8 Keys to LASIK Laser Eye Surgery The number of people treated with laser eye surgery in the United States has risen from a few hundred-thousand per year in the late 90s to well over a million a year in this new millenium. However, surveys show that people generally know very little about laser eye surgery - about what the procedures aim to accomplish as well as about the risks involved. Here are 8 keys that will help you determine whether you or a loved one are a good candidate for laser eye surgery, and that will help you prepare for and recover from the procedure should you decide to go through with it: 1. Educate yourself about your vision problems and what treatments are available. 2. Understand the risks involved with laser eye surgery. 3. Determine whether you are truly a good candidate for laser eye surgery. 4. Find a good doctor to oversee your surgery. 5. Have realistic expectations concerning your results. 6. Know how to prepare yourself before the surgery. 7. Know what to expect when you go in for surgery. 8. Know how to properly recover from the procedure. 1. Educate yourself about your vision problems and what treatments are available. Your regular doctor and/or your regular optometrist/ophthalmologist should be a key part to your exploration of laser eye surgery. Not only will he or she probably have good information concerning the procedures, but he or she also knows your personal medical history and could be a valuable resource in determining whether you are a good candidate for surgery. Additionally, your doctor may be able to recommend a good doctor to perform your laser eye surgery. There are a few types of laser eye surgery. LASIK stands for Laser Assisted In-Situ Keratomileusis and is now the most common type of corrective laser eye surgery. In LASIK, a knife is used to cut a slit in the cornea, forming a flap which is folded back. The laser is then used to reshape surface of the cornea. PRK, or Photorefractive Keratectomy, though performed less often than LASIK, is still commonly used. PRK is similar to LASIK in that it uses a laser to reshape the cornea, but different in that instead of using a knife to cut a slit in the cornea, some of the top layers of the cornea are scraped off before the laser is employed. LASIK and PRK are both used to treat the three most common vision problems - myopia, hyperopia, and astigmatism - all of which are caused by irregularities of the cornea, which in turn cause distortion or blurriness of the image projected onto the retina. Myopia is what we commonly call nearsightedness and hyperopia is also known as farsightedness. Astigmatism is a further distortion that is commonly found in combination with myopia or hyperopia. Other sorts of vision problems, such as cataracts or glaucoma, have just recently started to be treated using laser surgery and this article won’t be covering such procedures in-depth, though much of the information here is still relevant. Chances are if you are considering LASIK (and from this point on, instead of speaking of laser eye surgery, I will just call it LASIK, since LASIK is by far the most common procedure) you know what other options are available for correcting your particular vision problems. You will have to determine for yourself whether the convenience of not having to use glasses or contacts outweighs the potential risks of surgery. There are also a few other corrective surgeries available including lens implants or corneal ring implantations. 2. Understand the risks involved with laser eye surgery. As with any surgical procedure, there are a number of risks associated with LASIK and other laser eye surgeries. The goal of doctors performing LASIK is that patients never lose lines off of their vision. Some people might have LASIK done and then have much better uncorrected vision than they had previously, but they might still require glasses or contacts. While the majority of people who have LASIK report an improvement in their vision, there is a percentage that find their vision to be worse afterwards. For example if a woman had 20/200 uncorrected vision, but 20/20 with contacts, had LASIK surgery, and then after the surgery she had 20/40 vision uncorrected, but could only get to 20/25 with contacts. A doctor might be willing to do additional treatment, but LASIK is generally a procedure which doctors think should not be done more than once on any given eye. Some people who have LASIK also develop additional vision problems such as glare, halos, or double-vision. There is also an incidence of people who have trouble with nighttime vision after LASIK. Sometimes these symptoms can be severe enough to be debilitating which has led to a number of lawsuits against doctors and their clinics in recent years. Most people undergoing LASIK experience dry eyes for a while afterwards, and if you have dry eye problems already, there is a significant chance that your dry eye problems will only get worse. Finally, it must be noted that long-term effects of LASIK are just now being discovered due to the recent development of the procedures involved, and so it is yet to be seen whether LASIK could potentially cause long-term problems further down the road. 3. Determine whether you are a good candidate for laser eye surgery. There are some factors that might make laser eye surgery more risky for some people than others. If you are not yet an adult, there are some likely complications involved with LASIK. First, it is only legal if you are 18 or older; and second, if your eye still has growing to do, your eye might change shapes a bit, and your vision might turn for the worse. Since LASIK is for the most part a one-time-only kind of surgery, most doctors recommend that you wait until you are done growing. In the same way, anyone who has frequent prescription changes for their glasses or contacts should wait until their vision stabilizes before undergoing LASIK. If you have a disease or disorder that would affect how well you heal, or if you are taking any medications that might affect how well you heal, you should think twice about any surgical procedure. Additionally, any pervious eye wounds or surgeries or eye diseases should be caution flags as you determine whether you are a good candidate for LASIK. You should have your optometrist or doctor examine your eyes for any other potential risk factors - people with large pupils or thin corneas both tend to have more complications from LASIK. As mentioned above, dry eyes tend to be aggravated by LASIK. Another factor that you will have to consider is that laser eye surgery can be quite expensive - if you find a very good deal, you might want to ask yourself why it is so much less expensive than other places or doctors. And most insurance companies don’t pay for LASIK even if they do have vision coverage. Some people choose to have one eye done first and then the other. The reasons they do this are 1) cost - if you can only afford to have one eye at a time; and, 2) risk - if you have one done and it doesn’t turn out as well, you still have one good eye - if it does turn out well, you can still have the other one done. 4. Find a good doctor to oversee your surgery. Perhaps your regular doctor or one of his or her affiliates will be able to recommend someone - doctors often know which other doctors are the best. Don’t feel obligated to stick with a certain doctor just because you started with him or her. When it comes to medical procedures it is often best to stick with your instinct, even if you aren’t a medical expert. If you are uncomfortable at any point in time, its ok to back out. Find out how long the doctor has been using the particular laser that he or she is going to use for your surgery. Also find out what kind of follow-up care is provided for patients, whether you will continue to be seen by the same physician or another. Doctors who are associated with an academic medical center are often the most up to date on research or the latest technology available. Choosing a doctor based on price might not be a good idea - but you yourself must determine how valuable your sight is to you. Don’t be taken in by flashy advertisements or too-good-to-be-true deals. If the place guarantees you a successful surgery or your money back and they screw up… You aren’t going to be wanting your money back, but you are going to be wishing you still had what vision you previously had. 5. Have realistic expectations concerning your results. Laser eye surgery has its risks, as discussed above, and it also has its limitations. In some cases of extremely poor vision, it is possible that your vision might not be possible to completely correct even if the surgery does go ideally. There is good reason to expect your surgery to produce good results, as the majority of LASIK procedures do, but good results don’t always equal perfect results. Statistics vary, but of the 95% or greater that have improvements in vision, somewhere between 40% and 75% improve their vision to 20/20 while most of the remainder improve to 20/40 or better. That means that most people undergoing LASIK see 20/20 afterwards, but there is still a fair percentage that still require some minor correction from glasses or contacts to see 20/20. You should also realize that your vision will not be crystal clear immediately after surgery - in fact, it will probably be several days before you start to see improvements. 6. Know how to prepare yourself before the surgery. There are a few things that you must do before having LASIK surgery. If you regularly wear contact lenses, you should stop wearing them for a few weeks before your scheduled surgery. Contacts affect the shape of the cornea and it can take a while for your corneas to go back to their natural shape. Not doing this could negatively affect the outcome of your surgery. Try not to use and lotions, creams, or makeup on your face, especially around your eyes, in the two days before your surgery. Having debris of any sort on your face can increase the chance of infection. Get plenty of rest and arrange to have someone drive you home after the surgery. It is possible that if your job requires use of your vision you will have to arrange for some time off of work. 7. Know what to expect when you go in for surgery. Before you go in to have the procedure done, it is a good idea to be familiar with what you will be experiencing because 1) it will help you to remain calm and relaxed throughout, and 2) you will know if anything is going wrong or seems to be less than satisfactory. The entire procedure should not last longer than 30 minutes and the actual surgery will probably be about a minute long. Your eyes are numbed with anesthetic drops, so it shouldn’t be painful, though some patients do experience a small amount of discomfort. A device is used to hold your eyelids open. The surgeon will probably use a marker to mark out the spot, and then make the incision for the flap into the cornea. After this, the laser is used to reshape the cornea. You will probably have to stare at a light in order to keep your eye trained on the same spot, which means that if you can’t stare at the same spot for a minute or two, you might not be a good candidate for LASIK. The laser will probably make a small clicking noise as it releases bursts of energy and you may be able to smell the acrid odor of the cornea as it is burned away bit by bit. If you are having both eyes done at the same time, the doctor might take a short break before continuing on to the other eye. After the procedure itself if over, you will probably rest for a little while before being sent home in the care of the person whom you previously arranged to have drive you home. The doctor should give you an eye shield to protect your eyes and keep yourself from rubbing them. The eye shield should remain on until you return to see your doctor after 1-3 days. 8. Know how to properly recover from the procedure. After LASIK, you should continue to be careful about rubbing your eyes for a couple of days. For at least the first three days you should avoid all sports - even non-contact, non-strenuous activities. After that you should consult your doctor and see how you are feeling before resuming regular activities, but generally speaking, you should count on avoiding strenuous activities and contact sports for at least 4 weeks following the surgery. During this time, you should continue wearing the eye shield at night and avoid using make-up, lotions, or creams near your eyes. Avoid swimming or hot-tubbing for 8 weeks. If the initial dryness, itchiness, or soreness doesn’t seem to be going away, contact your doctor. He or she may prescribe lubricating drops that will help. If the doctor prescribes antibiotics to prevent post- operation infection, be sure to fill and use the prescription. Also, remember the basics of healing well: Eat extra protein and get extra rest; make sure you stay well hydrated. And again, realize that your vision might not be perfect, especially immediately after surgery. It usually only takes a couple days for vision to improve, but some patients report that their vision continued to improve through a couple of weeks. Your vision might fluctuate over the first couple of months while your eyes heal - potentially for as long as 6 months. If your gains in vision are not satisfactory, it is possible that you could have another procedure done to try to improve on your first results, but most of the time, doctors don’t recommend repeating LASIK. Conclusions Laser eye surgery, such as LASIK, is fast becoming one of the most common medical procedures in the United States, but it is still a surgical procedure and with it come a number of risks. Many of these risks can be minimalized by making sure that you are a good candidate for the procedure, by selecting a good doctor, and by being familiar with the proper ways to prepare for and recover from surgery. Additionally, having realistic expectations should help you to have a more positive experience with LASIK because it means that you fully understand the aims of the procedure as well as the potential pitfalls.
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