LASIK Eye Surgery (cont.)

Am I a good candidate for LASIK?

Refractive surgery is not for everyone. In addition to having a complete eye exam to find out if you are a candidate for surgery, there are certain questions you should ask yourself before considering LASIK or other refractive procedures.

1. Am I willing to accept a low but real risk of surgical complications? Even though modern LASIK is extremely safe with rare complications, there are still times when unavoidable complications occur that can negatively affect your vision. 2. Does my career allow me to have LASIK? Although there are now very few organizations that prohibit their employees or members to have refractive surgery, if there is any doubt, then it is important to ask your employer, professional society, or military service whether or not it is allowed for you to undergo refractive surgery. 3. Has my vision been stable long enough to have LASIK? While minor changes in your prescription are not uncommon from year to year, if your prescription continues to get progressively stronger (for example, more myopic, more hyperopic, or more astigmatism) each year, then you may not yet be a good candidate for refractive surgery. 4. Do I have any health conditions that make me a poor surgical candidate? Certain advanced autoimmune diseases, such as lupus and rheumatoid arthritis, may influence postoperative healing. 5. Do my recreational activities make me a bad surgical candidate? There is a lifelong risk of LASIK flap dislocation if there is significant trauma to the eye, so people who participate in contact sports such as boxing, martial arts, or wrestling are not likely not be a good candidate for LASIK. In these instances, other refractive procedures, especially surface ablation, may be more appropriate choices. 6. Am I too young or too old to have LASIK? There are no hard and fast rules about the appropriate age to have LASIK. However, patients under age 18 are rarely stable enough for LASIK, and older patients may begin to develop cataracts or other eye health issues that preclude them from undergoing LASIK. Again, the best way to determine these things is have a complete eye exam. 7. Do I have keratoconus?Keratoconus is a corneal disease resulting from decreased corneal strength that can be detected as an abnormal curvature on testing. Patients that have evidence of keratoconus are not candidates for LASIK or surface ablation, but new technologies may become available for these individuals.

What is my doctor looking for during my evaluation?

Your eye doctor should look for risk factors prior to surgery that may make you a less than ideal candidate for surgery and discuss any abnormal findings with you at length. The following are considered to be risk factors for refractive surgery.

1. High prescriptions: Patients with extreme eyeglass prescriptions (high myopia or high hyperopia) may not be good candidates for LASIK because too much corneal tissue would need to be removed to safely perform the procedure. 2. Thin corneas: Because all excimer laser surgery (LASIK and surface ablation) requires the removal of small amounts of corneal tissue to correct your refractive error, the thickness of your corneas must be measured before surgery. Patients who have very thin corneas are at risk for excessive corneal weakening after surgery and may not be good candidates for LASIK. In these cases, surface ablation or other procedures may be more appropriate. 3. Abnormal corneal curvature: There are many devices used today to measure the overall shape and curvature of your cornea. These devices are called topographers and are an essential part of your initial evaluation. Abnormalities in the shape and curvature of your cornea may indicate that your cornea is weaker than that of the average person, and this will exclude you from having LASIK safely. 4. Dry eyes: Patients with dry eye symptoms, such as burning, redness, and tearing may have worse symptoms after LASIK surgery. This occurs because corneal nerves are cut during this procedure, and these nerves are partly responsible for stimulating tear secretion. Most patients have a full return back to their baseline state after surgery; however, patients with significant dry eye before surgery may not be appropriate surgical candidates 5. Large pupils: Although less common today, some patients still notice glare, halos, or other night vision issues after LASIK. Patients with larger pupils may be more prone to noticing these things, so your screening evaluation should include measurement of your pupil size in a dark room. 6. Previous refractive surgery: Prior corneal surgery or other types of refractive surgery, especially radial keratotomy (RK), may complicate additional procedures. You should talk to your eye doctor about this situation in order to make the best decision possible about your ability to be corrected with further surgery. 

What are the risks of LASIK?

LASIK has been shown to be a very effective procedure, and most patients are very happy with their vision following the procedure. However, like any surgical procedure, LASIK does come with some risks. In order for you to decide whether LASIK surgery is right for you, you need to be aware of potential risks and complications and weigh these carefully before proceeding with surgery.

1. You may be over-corrected or under-corrected. Most patients are satisfied with their vision after a single treatment, but in some cases, you may not achieve quality vision initially and need a second surgery, called an enhancement, to sharpen your vision. Patients with more extreme prescriptions are at higher risk for needing an enhancement. This enhancement cannot be performed for many months after your initial surgery to allow for your eyes to heal appropriately from the first surgery and for your eyeglass prescription to stabilize. In some rare cases, you may not be able to have an enhancement if your corneas are too thin or abnormally shaped after surgery. 2. You may still need glasses or contact lenses after surgery to achieve your best vision. This is extremely rare for the average person; however, it is something you should discuss with your surgeon. In addition, if both of your eyes are corrected for good distance vision, you will still need glasses for close work when presbyopia develops as a part of normal aging process. 3. Your results may not be permanent. Although uncommon, some patients do experience a regression of their desired treatment effect many years after the surgery. This is more common in patients with hyperopia, or farsightedness. Those who need reading glasses are especially prone to having changes in their vision after LASIK surgery. If regression does occur, it may be possible for you to have an additional surgery many years after your initial LASIK. 4. You may experience visual aberrations, especially in low light. Visual effects that can occur with LASIK and decrease visual quality include: anisometropia (difference in refractive power between the two eyes), aniseikonia (difference in image size between the two eyes), double vision, hazy vision, fluctuating vision during the day and from day to day, increased sensitivity to light, glare, shadows, and seeing halos around lights. These visual aberrations are extremely unusual; however, they may be incapacitating for some time and may not ever go away completely. 5. Dry eye symptoms may persist or get worse. Most people experience some dry-eye symptoms immediately after surgery. In some cases, people may develop worsening of dry-eye symptoms, such as burning and redness, or even decreased vision, after surgery. This condition is occasionally permanent and may require medication to improve tear production or punctal plugs, which temporarily close off the drainage system for tears. 6. You may lose vision. Rarely, LASIK may result in worse vision that cannot be corrected with glasses or contact lenses. This could result from flap-related complications, equipment malfunction, infection, scarring, or extreme changes in corneal shape postoperatively.