STAR Excimer Laser

Learn More About LASIK


The History of LASIK

Over the years, many procedures have been tried to correct vision without glasses, some being more successful than others. One of the most promising avenues was to surgically alter the shape of the cornea or lens, thus refocusing the light. Since the light coming into the eye was refocused this was called refractive surgery. The first refractive procedure was actually cataract surgery, done using implantable lenses placed in the eye an attempt to correct refractive error in 1949.

Later, in the early 70's a procedure called Radial Keratotomy or “RK” was developed. It involved making very shallow radial cuts in the cornea to change it's shape and was moderately successful. However, due to advances in the medical profession, it is now typically done only on select patients. As technology has evolved, lasers have been found to be useful in eye care due to their ability to accurately reshape tissue on the eye. Initially, photorefractive keratectomy, or “PRK” was done using the EXCIMER laser with fairly good results. This procedure was commonly done in the 1990’s prior to LASIK (laser in-situ keratomileusis) becoming the refractive procedure of choice. Problems with PRK included slow healing time along with significant pain in many patients. Since the early 1990’s, LASIK has evolved to the point that it is now the refractive procedure of choice for most eye doctors. The lack of discomfort, the quick healing, and the accurate, stable outcomes have all contributed to LASIK’s widespread acceptance by eye doctors and the general public.



Why Do We Use Laser Light?

Laser light is different than light from a lightbulb or any other source. A lightbulb or normal light source gives off light that is many colors that are mixed together at random and they travel in all directions. LASER light is all the same color and al the light waves move in the same direction. Using mirrors and special lenses, this light can be highly focused on a single point. At this precise point there is a controllable amount of heat generated. This tool can be used to perform a wide range of medical procedures.

Using this highly focused energy, the eye surgeon can reshape the cornea and create a newly shaped surface on the eye, correcting nearsightedness, farsightedness and astigmatism.

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The LASIK Procedure

In PRK, the LASER is used on the outer surface of the eye or Epethilial Layer. This actually strips away part of the surface and takes some time to heal. This also affects the vision during the healing time and there can be some discomfort. LASIK improves on this procedure lifting a small portion of the cornea away from the eye first. To do this, a small instrument called a “microkeratome” is used to painlessly create a flap using the outer layers of the cornea. This flap remains attached to the eye but is folded back on a small "hinge" that is not completely cut. This creates a flat "bed" on the cornea and the laser is then used to reshape this part of the eye. Typically, the laser portion of the procedure takes less than one or two minutes to complete. Then the flap is repositioned over the front of the eye, checked for stability (no sutures used) and then the other eye is done in similar fashion. The entire process generally takes less than 30 minutes for both eyes and the patient can leave shortly afterwards. Patients can return to a normal lifestyle quickly and there are few restrictions during the healing period.

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Am I a Candidate?

Your optometrist is highly trained and knowledgeable regarding LASIK and will be able to tell you if you are a candidate. A dilated examination which includes special tests generally not done in a regular examination will be performed by your optometrist. This will allow the doctor to determine if there are any problems that would preclude you from surgery. If you have cataracts or keratoconus you may not be eligible for LASIK. If there are other issues that relate to your eligibility for LASIK, your doctor will discuss these in detail. If you are a contact lens wearer, removal of contacts prior to your evaluation will be necessary. At least 2 weeks is recommended for hard or “RGP” lenses and at least 3 days for soft lenses. This may vary depending on your doctor’s recommendation. Some preliminary tests include corneal mapping and measurement of the corneal thickness. These may be done at your doctor’s office or may be done prior to your procedure at Pacific ClearVision Institute.

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Is LASIK for everyone?

LASIK is a procedure that covers a wide range of vision correction but many factors need to be considered when deciding to have LASIK. Even if your eyes are healthy and the vision has remained stable for years, your optometrist considers your goals very seriously prior to LASIK. Should these be largely achievable with the procedure, you are likely a candidate. Your optometrist will question you about this in detail. Expectations need to be realistic as well. No surgeon can guarantee 20/20 vision. Studies indicate that 93% of all patients achieve 20/40 vision or better following LASIK which would allow you to pass a driver’s test without glasses. In our experience at Pacific ClearVision Institute, the majority of patients do achieve 20/20 and are very happy. We do tell patients it is possible that a thin lens may be necessary to provide the sharpest vision after LASIK. This is necessary mainly in those who have such a slight residual refractive error that may not be correctable by an enhancement.

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How Do I Prepare for LASIK?

If you and your optometrist decide that LASIK is for you, an information packet will be sent to you. You will also be required to view an informed consent video outlining the benefits and risks of LASIK either at your optometrist’s office or at Pacific ClearVision Institute. On the day of your LASIK, eat lightly if you wish and take your normal medications. A driver should bring you to the appointment because you will need to keep your eyelids closed for approximately six hours after the procedure. No makeup around the eyes should be worn the day of surgery. It is very important to have ALL makeup thoroughly cleaned from the eyelashes and eyelids prior to LASIK. Upon arrival to Pacific ClearVision Institute, some additional tests will be done. A final refractive check is done to confirm prior data. Our surgeon will also meet with you prior to the LASIK. This is the time to ask any questions you may have. Our physicians are happy to discuss your questions on a personal basis and will take the time to make sure they are answered to your satisfaction. Prior to LASIK, should you be concerned about nerves, please ask the helpful staff for some medication for this.

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What Can I Expect During LASIK?

After the doctor examines your eyes and answers any questions, you will be taken to the laser room. You will be seated in a comfortable chair that will lie back, placing your eyes in position for treatment. The first eye to be treated is prepared using special drapes and a separator is used to keep the lids from blinking. In some people, especially those with small eyelid openings, this can be slightly uncomfortable. At this point, a special instrument is placed on the eye to cause it to become firm. During this time your vision will go dark and you will hear a humming sound of the microkeratome making the “flap” as described earlier. This takes only a few seconds. After the microkeratome is removed, the flap is lifted out of the way and the laser is applied to the exposed surface of the cornea. The laser has been calibrated carefully to deliver the exact treatment your eye needs. This is highly controlled to insure an excellent outcome. Once the laser is finished, the flap is laid back down and adheres on it’s own without stitches. This takes a couple of minutes. After the surgeon is sure the flap is seated properly, the other eye is treated in the same way. Once the procedure is done, a careful examination by the surgeon is done at the microscope. The eyes are covered with a clear shield and you are advised to keep them closed for 6 hours.

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After LASIK

The use of these drops will be reviewed extensively with you at your LASIK appointment and you will receive prescriptions for both medications. These are to prevent infection and to control the healing of your eyes during the first week. Typically there is no pain following the procedure. Your eyes may feel scratchy but generally nothing worse. Six hours after surgery you should see a significant improvement in vision. In 24 hours, 80-85% of the healing has occurred. Usually you will be able to drive yourself to the post-op visit without glasses or contacts. For a week or so, it is common for one eye to be clearer then the other. Generally over the course of a month this difference lessens so they become quite balanced. You may need reading glasses if you had bifocals or reading glasses over contacts prior to LASIK. After the first day post-op exam with our surgeon, other follow-up appointments will be with your primary eye care provider. These usually occur at one week, one month and then three to six months.

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Will I Need an Enhancement?

At approximately three months, most individuals' vision will stabilize. In our experience about 5 percent of individuals need enhancements. This is greatly affected by the level of correction needed initially. The higher the change, the more chance one will have of needing a second correction.

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Changes to Expect

As a rule, LASIK is a very stable procedure. However, the eyes do change over time and things unrelated to your LASIK procedure can occur. The most common is “presbyopia” or the inability of the eyes to close focus as we age. Since LASIK attempts to achieve clear vision in the distance, your eyes will need to adjust to see up close. Those between 40 to 45 years of age or older notice that near vision may be more difficult and their eyes will not be able to adjust automatically. It is important to understand this as it will affect the way you use your eyes after LASIK if you are of this age. Typically glasses for reading only are used. In some people “monovision” can be done surgically, making one eye see better for reading and the other for distance. Ask your optometrist if this may work for you.

Some people will note an increased dryness of the eyes after LASIK. This is generally temporary and will diminish over the course of several weeks or months. Use of eye lubricating eye drops frequently helps alleviate the symptoms. Other changes in the eye over time can be cataracts, glaucoma, macular degeneration and other health-related problems. These occur regardless of having had LASIK. Other specific questions about possible changes in vision should be addressed to your optometrist or to the staff at Pacific ClearVision Institute.

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