LASIK EYE SURGERY
Category: Ophthalmology
Abstract :
lasik eye surgery treatment options / Informed consent : After the exam, the patient and physician discuss treatment options and expectations. Patients who expect to see perfectly after LASIK are usually not considered good candidates because they usually are dissatisfied with the results. Surgeons also discuss how patients will handle presbyopia, which occurs during the patients 40s. LASIK does n
lasik eye surgery treatment options / Informed consent : After the exam, the patient and physician discuss treatment options and expectations. Patients who expect to see perfectly after LASIK are usually not considered good candidates because they usually are dissatisfied with the results. Surgeons also discuss how patients will handle presbyopia, which occurs during the patients 40s.
LASIK does not correct for presbyopia, and patients will need reading glasses to accommodate for reading when presbyopia occurs. Sometimes patients 40 and older opt for monovision to treat presbyopia, where one eye is left untreated or one eye is only partially corrected.
Monovision means one eye is for short-term vision and the other is for distance vision. The doctor will advise the patient of any possible LASIK complications, explain the procedure and answer questions. After deciding on a treatment option, the patient is required to sign an informed consent form.
At this time, payment will also be discussed. Insurance usually does not cover LASIK, although some offer a limited benefit for the procedure. Some laser centers offer payment plans and some physicians have begun using credit companies to handle payments. LASIK can cost anywhere from $999 to $3,000 per eye. The cost varies greatly from surgeon to surgeon. Most of the fees are global, and cover all the pre-operative and post-operative exams as well as the procedure. Patients should be advised of what the fee covers, and if retreatments to the original surgery are included in that price.
lasik eye surgery Pre-surgery preparations : The patient is advised to discontinue contact lens wear immediately and refrain from using creams, lotions, make-up or perfume for at least two days before surgery. Patients may also be asked to scrub their eyelashes for a period of time to remove any debris. Patients also must find transportation to and from the surgery, and also to and from the first post-operative visit. Medication and distorted vision make it unsafe for the patients to drive after LASIK.
lasik eye surgery aftercare : After LASIK, patients may experience burning, itching or a foreign body sensation. They should be advised not to touch the eye as that could damage the flap. Many physicians recommend sleeping after the surgery. Patients may also experience glare, starbursts, or halos that should improve after the first few days. Patients are advised to seek help immediately if they feel severe eye pain, or if symptoms worsen.
The first follow-up visit is from 24 to 48 hours after surgery. The physician will remove the eye shield, check the patients vision, and may prescribe more antibiotic drops or artificial tears. Patients must refrain from strenuous activity, such as contact sports, for at least a month. The use of creams, lotions, and make-up must also be avoided for at least two weeks. Hot tubs and swimming pools should be avoided for at least two months. Patients are advised that refraining from these activities and products will help stem infection and aid healing of the cornea. Patients will have regularly scheduled visits post- LASIK for at least six months. Vision gradually improves the first few months after surgery. In some cases, if the vision does not meet expectations and the surgeon believes it can be further corrected, he will perform an enhancement. Enhancements are usually done for under-correction. Overcorrected patients usually need eyeglasses or contact lenses.
lasik eye surgery risks : Surgeons separate LASIK complications into two categories.
lasik eye surgery intraoperative risks
• Cornea perforation.
This complication has almost disappeared because of advances in microkeratome design.
• Flap complications.
Newer microkeratomes also have reduced the likelihood of free caps, where the cap becomes unhinged. An experienced surgeon replaces the cap after ablation. In some cases, the procedure must be aborted while the eye heals.
• Laser hot spots.
Higher energy surrounding the laser beam can cause irregular astigmatism. Proper laser testing before the procedure eliminates this risk.
• Central islands.
This refers to a raised area in the central part of the treated zone that receives insufficient laser treatment. Any raised area can decrease the laser's effectiveness. The island either shrinks by itself or can be remedied with retreatment.
• Decentered ablation.
This occurs when the laser beam is aimed incorrectly. This can result in permanent halos and ghost images.
Post-operative complications
• Undercorrection or overcorrection.
Undercorrection can usually be treated with an enhancement, but overcorrection will require the use of eyeglasses or contact lenses.
• Debilitating symptoms.
These can be permanent or transient, and include glare, halos, double vision and poor nighttime vision. Some patients may also lose contrast sensitivity.
• Dry eye.
This also can be permanent or transient. Most patients experience some dry eye immediately after surgery. Some patients continue to experience dry eye and are treated with artificial tears or punctal plugs.
• Displaced flap.
Occurs after the eye is hit or rubbed. If immediate attention is given by the surgeon, who must lift the flap and clean under it, no long-term effects occur.
• Nonspecific diffuse intralamellar keratitis.
Commonly known as Sands of the Sahara, this complication can range from corneal haze to eye clouding that resembles swirling sand. It is treated with topical steroids, although severe cases may require eye irrigation.
• Epithelial ingrowth.
The cells of the lower cornea migrate under the corneal cap. The surgeon must lift the cap and remove the cells. If untreated, vision is impaired.
• Striae.
These are wrinkles in the flap that can reduce visual acuity. The surgeon must lift the corneal flap and smooth the wrinkles.
• Photophobia.
Extreme sensitivity to light can last a few days or a week after surgery.
• Infection.
This rarely occurs after LASIK. It is treated with antibiotics.
lasik eye surgery normal results : After LASIK, most patients are able to see well enough to pass a drivers license exam without glasses or contact lenses. Some patients will still need corrective lenses, but the lenses wont need to be as powerful. Because LASIK is a relatively new procedure, there is limited information on long-term regression. If patients are being treated for myopia, they should be aware they will have to rely on spectacles with the onset of presbyopia.
lasik eye surgery morbidity and mortality rates : Information about mortality rates following LASIK is limited because the procedure is elective. Complications that can lead to more serious conditions, such as infection, are treated with topical antibiotics after LASIK. The most serious possible complication from LASIK is blindness from an untreated complication. As of 2000, there had been no reports of blindness-induced LASIK. One incidence of legal blindness was reported after a severely myopic patient had retinal hemorrhages. However, it was inconclusive whether or not LASIK was the causative agent.
Nonsurgical alternatives
Nonsurgical alternatives to LASIK are contact lenses and eyeglasses, which can also correct refractive errors. Continuous-wear contact lenses, which a patient can sleep in for as long as 30 days, can provide the same effect as LASIK if the patient wants good vision upon waking. Orthokeratology involves a rigid gas permeable contact lens the patient wears for a predetermined amount of time to reshape the cornea. After removing the lens, it takes weeks for the cornea to return to its normal shape. At that time, the patient repeats the process.
Corneal rings and implants are another alternative for myopes. These require surgery without lasers and involve a corrective lens surgically implanted in the eye. One of the biggest benefits to these procedures is that they are reversible. However, they may not provide the crisp vision of a successful LASIK. There also are several different types of intraocular lenses being tested to treat myopia and hyperopia.
Surgical alternatives
There also are surgical alternatives to LASIK. They include:
• Conductive keratoplasty. This uses radio frequency waves to shrink corneal collagen. It is used to treat mild to moderate hyperopia.
• Photorefractive keratectomy (PRK). PRK also uses an excimer laser and is similar to LASIK. However, in PRK, the surface of the cornea is removed by the laser. PRK patients have a longer recovery time and may need steroidal eye drops for months after surgery. Its success rate is similar to that of LASIK.
• Radial keratotomy (RK). RK was the first widely used surgical correction for mild to moderate myopia. The surgeon alters the shape of the cornea without a laser. This is one of the oldest refractive procedures, and has proved successful on lower and moderate corrections.
• Astigmatic keratotomy (AK). AK is a variation of RK used to treat mild to moderate astigmatism. AK has proved successful if the errors are mild to moderate.
• Laser thermal keratoplasty (LTK). LTK was approved as to treat hyperopia in 2000. An LTK patients vision is overcorrected for one to three months, and the effect of improved near vision may diminish over time as distance vision improves. Some regression has been noted.
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