the first 24 hours, it is important to rest your eyes as much as possible. Avoid strenuous activity, computer use, watching TV, and reading. If possible, keep your eyes closed for the first 2 to 4 hours after your procedure. The day after your surgery, you should not shower, and you should be careful to avoid getting soap in your eyes.
Immediately after the surgery, your doctor will place protective shields over your eyes (much like contact lenses). A few hours after the treatment, you can remove the shields and begin a regimen of medicated eye drops. Your doctor will provide instructions about how often to apply these drops.
LASIK is a fast, easy procedure, and its recovery is typically just as hassle-free. Any post-treatment sensitivity and blurriness will usually disappear within a few days, and you should begin to enjoy your sharper, clearer vision. You should be aware, however, that it may take several months for your eyes to adjust fully to the new shape of your corneas.
Enhance Your Healing
Because recovery time is so minimal, it can be tempting to jump back in to your normal routine. However, for optimal results and to reduce your risks, especially your chances of corneal flap complications, you should take several precautions:
- Follow any post-surgical instructions
- Carefully monitor your doctor and alert him or her if you notice anything unusual
- Sleep with the protective shields on your eyes for about a week after your treatment
- Avoid swimming, hot tubs, and other water activities for approximately two weeks
- Attend all follow-up appointments with your doctor
- Do not use eye makeup until otherwise instructed by your doctor
- Avoid contact sports and high impact aerobics until your doctor gives clearance
Although healing varies for each patient, you can expect your recovery to follow a general timeline.
One to Two Days after Surgery
Your first follow-up appointment will typically be within 24 to 48 hours of your procedure. At this time, your doctor will check your vision, look for any unusual redness or irritation, and answer your questions. Typically, he or she will give you permission to drive after this appointment. You can usually go about your daily routine after the first day, but you should avoid strenuous activity and dusty environments. You should wear sunglasses whenever you go outside. To avoid eye irritation, use lubricating eye drops if you plan to read or use the computer for an extended period of time.
One Week after Surgery
Many doctors schedule one-week follow up visits to check your recovery and the progress of your vision. After one week, you can typically resume a regular exercise routine, although you should continue to avoid swimming and high-contact activities for at least two more weeks. Note that it is normal for the quality of your vision to vary during the recovery period. While you may have outstanding vision one day, you may struggle with glare or halos the next. This is normal, and your doctor can put your mind at ease during your follow-up appointment.
Three Weeks after Surgery
Your doctor will typically schedule your third follow-up about three weeks after your treatment. By this time, you can resume your total routine, including swimming and contact sports. You should continue to wear sunglasses when you are outside. If you go swimming, you should protect your eyes with goggles. Continue to follow all instructions provided by your doctor. During this period, your eyesight may still vary somewhat. Dry eyes and excess tearing are common side effects, and you can usually treat these conditions with non-prescription eye medication.
Three to Six Months after Surgery
By the sixth month after your surgery, your vision should have completely stabilized. Like many patients, you may enjoy 20/20 vision or better. You may no longer rely on corrective lenses, or your dependence could have greatly decreased. Your doctor will typically schedule one or two more follow-up appointments, and you should attend these consultations to ensure a smooth recovery and good vision for years to come.
You may have seen doctors advertising a "20/20 guarantee." The truth is that these promises are unrealistic, as no doctor can accurately determine the precise degree of vision correction possible prior to surgery. What is certain is that almost all patients enjoy much better vision after LASIK and a greatly reduced dependence on glasses or contacts. In fact, the majority of patients have between 20/20 and 20/40 vision following laser eye surgery.
In addition, most individuals enjoy a vastly decreased reliance on glasses or contacts following LASIK. Some people may still need glasses for certain activities (reading, driving, etc.), but they may no longer need them for most of their daily activities. Many no longer need corrective lenses at all!
A Permanent Procedure
In general, LASIK results are permanent. However, the treatment cannot prevent the development of presbyopia, an age-related condition that occurs when the eyes' natural lenses become less flexible. At this point, patients may choose monovision or reading glasses to enhance their visual acuity. Additionally, women who become pregnant may find that their eyes change shape slightly due to hormonal changes. Fortunately, a doctor can typically correct these changes with a simple retreatment procedure.
Occasionally, patients may require a second LASIK procedure. However, this is quite rare; according to a study that appeared in the April 2003 issue of Ophthalmology, only 10 percent of all LASIK patients require a second procedure.[ii]
Why Someone Might Require Retreatment
There are several reasons that these relatively few patients need a secondary procedure. Occasionally, the shape of a patient's eyes will continue to change, even after LASIK. This is why doctors ask patients to wait until their glasses prescription has stabilized before undergoing surgery. As stated above, some women may find that hormonal fluctuations during pregnancy cause their eyes to change shape. Finally, advanced technology has made it possible for doctors to correct a much wider range of vision aberrations and to achieve better results than ever before. Some patients who have already undergone LASIK may choose retreatment to achieve an even higher degree of vision correction.
Older Patients More Likely to Need Touch-ups
Patients over the age of 40 typically require retreatment more often than younger individuals. The April 2003 study, mentioned above, monitored 2,500 different eyes from 1,300 patients. The results showed that 14 percent of older patients required retreatment. In contrast, only 5 to 9 percent of patients under 40 needed a second surgery.[iii]
Candidates for LASIK Retreatment
Because a doctor will have to recreate the corneal flap during retreatment, patients must have enough tissue to qualify for the procedure. If an individual has already undergone LASIK, the doctor must carefully evaluate the structure of his or her eyes to determine whether touch-up surgery is a viable option. Fortunately, even if a patient is not a candidate for a second LASIK procedure, he or she may be able to receive an alternative procedure, such as PRK (photorefractive keratectomy).
Most LASIK patients are extremely pleased with their results. There are many benefits of laser eye surgery, including immediate vision improvement, decreased reliance on corrective lenses, and broadened social, recreational, and career opportunities.
Benefit #1: Immediate Results
One of the truly remarkable benefits of LASIK laser eye surgery is that most patients experience dramatically improved vision within mere moments of the procedure. While it may take up to six months to achieve optimal visual acuity, it is very common for patients to demonstrate near-perfect vision during their follow-up examinations.
Benefit #2: Freedom from Corrective Eyewear
After successfully undergoing surgery, one of the most significant benefits is a new-found freedom from corrective eyeglasses and contact lenses. In the vast majority of cases, patients are no longer dependent on glasses and contacts. Most enjoy better vision following surgery than they ever experienced with corrective lenses. With LASIK eye surgery, patients not only have sharper vision; they also enjoy a life free from the daily hassles and expenses of glasses and contact lenses. Patients will no longer have to worry about broken glasses or lost contacts. They also do not have to pay for costly replacements each time their prescription changes.
Benefit #3: New Activities and Career Opportunities
Some fields, especially law enforcement and aviation, require excellent vision that is not dependent upon corrective lenses. After undergoing LASIK, patients who were not formerly suitable candidates for such occupations may find themselves embarking on the careers of their dreams.
In addition to the many professional benefits, patients experience greater freedom and convenience during leisure activities. Patients who have undergone successful surgery find that travel becomes much more enjoyable and convenient. When travelling, they no longer have to worry about packing an extra pair of glasses or all the accessories necessary for contacts. Many activities, such as swimming, cycling, and spending a day at the beach, become more pleasurable without the worries and hassles associated with corrective eyewear.
Benefit #4: More Self-Confidence
One of the most significant benefits of LASIK surgery is the heightened self-confidence many patients attain. Individuals who did not like the way they looked with glasses feel that their faces take center stage. Furthermore, many patients find that their clearer vision helps them to be more socially outgoing. For instance, patients who had difficulties navigating low-light environments now feel more at ease in dimly-lit clubs and restaurants. Those who had difficulties with night vision may enjoy increased freedom and greater ease driving at night. Increased self-confidence not only enhances many patients' social lives; it can also lead to a more satisfying love life and a dramatically enhanced professional life.
LASIK is an extremely safe procedure, especially when you choose a qualified surgeon. However, as with all medical treatments, there are some risks with LASIK. It is important to educate yourself about these complications so you can look for any early warning signs and alert your surgeon.
Dry eye is the most common risk of LASIK surgery. In most cases, the condition is temporary, although it can take several months to dissipate completely. Dry eye often occurs when you do not produce enough tears to sufficiently moisturize the entire surface of your eyes. Additionally, your tears are comprised of water, mucus, and oil. Therefore, you may struggle with dry eye if there is a deficiency in one of these layers.
Symptoms include redness, irritation, a feeling of something in your eye, sensitivity, eye fatigue, and excess tearing. Because LASIK can reduce nerve sensitivity in your cornea, your eye may not recognize these symptoms to trigger normal tear production.
Some patients have a higher risk for developing post-LASIK dry eye. These risk factors include:
- Severe myopia (nearsightedness)
- Being post-menopausal
- Taking certain allergy medications, blood pressure medications, and anti-depressants
- Living in a particularly dry environment
Infection following LASIK is extremely rare. Most surgeons follow impeccable hygiene standards, and when you choose all laser surgery, there is a virtually negligible risk of contact contamination. To further reduce your risk of infection, you should maintain good hygiene at home. Do not use eye makeup in the days before and after your surgery, and avoid touching your eye until healing is complete.
Inflammation is a common sign of infection, but it is also normal to experience some minor irritation after surgery. In general, you can control discomfort with eye drops and non-prescription pain medications. However, if the irritation is severe, does not respond to medication, or increases rapidly, you should contact your doctor immediately.
Higher Order Vision Aberrations
Higher order vision aberrations are caused by miniscule irregularities in the shape of the cornea. Therefore, in rare instances, a patient may experience higher order vision aberrations following LASIK surgery. These aberrations can include glares, halos, and difficulties with night vision, among others. Blade-free techniques have greatly reduced these already low risks. When they do occur, a doctor can often treat them with a secondary LASIK surgery.
Though rare, some patients may suffer from complications with the corneal flap. These could include:
- Buttonhole flaps: If the flap is too thin, there will be a small hole in the center
- Partial flaps: If the flap is not large enough, the doctor cannot fully access the underlying corneal tissues. Therefore, patients may not achieve optimal vision enhancement. In some cases, they could experience night vision difficulties and a longer healing time. When patients choose experienced LASIK surgeons, they face a much smaller risk for a partial flap.
- Free caps: If the corneal flap is too large, it could completely detach. Fortunately, this complication does not usually cause significant or long-term damage. In very rare cases, it could lead to astigmatism.
- Epithelial ingrowth: The epithelium is the outermost layer of the cornea. If these cells begin to grow under the corneal flap, it can leave bumps in the area and distort a patient's vision. In many cases, epithelial ingrowth will clear up on its own. In some cases, however, a doctor may need to lift the flap and clean out the errant cells.
Blade-free LASIK has greatly reduced the incidences of corneal flap complications.
Risks of Monovision
If a patient selects monovision LASIK, he or she will face a few additional risks. Because the eyes no longer work in conjunction with one another, signals may get crossed on their way to the brain. Individuals may have some problems with depth perception and vision in low-light environments. Due to these risks, doctors are typically cautious about recommending monovision treatment. Nevertheless, when performed by a skilled surgeon, the treatment can be a good option for some patients.
Patients may choose to have LASIK performed on both eyes at once. However, many doctors recommend that they have the procedure done one eye at a time, as this can decrease their risk for complications. It also gives the surgeon a chance to see how the first eye responds to surgery. If needed, he or she can make adjustments when treating the second eye. Additionally, because patients may experience some temporary blurred vision and glare following surgery, they may have difficulties completing routine tasks if they receive simultaneous treatment.
In a few cases, a patient may require a second surgery due to over- or under-correction. Because each patient's eyes are different, even the best surgeons may need to make slight adjustments to achieve optimal vision correction. The procedure is very similar to first-time LASIK. However, instead of creating a corneal flap, the doctor will lift the original flap. Then he or she can make the final corrections to the underlying corneal tissues.
Because it can take several months for a patient's vision to stabilize, doctors typically wait to see if vision stabilizes before recommending secondary LASIK. If a patient requires an additional treatment, many surgeons provide this treatment free of charge.
Temporary Side Effects
Dry eye is the most common LASIK side effect.
Although long-term LASIK complications are rare, it is not unusual to experience some short-term side effects. These symptoms are typically minor and are not cause for alarm. However, patients should monitor their side effects and alert their doctors if they suddenly get worse or do not begin to clear up within a few days or weeks.
Dry eye is the most common LASIK side effect, and it may linger for several months after surgery. As mentioned above, the condition occurs because the corneal nerves do not recognize the signs of dryness, and, as a result, they do not trigger tear production. While patients are waiting for the condition to clear up, they can usually control their symptoms with prescription or over-the-counter eye drops.
Eye Sensitivity and Irritation
Post-surgical discomfort typically only lasts about 24 hours, and patients can usually control their symptoms with prescription or over-the-counter pain medication. Getting plenty of rest and wearing the protective eye shield can also minimize discomfort.
Many patients may struggle with glare following surgery. This usually goes away within a few weeks, although for some patients, it may take several months to dissipate fully. This common side effect occurs because the eyes may need some time to adjust to the new shape of their corneas and the corrected refraction of light.
More commonly known as a "bloodshot eye," conjunctival hemorrhage is caused by blood leaking under the surface of the eye. The eye may appear extremely red and inflamed, but the condition is rarely cause for alarm. Conjunctival hemorrhages usually clear up on their own within a few weeks. With the advent of all-laser LASIK, this side effect is becoming increasingly rare.
Although LASIK is a relatively new procedure in the history of medicine, multiple studies have confirmed that it is extremely safe with a low risk of side effects.
Overall Complication Rate
Although the exact numbers can vary, the complication rate for laser vision correction is extremely low. According to the American Academy of Ophthalmology, between 0.2 and 2 percent of patients experience some type of complication. The Royal College of Ophthalmologists reports a complication rate of less than 5 percent complication rate, noting that severe vision impairment is extremely rare.[iv]
Military Complication Rate
The Department of Defense is one of the biggest advocates of LASIK surgery, having conducted 45 separate studies on the safety and effectiveness of the procedure. According to Naval Cmdr. David Tanzer, MD, there has only been one instance of medical disability retirement related to LASIK. This translates to an overall 0.009 percent complication rate among military personnel.[v]
Incidences of Dry Eye
Dry eye is widely recognized as the most common LASIK side effect. However, many patients who experience this symptom after surgery already suffered from dry eye before their procedures. In 2008, Dr. Eric D. Donnenfeld, conducted a review of worldwide data regarding LASIK and dry eye. According to the study, which the task force presented to the U.S. Food and Drug Administration Ophthalmic Devices Panel, 35 percent of patients suffer from dry eye after LASIK. However, 32 percent of those patients had a previous history of the condition.[vi]
For many patients, the risk of flap complications is the biggest concern. However, various studies have confirmed that intraoperative complications are quite unusual. J.M. Jacobs and M.J. Taravella conducted a review of 84,711 LASIK procedures performed at 28 different US facilities between November 1998 and May 2000. The researchers, employed at the Department of Ophthalmology at the University of Colorado Health Sciences Center, reported:
- 256 total complications (0.302 percent)
- 84 partial flaps (0.099 percent)
- 74 thin or irregular flaps (0.087 percent)
- 59 buttonholes (0.070 percent)
- 29 cases in which doctors could not achieve intraocular pressure (0.034 percent)
- 10 free flaps (0.012 percent)[vii]
Despite the remarkably low risk of side effects, you may be apprehensive about your upcoming LASIK procedure. A look at some additional data may put your mind at ease.
Thousands of patients enjoy better vision thanks to LASIK surgery. According to the American Academy of Ophthalmology, 3 million people have chosen to undergo refractive surgery, and 96 percent of these procedures were LASIK.[viii] The numbers indicate that LASIK is the most popular elective procedure in North America, especially among patients around age 35. However, recent data has suggested that the treatment may be more effective at treating visual errors in younger adults than previously thought, which could lead to growing popularity of LASIK among people aged 18 to 24.[ix]
LASIK enjoys a remarkably high patient satisfaction rate. In 2008, the American Society of Cataract and Refractive Surgery conducted a review of 3,000 articles on LASIK. Through careful analysis, they found a worldwide patient satisfaction rate of 95.4 percent. [x]
High Success Rate
There is a good reason for the high rate of patient satisfaction; the procedure is remarkably successful:
- 98 percent of wavefront patients who have mild to moderate nearsightedness achieve 20/20 vision or better after surgery. [xi]
- 92 percent of new naval recruits achieved 20/20 vision after LASIK surgery. 70 percent enjoyed 20/16 vision. [xii]
- 45 to 83 percent of mildly nearsighted patients enjoy 20/20 vision or better after LASIK.[xiii]
- 26 to 57 percent of moderately nearsighted patients attain 20/20 vision after laser vision correction. [xiv]
It is important to remember that, while the majority of patients do attain 20/20 vision, no doctor can guarantee "perfect" eyesight following LASIK.
Alternatives to LASIK
If you are not a suitable candidate for LASIK, you may still be able to permanently improve your vision. There are several alternatives to LASIK - so many in fact that you may be unaware of the differences among the various techniques.
PRK (photorefractive keratectomy) is one of the most common alternatives to LASIK surgery, and it can correct nearsightedness, farsightedness, and astigmatism. This procedure was actually the forerunner to LASIK, and the two treatments are quite similar. However, PRK does not involve the creation of a corneal flap. Before performing PRK, your doctor will provide a complete examination and evaluation of your eyes to determine your candidacy for the procedure. You will need to follow a preparation protocol, maintaining good eye hygiene and leaving out your contacts for several weeks before the procedure.
On the day of the surgery, the doctor will numb your eyes with anesthetic eye drops. Then he or she will completely remove the outer layer of your cornea, using a mild alcoholic solution, a buffing instrument, or another handheld surgical tool. Although this may sound rather extreme, the procedure is safe and discomfort-free. The layer of cells is so thin that new cells will naturally regenerate within a few weeks.
After removing the top layer, your doctor will use an excimer laser to reshape your cornea, just as in LASIK surgery. When the procedure is complete, your doctor will place a soft protective shield, much like a contact lens. You should wear this shield continually over the next several weeks until your eye has fully healed.
Thanks to advanced wavefront technology, custom PRK is also available. Your doctor will shine a laser, comprised of flat sheets of light, through your eye. As the light exits your eye, you doctor can create a detailed three-dimensional image. Then he or she can precisely tailor your treatment to meet your individual needs.
PRK Results and Recovery
Of course, as with LASIK, no doctor can guarantee "perfect" results. However, the procedure enjoys a high success and patient satisfaction rate. Following PRK, many patients enjoy 20/20 vision, and most achieve vision between 20/20 and 20/40.
PRK involves a slightly longer recovery time than LASIK. Your vision may not improve for several weeks after the surgery, and it may not completely stabilize for several months. During your recovery, you may experience some mild eye irritation, sensitivity to light, glare, halos, and similar side effects. However, as your corneal cells regenerate, your vision will continue to improve, and you could enjoy dramatically better eyesight for years to come.
Choosing between PRK and LASIK
Both PRK and LASIK are safe and effective. However, you may be a better candidate for PRK if:
- You have thin or irregularly shaped corneas
- You have had previous LASIK surgery
- You routinely play contact sports or engage in other high-impact activities
- You have an occupation (such as pilot, police officer, etc.) in which flap complications could prove dangerous
LASEK (Laser-Assisted in Situ Epithelial Keratomileusis) combines LASIK and PRK techniques. Your surgeon will create a corneal flap using an alcoholic solution, rather than a surgical laser. Then, as in LASIK and PRK, he or she can reshape the underlying cornea with an excimer laser. Some surgeons also offer custom LASEK using wavefront technology. LASEK involves a longer recovery time than PRK and LASIK, but the final results are typically comparable. The procedure may be an ideal solution if you have thin corneas or a higher risk for corneal flap complications.
If you are considering this procedure, you should be aware that it has not yet been approved by the FDA. However, because of its many benefits, more surgeons are starting to offer LASEK. These advantages include:
- Low risk of complications
- Slightly lower risk of dry eye than with LASIK
- Easy for a doctors to learn and perform
- Suitability for a wider range of patients
- Patients can receive the treatment more than once
Epi-LASIK is a newer procedure, combining LASIK and LASEK techniques. Instead of creating the corneal flap with a femtosecond laser, the doctor will use a precise surgical blade called an epikeratome. Then he or she can lift the flap, placing it to the side to access the underlying corneal layers. Epi-LASIK is unique because the flap is so thin that it only penetrates the top layer of the cornea, or epithelium. This may make it a great solution for you if you have thin corneas, dry eye, or occupational concerns regarding the flap.
Epi-LASIK can achieve similar results to other laser vision procedures. Many patients achieve 20/20 to 20/40 vision after the procedure. Initial studies indicate that Epi-LASIK may involve fewer complications than similar treatments. However, the procedure is quite new, and research is still underway.
Implantable Contact Lenses
Implantable contact lenses, or ICLs, are an innovative new treatment for moderate to severe nearsightedness. These lenses actually replace the natural lens inside the eye, permanently correcting the refraction of light. To place an ICL, your doctor will numb your eye with anesthetic eye drops. Then he or she will use a surgical laser to create a tiny incision between your iris and the white of your eye. The contact lens will fit through this incision, and it will heal naturally on its own.
There are currently two FDA-approved ICLs available:
- VerisyseTM Phakic IOL: This tiny plastic lens goes in front of the iris and actually clips on to the iris for greater stability.
- Visian ® Implantable Collamer Lens: Made from collamer, a naturally occurring substance in the body, this lens is highly flexible. Your doctor can fold it in half to fit through an extremely small incision. Visian lenses rest behind the iris.
Your doctor will help you choose the right lens for your ocular needs.
Recovery and Results
After receiving your ICL, you may experience some minimal discomfort, which can typically be controlled with mild pain medication. Your vision may also be a bit blurry, but this will dissipate as your eyes heal and adjust to the new lenses. Although you will typically notice some immediate improvement in your vision, it may take one to two months for your eyesight to stabilize completely. Although ICLs are considered a permanent vision solution, the lenses can be removed and/or replaced if your vision changes later down the road.
ICLs have a remarkably high success rate. According to FDA clinical trials, 84 percent of patients enjoyed 20/40 vision or better after surgery. 41 percent had 20/20 vision or better.[xv]
Candidates for ICLs
To be considered for implantable contact lenses, you must:
- Be between ages 21 and 45
- Suffer from myopia
- Have little to no astigmatism
- Have good physical and ocular health
- Have a stable glasses prescription for at least 6 months
- Not be pregnant or breast feeding
Additionally, ICLs may be a good solution if you are not a candidate for LASIK, due to thin or irregularly shaped corneas, dry eye, and similar concerns.
Frequently Asked Questions
Am I too old for LASIK?
There is no upper age limit for LASIK. Though the average patient is in his or her mid-thirties, patients in their sixties and above may choose the procedure to treat nearsightedness, farsightedness, and astigmatism. However, individuals should be aware that their eyes will change as they get older and their natural lenses lose flexibility. Therefore, they may still need corrective lenses, especially for reading and detail oriented tasks.
Am I too young for LASIK?
The FDA has approved LASIK for patients age 18 and older. However, many doctors recommend that you wait until age 21 to undergo laser vision correction. This helps to ensure that your eyes have stopped growing and your vision is stable.
What kind of eye drops should I use after my surgery?
Most doctors recommend a combination of prescription and non-prescription eye drops. Prescription antibiotic and steroid drops can fight irritation and prevent infection. Non-prescription lubricant drops, such as Visine® can soothe your eyes, reduce redness, and treat dry eye.
How soon can I resume running or jogging after LASIK?
Typically, you can go back to running and similar exercise about a week after your procedure. However, if you play high contact sports, you will need to wait several weeks to avoid dislodging the corneal flap. Of course, you should follow your doctor's instructions regarding exercise and recovery.
Can I fly after LASIK?
Yes. However, doctors typically advise patients to wait 24 to 48 hours before getting on a plane, as the changes in altitude can cause corneal swelling (edema). When you do fly, be sure to bring extra lubricating eye drops to combat the dry air on the plane.
Can I get LASIK if I plan to become pregnant?
Hormonal changes during pregnancy can cause changes in your vision, but this is extremely rare. Most doctors simply recommend that women delay LASIK surgery if they plan to become pregnant in the next 3 to 6 months.
Can I get cataract surgery if I have had LASIK?
Absolutely! To treat cataracts, your doctor will remove your cataract-clouded lens and replace it with an artificial intraocular lens (IOL). LASIK affects the shape of your cornea, and therefore will have no bearing on your candidacy for cataract surgery.
Can I get LASIK after I have had cataract surgery?
In many cases, patients can benefit from LASIK after cataract treatment. For example, you may choose monofocal IOLs, which only correct vision at one distance. Then your doctor can perform LASIK to further refine and enhance your eyesight. Of course, you will need to schedule an appointment with your eye surgeon to determine your candidacy for LASIK.
[i] IntraLase Wins Right to Market Laser Used for LASIK Procedure in Canada. (Vision Monday, 2005) < http://www.visionmonday.com/article/intralase-wins-right-to-market-laser-used-for-lasik-procedure-in-canada/>
[ii] DeNoon, Daniel J. Some Patients Need Second LASIK Surgery. (WebMD, 2003) < http://www.webmd.com/eye-health/news/20030410/some-patients-need-second-lasik-surgery>
[iv] Tempted by laser eye surgery? (Daily Mail Online, 2010) <http://http://www.dailymail.co.uk/health/article-1334246/Tempted-laser-eye-surgery-Its-risks.html>
[v] Mullin, David W. FDA Panel Scrutinizes LASIK Safety Data. (Ocular Surgery News®, 2008) <http://www.helio.com/ophthalmology/refractive-surgery/news/print/ocular-surgery-news percent7b0cc6f2ea-41a7-429f-8497-a1901be72e1a percent7D/fda-panel-scrutinizes-lasik-safety-data>
[vii] Jacobs, JM and Taravella, MJ. Incidence of Intraoperative Flap Complications in Laser in Situ Keratomileusis. (Journal of Cataract and Refractive Surgery, 2002) <http://www.ncbi.nlm.nih.gov/pubmed/11777706>
[viii] Lombardo, Anthony J. and Lindstrom, Richard L. Demographics of Refractive Surgery Patients and Market Trends. (American Academy of Ophthalmology, 2002) <http://www.aao.org/vp/edu/refract/v1m5/refractive_management_v1m5.pdf>
[ix] LASIK Effective, Safe in Patients Under 25. (Medscape, 2014) <http://http://www.medscape.com/viewarticle/824920>
[x] Stuart, Annie. A Look at LASIK Past, Present, and Future. (Eye Net Magazine, 2009) <http://www.aao.org/publications/eyenet/200906/feature.cfm>
[xi] Singer, Thea. 10 Minutes, Perfect Vision: What's New with LASIK and Is It for You?. (O, The Oprah Magazine, 2006)
[xii] Wallace, David A. LASIK for Pilots. (Plane and Pilot, 2000)
[xiii] Singer, Thea. 10 Minutes, Perfect Vision: What's New with LASIK and Is It for You?. (O, The Oprah Magazine, 2006)
[xv] STAAR Surgical AG Reports Favorable Findings For Long-term ICL Implants. (The Free Library, 1999) <http://http://www.thefreelibrary.com/STAAR+Surgical+AG+Reports+Favorable+Findings+For+Long-term+ICL...-a055700273>
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