Patients with poor vision often seek to have refractive surgery to help them see better without glasses or contacts. Refractive surgery refers to any procedure designed to improve a patient’s uncorrected vision by which we mean the quality of one’s eyesight without the help of contact lenses or glasses. LASIK is by far the most common refractive procedure performed today, but there are other refractive procedures that may be more suitable to certain individuals. Typical procedures directed primarily at reducing one’s dependence on glasses include the Excimer laser-based procedures LASIK, PRK, and LASEK.
What is LASIK?
LASIK is the most widely performed refractive laser eye surgery procedure. LASIK surgery is a 2-step procedure. Since the F.D.A. approval of the Excimer laser in 1995, Dr. Evans has been performing LASIK in Greater Boston for the correction of vision disorders such as nearsightedness, farsightedness, and astigmatism. Dr. Evans uses a specialized Femtosecond laser to create a thin clear flap of tissue in the center of the cornea. Then he is able to apply the Excimer laser to reshape your cornea and correct your prescription. After having this treatment, most patients who normally require glasses or contact lenses to see distance objects are able to see clearly without such aides.
Can LASIK Treat Dry Eyes?
Many patients who desire LASIK surgery have dry eyes. They have become intolerant of their contact lenses because the dryness makes them uncomfortable. LASIK occasionally worsens dry eyes, but typically, this is temporary and usually can be treated with frequent artificial tear lubrication. In special cases of severe dry eye, special punctal plugs that are placed in the lower eyelid tear ducts can cause significant improvement in dryness. These are easily removed in the office once the dryness resolves, or they can be left in place permanently.
Who is an ideal candidate for LASIK?
The only way to know if you are a LASIK candidate is to schedule a consultation with a board-certified ophthalmologist. North Suburban Eye Associates, P.C. will provide patients with a thorough evaluation at any of our greater Boston locations before making any recommendations on laser vision correction. During the consultation, a complete eye evaluation will take place so that the doctor can determine if you are a strong candidate for LASIK. There must be no signs of ocular diseases present, such as signs of glaucoma or cataracts. If the doctor does not think you are qualified for LASIK, he or she will recommend vision correction alternatives.
If you have poor vision and are interested in improving your vision there are some general requirements to take into consideration before meeting with a doctor about laser vision correction:
- I’m nearsighted, farsighted, or have astigmatism.
- I’m age 18-60 (If you’re over the age 60, you may be a candidate if you’re free from cataracts. If you have cataracts, cataract surgery may be an option for you. Cataract surgery is also a refractive procedure, and it’s usually covered by insurance).
- My vision has been stable for about 3 years.
- I have no eye problems-no recurring inflammation that causes itching. (If you have eye problems, you may still be a candidate once your doctor assists you in clearing up the problem).
- I have no health issues that may affect my eyes (e.g., Rheumatoid Arthritis or Diabetes that’s currently affecting your eyes.
What To Expect During Your LASIK Evaluation
If you feel as though you meet the general requirement to be a candidate for laser vision correction you should schedule an evaluation to determine if you are truly a strong candidate for a LASIK procedure. Each set of eyes is extremely unique. The only way to determine your candidacy 100% is to have an evaluation with a board certified ophthalmologist. The pre-operative evaluation will involve a series of diagnostic tests to determine the stability of your vision. After a thorough evaluation of your cornea, the doctors will be able to determine if you are a candidate. Below is a list of some items that are typically involved with the evaluation process:
- The measurement of corneal thickness, including corneal topography
- Complete review of overall eye health
- The measurement of your prescription or refractive errors
- Custom LASIK measurement for higher order aberrations.
- Dry eye test
- Complete dilation to view the back of the eye or the retina
- Glasses or contact lens history review
- Measurement of pupil size
If for some reason you are not eligible for LASIK, the ophthalmologists at North Suburban Eye Associates, P.C. will be able to recommend other procedures that can help you improve your eye sight. There are many suitable alternatives out there for patients with different needs.
For patients who have extremely complex prescriptions, Dr. Evans may suggest the use of a “wavefront-guided” or “wavefront optimized” LASIK treatment. This is often called “Custom LASIK”. Wavefront-guided ablations can assist a greater percentage of patients in achieving 20/20 vision and avoid unwanted visual symptoms. We are happy to arrange screening examinations for LASIK in our Beverly, Wakefield or Winchester offices during a routine ophthalmologic evaluation or at other times that might be convenient for you.
PRK and LASEK
For some patients who are not good candidates for LASIK in Greater Boston, several different laser eye surgery procedures are available to correct refractive errors such as nearsightedness, farsightedness, and astigmatism.
PRK, or Photo-Refractive Keratectomy was the first F.D.A approved type of laser vision correction. This technique reshapes the surface of the eye by flattening the surface contour of the eye rather than doing so under a “flap”. Another procedure, LASEK is similar to PRK but preserves the first layer of the cornea in order to minimize discomfort. Both PRK and LASEK may be suggested in certain patients with very thin corneas where LASIK would not offer the best clinical results.
The LASIK procedure takes 8-15 minutes per eye. It is done under topical anesthetic drops, so you will be awake throughout the procedure. If you are nervous about something in your eye, a mild sedative is available prior to surgery to encourage relaxation during the procedure and to encourage sleep afterward. The surgeon and operating room technicians often will talk throughout the procedure to help keep patients at ease.
A corneal flap is created so that the laser can modify the cornea. Once the corneal flap is created and lifted a laser is used to change the shape of the cornea which well help to enhance your vision. After the laser treatment, the corneal flap is set back into position and kept in place by natural suction, not sutures. Eye drops are used and plastic shields are placed over the eyes to protect them until the following day.
Is LASIK Done On Both Eyes At Once?
Some patients may prefer to have each eye done on different days. In most cases, however, both eyes are done on the same day. This avoids the period of imbalance that occurs if one eye still needs correction while the other one doesn’t. This is a discussion that you should have with the surgeon so that you can decide what is best for you.
Recovery After Laser Vision Correction
Recovery is relatively quick considering the nature of the surgery. The first couple of hours after surgery, the eye(s) may feel somewhat irritated, with a burning sensation and some tearing. Vision is typically blurry during this time. Most patients nap for a couple of hours to rest the eyes. After several hours, the irritation goes away and the vision begins to clear. The day after surgery, most irritating sensations are completely gone and vision is remarkably clear.
Active sports should be postponed for two weeks or until the eye is fully healed, unless protective eye wear is approved by the surgeon. Swimming, hot tubs and saunas should be avoided, as well. After full recovery, normal activity can resume, and the ability to play sports without glasses makes them more enjoyable for many patients.
Laser Vision Correction Results
Fluctuation can occur, but most visual improvement takes place immediately following the procedure. Most patients note that major fluctuations have stopped after two weeks. At the same time, it may take additional time for all of the swelling in the eye to resolve and fluctuations to cease. Many patients have healing that may continue to improve over six to nine months.
Will I Need Glasses After LASIK Surgery?
There are never any guarantees with medical procedures. LASIK is no different. Not everyone will achieve perfect vision with LASIK but almost all will experience drastic improvements. It is important to know that LASIK does not eliminate the need for reading glasses. Beginning at around the age of 40, a condition called presbyopia usually begins, requiring reading glasses or bifocal correction. The laser cannot correct presbyopia at this time; however, there are some promising treatment options on the horizon.
Is LASIK Permanent?
LASIK is a permanent procedure. In some cases, however, an enhancement procedure may be required. Some patients’ eyes may change throughout their lifetime, which can happen with glasses or contact lenses as well.
Are There Complications With LASIK Surgery?
The LASIK procedure is very safe, and that is why it has been accepted worldwide. With any surgical procedures, however, complications may arise. Vision-threatening complications do exist, but they are extremely rare. These include infections (an incidence of 1 in 5,000) and irregular healing processes that can lead to something called “irregular astigmatism” that glasses cannot correct and contact lenses or further surgery may be required to improve.
There are also complications, which may lead to temporary blurriness, temporary dependence on glasses or contact lenses or a need for additional surgery. In most cases, the patient can still do well and recover with good vision. It is for this reason that LASIK patients should confirm the experience of their surgeon to determine if he or she has specialized training in cornea surgery. Because LASIK is performed on the cornea, the surgeon’s knowledge of the healing properties of the cornea and management of any complications is critical to the patient’s well being. The surgeon’s knowing how to handle a complication, should one occur, can make a significant difference in the patient’s outcome.
LASIK Success Rate
Success depends on several factors, the most important being the degree of nearsightedness, farsightedness or astigmatism. Prior to surgery, your surgeon will be able to tell you your likely vision following the procedure. Approximately 95 percent of eyes treated with LASIK reach 20/40 or better vision with one procedure, which is the requirement for driving legally without having to wear any corrective lenses. If a patient does not achieve their desired goal, enhancements can be performed to help further improve vision.
Other Vision Correction Options
In addition to the laser-based procedures, lens-based procedures are commonly being utilized to achieve more precise refractive results. With the introduction of premium intraocular lenses that correct astigmatism (Toric IOL’s) and those that correct presbyopia, referred to as PCIOL’s, and with the advent of refractive lens exchange (RLE), more options are available that allow patients to see well without the use of contact lenses or glasses. Since some patients are better suited to one procedure than another, the evaluation for refractive surgery is considered just as important in achieving a successful outcome as the performance of the procedure itself.
What Should I Look For In Choosing A LASIK Surgeon?
When selecting a surgeon for LASIK you should consider their experience. A qualified surgeon should meet the following basic criteria:
- Board certification by the American Board of Ophthalmology, with advanced training in corneal and refractive surgery
- Skills and experience with a prominent ophthalmology practice
- Having performed thousands of LASIK and refractive surgical procedures
- The ability to help patients understand potential outcomes and complications.
LASIK is a lifetime investment and like all major decision you should not rush into the procedure if you are have any uncertainties.
“Dr. Evans is a wonderful surgeon. I can’t praise him enough based on my personal experience. Thank you Dr. Evans for taking such good care of me.” – Partha P.
Choose North Suburban Eye Associates
At North Suburban Eye Associates, Dr. Evans is an American Board of Ophthalmology certified eye surgeon with over 20 years experience in intraocular surgery and refractive procedures in the Greater Boston area. As a patient at NSEA, your surgeon will perform the preoperative assessment, the surgical care, and the postoperative follow-up necessary for you to achieve an optimal outcome. Whether the optimal procedure is a laser-based or a lens-based procedure done in association with cataract surgery, you can feel confident that your surgery will be performed in a caring environment by a highly trained surgeon utilizing the most modern and technologically advanced equipment.
Schedule a Consultation
Those with an interest in decreasing their dependency on glasses or contact lenses are encouraged to consider laser vision correction and call us at 781.928.2110. North Suburban Eye Associates serves Wakefield, Winchester, MA and the surrounding Boston area.