Is LASIK surgery right for me?

Eyeglasses and contact lenses can be a burden. Many would love to ditch them. It is only natural to wonder whether LASIK surgery can improve vision and correct visual impairment.

Commonly, those who opt to have LASIK, or laser-assisted in-situ keratomileusis eye surgery, enjoy improved vision, reporting 20/25 acuity which allows for most activities without corrective lenses. Most will still eventually need corrective lenses for night driving or reading, due to presbyopia, an age related vision impairment

LASIK has an excellent record, with a 96 percent satisfaction rating. Vision loss or impairment due to complications is rare, with most patients satisfied with their results. Some side effects such as dry eyes and temporary visual disturbances are fairly common and last for a few weeks or months. Very few report lasting or permanent disturbances to their vision.

Results are often based on the degree of correction and difficulty of the procedure. Mild nearsightedness has the best success with refractive surgery. Severe levels of farsightedness, nearsightedness, and astigmatism may result in less improvement.

The following details many facts to consider in making your determination.

How does laser eye surgery work?

LASIK, or laser eye surgery, uses lasers to correct various visual impairments and refractive errors in the cornea. LASIK is the current standard in laser corrective surgery. Though there are other technologies, LASIK is a common term to refer to them.

The eye can be described in simple terms. The cornea, or front of the eye, is a lens which refracts light onto the retina, where it is processed as an image. Impairments such as nearsightedness (myopia), farsightedness (hyperopia), or astigmatism, cause the light to be refracted improperly, decreasing the clarity of vision.

The Mayo Clinic defines the following:

• Nearsightedness (myopia) — is a condition in which you see nearby objects clearly, but distant objects are blurry. When your eyeball is slightly longer than normal or when the cornea curves too sharply, light rays focus in front of the retina and blur distant vision. You can see objects that are close more clearly, but not those that are far away.
• Farsightedness (hyperopia) — is a condition in which you can see far objects clearly, but nearby objects are blurry. When you have a shorter than average eyeball or a cornea that is too flat, light focuses behind the retina instead of on it. This blurs near vision and sometimes distant vision.
• Astigmatism — causes overall blurry vision. When the cornea curves or flattens unevenly, the result is astigmatism, which disrupts focus of near and distant vision.

Most commonly, glasses or contact lenses are used to correct the refraction errors which cause blurry vision. But these are not permanent solutions, and the eye may continue to degrade. Reshaping the cornea is possible through LASIK, providing a more permanent fix. Specifically, lasers are used to remove portions of corneal tissue to create a better shape in the cornea.

During a free consultation, and before the LASIK procedure, a specialist will determine the both the nature and degree of vision impairment. 3D mapping may also be used to determine the unique features of a patient’s eye so as to provide the utmost of precision. The procedure will use a laser to then reshape the cornea. Every pulse of the laser will ablate a small amount of corneal tissue, allowing your eye surgeon to flatten the curve of your cornea or make it steeper.

The surgeon may create a flap in the cornea and then raise it up before reshaping the cornea, providing additional material to shape. There are also variations in which a very thin flap is raised or no flap is raised. Each procedure meets the needs of different patients.

The Mayo Clinic reports that individual eye surgeons may specialize in specific types of laser eye procedures. The differences among them are generally minor and none are clearly better than any others. Depending on your individual circumstances and preferences you may consider:

• Photorefractive keratectomy (PRK) — With PRK, rather than forming a flap, the top surface (epithelium) is scraped away. This corneal abrasion takes three or four days to heal, resulting in moderate pain and blurred vision in the short term. It was thought that these drawbacks were outweighed by the theoretical advantage that PRK was safer for people who are more likely to be struck in the eye — for example, those involved in contact sports, law enforcement or the military. But even with standard LASIK, the risk of eyeball rupture is still very low, so there is probably no significant advantage with PRK. LASIK is also a better option than PRK for correcting more severe nearsightedness (myopia).
• Laser-assisted subepithelial keratectomy (LASEK) — LASEK is similar to LASIK surgery, but the flap is created by using a special cutting device (microkeratome) and exposing the cornea to ethanol. The procedure allows the surgeon to remove less of the cornea, making it a good option for people who have thin corneas. For people at greater risk of eye injuries, LASEK does not have any significant advantages over LASIK.
• Epithelial laser-assisted in-situ keratomileusis (epi-LASIK) — In an epi-LASIK procedure, your surgeon separates the epithelium from the middle part of the cornea (stroma) using a mechanized blunt blade device (epikeratome) and reshapes the cornea with a laser. This procedure is similar to LASEK.
• Implantable lenses — Corrective lenses can be surgically inserted in the eye to improve vision. This is routinely done as part of cataract surgery (in which the old, cloudy natural lens is removed). It may also be an alternative to LASIK for older adults who may need cataract surgery in the future. Younger people with high degrees of nearsightedness that cannot be satisfactorily treated with corrective lenses may also be offered implantable lenses. But this is not a routine option for most people.
• Bioptics — Bioptics combines one or more techniques, such as implantable lenses and LASIK, to treat nearsightedness or farsightedness. Again, this is not an option for most people seeking refractive eye surgery.

Do you have healthy eyes?

Laser corrective surgery is best suited for those suffering from moderate refractive error, and those without unusual or major visual impairments.

During a free consultation, patients should provide information detailing their health and current condition. This will allow their doctor to make an informed decision about the necessary procedure and what complications may arise.

Common information includes:

• An eye disease that results in a progressive deterioration of your vision and thinning of your cornea (keratoconus). In fact, if keratoconus runs in your family, even if you don’t have it, be very cautious about elective eye surgery.
• Keratitis, uveitis, herpes simplex affecting the eye area, and other eye infections.
• Eye injuries or lid disorders.
• Dry eyes. If you have dry eyes, LASIK surgery may make the condition worse.
• Large pupils. If your pupils are large, especially in dim light, LASIK may not be appropriate. Surgery may result in debilitating symptoms such as glare, halos, star bursts and ghost images.
• Glaucoma. The surgical procedure can raise your eye pressure, which can make glaucoma worse.
• Cataracts.

You might also rethink having LASIK surgery if:

• You have severe nearsightedness or have been diagnosed with a high refractive error. The possible benefits of LASIK surgery may not justify the risks.
• You have fairly good (overall) vision. If you see well enough to need contacts or glasses only part of the time, improvement from the surgery may not be worth the risks.
• You have age-related eye changes that cause you to have less clear vision (presbyopia).
• You actively participate in contact sports. If you regularly receive blows to the face and eyes, such as during martial arts or boxing, LASIK surgery may not be a good choice for you.

Are you healthy in general?

General health questions may also determine if you are unsuitable for elective surgery. Some medical conditions, unrelated to your eyes, can increase the risks associated with LASIK surgery or make the outcome less predictable. Specifically, they can complicate the healing process and lower the effectiveness of treatment.

These include:

• Any disease or condition that affects your immune system and impairs your ability to heal or makes you more prone to infections, such as rheumatoid arthritis, lupus, HIV and other autoimmune disorders.
• Taking an immunosuppressive medication for any reason.
• Diabetes.
• Depression or certain chronic pain conditions, such as migraine, irritable bowel syndrome and fibromyalgia. If you have one or more of these conditions, you may have more problems with dry eyes and postoperative pain than other people. The reasons for this are not entirely clear but may be related to how you perceive pain.

Is your vision stable?

Myopia may continue to change throughout adolescence, or even into adulthood or longer, requiring periodic changes in the prescription of glasses or contact lenses. As a result, LASIK is not to be taken until after the age of 18, and is best when the eyes have reached a stable condition. Having the same prescription for two or more years is sufficient for determining if the eyes are stable.

Pregnancy, breast-feeding, steroid drugs, and other temporary conditions may cause fluctuations in vision. It is best to postpone LASIK until after these conditions end, and the eyes have stabilized.

Is LASIK affordable?

It should be noted that LASIK is considered an elective surgery and is subsequently not covered by most insurance. Only insurance specializing in visual impairments is likely to cover LASIK. The procedures themselves average between $1,000 and $3,000. But most clinics seek to work with patients, ensuring LASIK is not only affordable but available to most budgets.

What are the side effects and complications?

Though loss of vision may result in certain cases, it is rare. Most complications are temporary problems, particularly dry eyes and minor visual disturbances. Most report that they clear within weeks or months Very few people consider them to be a long-term problem, and satisfaction remains at 96 percent of patients.

• Dry eyes — LASIK surgery causes a temporary decrease in tear production. For the first six months or so after your surgery, your eyes may feel unusually dry as they heal. Even after healing, you may experience an increase in dry eye. Your eye doctor might recommend that you use eyedrops during this time. If you experience severe dry eyes, you could opt for another procedure to get special plugs put in your tear ducts to prevent your tears from draining away from the surface of your eyes.
• Glare, halos and double vision — After surgery you may have difficulty seeing at night. You might notice glare, halos around bright lights or double vision. This generally lasts a few days to a few weeks.
• Undercorrections — If the laser removes too little tissue from your eye, you won’t get the clearer vision results you were hoping for. Undercorrections are more common for people who are nearsighted. You may need another refractive surgery within a year to remove more tissue.
• Overcorrections — It’s also possible that the laser will remove too much tissue from your eye. Overcorrections may be more difficult to fix than undercorrections.
• Astigmatism — Astigmatism can be caused by uneven tissue removal. It may require additional surgery, glasses or contact lenses.
• Flap problems — Folding back or removing the flap from the front of your eye during surgery can cause complications, including infection and excess tears. The outermost corneal tissue layer (epithelium) may grow abnormally underneath the flap during the healing process.
• Vision loss or changes — Rarely, you may experience loss of vision due to surgical complications. Some people also may not see as sharply or clearly as previously.

LASIK versus reading glasses

Presbyopia is an age related visual impairment which degrades the ability of the eye to focus on near objects. Most individuals will experience the beginning stages by their 40s, making it more difficult to read small print or to perform detailed tasks without the aid of corrective lenses.

Interestingly, those suffering from nearsightedness will be resistant to the loss of vision from presbyopia. The ability to focus on near objects is preserved by the nearsighted to some degree. LASIK corrective surgery corrects the refractive error of nearsightedness, eliminating this resistance. As a result, glasses or contacts will likely be necessary at some point. It is common to give up one benefit of nearsightedness to avoid the need for glasses when older

Older adults who are thinking of LASIK may might be interested in monovision, which improves near vision. Monovision procedures correct one eye for distance, and one eye for near vision, providing a balance in a person’s sight. Monovision is not for everyone, as some are less tolerant, or receive less benefit. Luckily, monovision can be tested for through the use of a combined prescription.

Should you stop wearing contact lenses before surgery?

Yes. It is recommended for patients to stop using contacts completely before surgery, for a period of at least two weeks. A contact lens rests directly against the eye, and distorts the shape of the cornea. Without this constant pressure, the cornea relaxes into its original curve. LASIK surgery may be affected if the shape of the eye is distorted in this way, resulting in sub-optimal results. However, this is seldom an issue,. And should not be cause for alarm. During your free consultation, your doctor should outline any requirements or instructions to avoid difficulties, and allow for the most accurate measurements and results.

What should you expect for LASIK?

LASIK provides moderate to excellent vision for most people who undertake the procedure, and has a high degree of satisfaction. Improvements to vision last for years or decades, and enhancement surgeries can extend this period of peak vision. No more need to worry about glasses or contacts. No bother with sports, or swimming. Never fear about leaving your contacts in at night, or accidentally breaking your frames or scratching your lenses. LASIK offers not just freedom from vision impairments, but freedom to live life.

Though LASIK can benefit most people, it is not a solution to all sight problems. As people age, they are more likely to need corrective lenses, and LASIK cannot prevent this in all cases.

From surveys, LASIK enjoys a 96 percent satisfaction rating. However, detailed studies on the lasting effects of LASIK are less known, and need more information to make an accurate statement on efficacy. Often, this is the result of patients being generally satisfied with their procedure, and no longer reporting on the status of their vision. Moreover, as LASIK technology has improved, the new equipment and techniques make it difficult to make any claims about the procedures.

We would note that tests are likely conducted in lab conditions, and so certain results may not match the experience of patients in all situations. This is especially true of low light settings, where vision may not be the best. If this is a concern, we suggest raising this issue with your doctor and discussing the potential risks and benefits.

Ultimately, the eye tends to degrade over time, and vision will continue to worsen even after surgery. This is seldom a problem, but should be understood before making a decision.

How should you choose an eye surgeon?

Primarily, it is important for people to be happy and comfortable with their medical professionals. Generally, people don’t have a thorough knowledge of LASIK or specialists. It may be necessary to do some research, and to have a free consultation with local providers in order to develop a rapport and answer questions.. Friends and colleagues who have had LASIK might also be able to provide their perspective and suggest a competent doctor.

Most doctors work with a team of trained professionals from a clinic or medical care provider. Though any of them could provide you with information, consultation, or take the initial measurements, it is important that the doctor make the final determination of whether LASIK is appropriate for the individual, and which procedures should be used.

There are many questions to ask, and patients should not go through with LASIK until they are fully satisfied with the answers and knowledge. Your doctors are more than willing to discuss the procedure, technology, or results.

Final Thoughts

Although it is important to be knowledgeable about LASIK before getting the procedure, it is not possible to know from reading if it is the right choice. There is always an amount of risk, even if small. Consider your options, seek a free consultation, and understand the risks and reasonable expectations.