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LASIK Surgery - What to Expect

Reviewed By:
Dr. Gary Kawesch

Before Surgery

Before Surgery

One of the interesting aspects of LASIK surgery is that the procedure takes about ten to fifteen minutes; where as the prepping and post-operative care can take months. After finding the right surgeon, there are several steps every patient should take, including a baseline evaluation to determine candidacy, before the surgery takes place.

Baseline Evaluation

Prior to your baseline evaluation, patients wearing contacts should remove them and switch to glasses. The reason for this is that contact lenses may change the shape of the patient's cornea. Leaving the contacts on for too long can result in poor corneal measurements, which may delay the procedure, or in some cases, mask corneal irregularities which help determine candidacy.
Different types of contact lenses will mean different lengths of time for removal.

• Hard Contacts: Stop wearing them a minimum of 4 weeks before the baseline exam.
• RGP/Toric lenses: Take them out 3 weeks before the baseline exam.
• Soft lenses: Remove them one to two weeks before the baseline exam

Eye Examination

The surgeon will need to examine and measure your eyes. Expect the exam to include the following measurements:

• Corneal thickness – Patients with thin corneas may not qualify for standard LASIK surgery. The surgeon needs to know whether there will be enough of your cornea left once the flap is cut and reshaped. If you do have thinner corneas and cannot have traditional LASIK surgery, alternative methods are still available.
• Topographic map of the cornea – This will also detect astigmatisms and irregularities.
• Size of your pupils – Patients with larger pupils may be more subject to glare or haloes than patients with smaller pupils, though this is controversial—several studies actually show no relation between pupil size and side effects.
• Vision - This will determine whether your eyesight falls into the range where it can be fixed by the Excimer laser or not.
The FDA has approved various manufacturers of Excimer Lasers each with a particular approved range of correction:
• Myopia (nearsightedness) up to -12.00D (D=Diopter) with up to -6.00D astigmatism.
• Hyperopia (farsightedness) between +1.00D and +6.00D with up to 6.00D astigmatism.

The surgeon will also examine your eyes and review your medical history to make sure you are an appropriate candidate for surgery.

They will look for:
• Dry eye
• Corneal scarring or other irregularities
• Cataracts
• Other eye Diseases/Disorders
• Other aging changes of the eyes such as presbyopia

Some of these may delay the procedure, some may cause your surgeon to recommend a procedure other than LASIK to get the best and safest results, and some may disqualify you altogether as a candidate.

Questions:

What your surgeon will likely ask is:
• General questions about your past and present health and medical history.
• General questions about your past and present eye health and history.
• Questions about medications (prescribed or over-the-counter) which you are taking or have been taking. This will also include, if it hasn't already, questions about allergic reactions to medications.

They will also discuss the process; making sure you understand each step and asking what your expectations are about the procedure.
You should have questions for the surgeon ready regarding the procedure.

Consent

Once the eye exam and the discussions are over, the surgeon will ask that you sign an Informed Consent Form. An Informed Consent Form is a legal document which states the patient has given consent based on an understanding of facts regarding the risks, benefits and alternatives of LASIK surgery.

If you have weighed all the pros and cons of LASIK surgery and are confident that this is the correct decision then signing the form makes perfect sense. If not, then wait. There is no rush to have LASIK surgery and every patient should be confident that the procedure is correct for them. Although no surgeon will proceed with surgery without a signed consent, the informed consent document is not simply a formality—it is meant to be an educational document and should be read and understood prior to surgery.

Surgery

A day or two before the procedure, stop using:
• Creams
• Lotions
• Makeup
• Perfumes

You should also give the outside of your eyes, including your eyelashes, a good scrubbing. The reason for this extra attention is that residue from any creams or makeup increases the risk of post-operative infection.

You should also secure a ride to and from the procedure. This is not the time to take your new eyes out for a ride as your vision may be blurry right after the surgery. Arranging a ride for the first post-op visit also makes sense as the appointment is usually scheduled for the day after the procedure, and there is a chance the vision could be blurry. That being said, nearly all patients are able to comfortably drive the day after their LASIK surgery.

The Procedure

Before the procedure begins, you may be given a mild sedative, possibly valium. This is not done with everyone but it is another good reason to have a friend along as your post-operation chauffeur.

The doctor will have you lie down in a special chair and position your eye under the laser.

Here are the steps to your LASIK surgery:

STEP ONE – Preparing your Eye

• You will be given eyedrops to anesthetize the eye.
• Your eyelids will be held open and then a suction ring will be applied to the eye,creating suction to the cornea. Expect your vision to blur or even go dark, and there may be some discomfort or pressure sensation.

STEP TWO – Creating the Flap

• The next step is for the surgeon to create the flap. This is done in one of two fashions: Microkeratome (an oscillating blade) or laser (referred to as All-Laser LASIK or IntraLase LASIK). There are arguments for both, but your surgeon will use the tool they feel most comfortable with.
• Once the flap is created (a hinge is left on one end) it will be folded out of the way. There may be a little discomfort.

STEP THREE – Removing tissue

• The laser will be positioned over your eye, you will be asked to focus on a light and the surgeon will start the laser.
• You'll likely feel no pain, might hear a slight clicking noise and possibly smell burning hair. The laser has been programmed to remove only the amount of tissue based on the earlier measurements.

STEP FOUR – Finishing the procedure

• Once the tissue has been vaporized the flap is repositioned and smoothed.
• Your surgeon might place a temporary “bandage” contact lens on the eye.
• A shield is placed over your eye to protect the flap.
• After a short wait, the surgeon will then start on your second eye.
• Protective eye shields or sunglasses will be placed over your eyes, and you will wear these home.

After Surgery

After the procedure there will be a short resting period and then you'll be cleared to go home. The surgeon may prescribe medication for pain and antibiotics to control infection. Your eye may burn or itch immediately after the procedure, unless it is severe, this is quite normal.

Other short-term irritations to expect:

• Mild pain and discomfort – up to three days
• Burning – up to three days
• Tearing or watery eyes – up to three days
• Light sensitivity – up to one week
• Hazy or blurred vision – up to one week
• Dry eyes – up to several months
• Glare – up to several months
• Fluctuating vision – up to six months

You will be tempted to rub your eyes. Don't! Rubbing may cause the flap to dislodge or tear. Most surgeons recommend no eye rubbing for one month.

Everyone wants to return their life to normal as quickly as they can. And while it is a quick and relatively painless procedure there are many precautions about what to do after LASIK surgery.

Here's how long to expect to wait before doing these activities:

• Work – up to three days (getting surgery on Friday will allow you to have the weekend to recover), though most patients do return to work the next day.
• Wearing makeup or lotions – up to two weeks
• Non-contact sports – up to a week
• Contact sports – one month
• Wearing eyeshield at night – one to several weeks
• Swimming or any water sports – several weeks to months

Expect to see your surgeon within the first day or two after surgery. They will examine the eye, test your vision and ask you about any complications. Expect similar visits after a week, month, three months and six months.

If you have any complications that go beyond what's been advised by your surgeon, do not wait for your next appointment. Call them immediately.




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