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Big Eyes, Small Eyes: It Makes a Difference in Laser Eye Surgery

Big Eyes, Small Eyes: It Makes a Difference in Laser Eye Surgery


When considering laser eye surgery, look in the mirror and look at the eyes of people around you.

What you'll discover is difference—unique shapes, sizes, folds and lids.

When eye surgeons are trained on the laser they are often told, “Watch out for small eyes, they can make surgery difficult.” Yet, the smallness of the eye itself isn't truly what matters.

Hawaii ophthalmologist Tyrie Jenkins, M.D., explained some of those differences and why they matter in laser eye surgery. Dr. Jenkins and Carlos Omphroy, M.D., are the most experienced laser refractive surgeons in Hawaii. (Dr. Omphroy performed the first PRK laser eye surgery in the islands and Dr. Jenkins did the first LASIK.)

“It's not really the eyeball that's small,” Dr. Jenkins said. “It's the aperture (the opening). There's a misconception that the Asian eye is smaller. Not all Asian eyes are alike. Korean eyes differ from Japanese eyes, which differ from a Chinese eye, although all are considered Asian.

"In my experience, Korean eyes tend to be a little more forward in the orbit (eye socket) therefore generally quite accessible for surgery," she said.

The Japanese eye is more variable and can pose a challenge to the laser eye surgeon. "There is a higher percentage of patients among those of Japanese ancestry who have smaller interpalpebral fissures —that's the distance from corner to corner.” Deep set eyes, which are more common in Caucasians, can also pose challenges.

Aging is a factor, too. "As you age, the fat around the eye may lessen, making it sit further back in the orbit," Dr. Jenkins explained.

And, no matter what the race or age, patients who have had plastic surgery around the eyes raise a red flag. Plastic surgery is a tightening procedure. Ocular plastic surgery may artificially foreshorten the interpalpebral fissure — that corner-to-corner space — making for a smaller, tighter space, and the eye is harder to get to. Postoperatively these patients are more susceptible to dry eye symptoms.

You have to know where the potential problems are, be prepared for them, and you must know when to say, “no, you really should not have this procedure done,” Dr. Jenkins said.

To minimize risks and problems, the experienced laser eye surgeon first carefully determines the patient's proper prescription and then takes careful measurements prior to surgery.

On small eyes, they measure the corner-to-corner distance. “You really need to know the limitations,” Dr. Jenkins said. If the opening is small, the laser center staff should be on alert that a tiny incision may be needed at the eye's outer corner.

The patient should be informed as well. If the incision is needed, the eye corner is generally numbed for patient comfort. The incision is so small it doesn't require stitches and it heals rapidly.

Before surgery, the cornea or the front surface of the eye should be carefully measured too. Both the curvature and the corneal thickness are analyzed.

The experienced laser eye surgeon will modify the thickness of the flap (which is cut by the laser) if the patient's cornea is on the thin side, Dr. Jenkins explained.

Experienced laser eye surgeons know how to compensate to minimize any potential difficulties.

Research has shown that experience makes a difference, particularly in the LASIK procedure when the flap is made. Anticipating potential problems through a careful preoperative evaluation minimizes flap complications. The treatment of each patient should be customized based on that examination to ensure a safe and predictable result.

Ask a lot of questions before committing to laser eye surgery. Find out how much experience the surgeon has with your size or type of eye.

If you've had any plastic surgery, make sure your eye surgeon is aware of that. Ask how much experience he or she has had in this area.

Laser eye surgery is a marvelous benefit that has improved the eyesight of many, many people. If you are considering the surgery, be informed; ask lots of questions and look for experience. This will help ensure you are happy, too.

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