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Schedule an Eye Evaluation to Determine if You Are a Candidate for LASIK

LASIK corrective surgery - Is it right for me?

Schedule an Eye Evaluation to Determine if You Are a Candidate for LASIK

October 7, 2007       Leave a Comment
By: Dr. Lee Newton, Eye Care

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LASIK stands for Laser-assisted in-situ keratomileusis, commonly known and understood as refractive surgery or corrective surgery. Especially lately, there are many variants of the procedure (bladeless, custom, etc.) all with accompanying hype. How do you know if it will work for you? How do you know about the subtle differences between the techniques? We'll explain.

This column is unable to determine your individual candidacy for LASIK, but hopefully it will provide a clearer picture of the procedure, effects on your vision, and types of patients whom are good candidates.

LASIK evolved as part of the natural progression of improvements on the old RK (radial keratotomy) procedure. RK involved making radial incisions in the cornea (front part of the eye) to effectively flatten the cornea and reduce nearsightedness. (For a discussion of nearsightedness and farsightedness, please see the corneal reshaping column in the archives). Although many patients achieved improved uncorrected vision with RK, there were limitations such as stability of the endpoint, experiencing glare afterward, and the accuracy of the endpoint.

After RK, PRK (photorefractive keratectomy) evolved. PRK evolved applying laser energy to the cornea beneath its outer later, the epithelium, to reshape the cornea. In this procedure, the corneal epithelium is removed and allowed to regrow. There is more post-operative discomfort with PRK.

LASIK is a modification of PRK whereby a tiny blade, known as a microkeratome, creates a flap of corneal tissue. This flap is peeled back to expose deeper corneal layers, where laser energy is applied to reshape the cornea and correct vision. Subsequently, the flap is positioned back in place and heals. There is less post-operative discomfort with this technique.

What LASIK can do for you visually is limited by how well you currently see with glasses. For patients with healthy eyes and no medical disorders, the upper limit of vision is your corrected vision with glasses or contact lenses. LASIK cannot do better than that. The goal of LASIK is to reduce your dependence on other forms of correction, not give you "perfect" vision or a "zero" prescription. Most patients do end up with 20/20 vision or very close to that.

For those of you whom are nearsighted (rely on correction to see clearly far away) and also need bifocals for reading correction, there is a very important concept you MUST understand: After LASIK, you will still need to wear some correction for near vision. LASIK, in your case, would ideally produce an endpoint similar to always looking out of the top (distance) portion of your glasses, so you will need to put on reading glasses for intermediate and near vision. The exceptions are the patients that opt for one eye to be corrected for distance and one eye to be corrected to the reading level.

For many occupations, this scenario would not provide adequate binocular vision for sustained clear and comfortable vision. The reason nearsighted patients need to understand this is that they are accustomed to great close vision WITHOUT their glasses, but LASIK changes that. The need for reading glasses subsequent to LASIK still applies to farsighted patients, but they are already used to wearing correction 100% of the time for reading. It is still important to understand that LASIK is not a panacea for all visual conditions. I have talked patients out of the procedure for this reason.

The visual endpoint of LASIK is most predictable and stable for those patients whom are nearsighted, have astigmatism, or a combination of the two. LASIK may be performed on patients with farsightedness or farsightedness with astigmatism, but the endpoint is less stable. This means that statistically, there is a higher chance of the correction wearing off to some degree. But it has been done and continues to be done on these patient types with success.

If LASIK results in a mild over-or under-correction, or happens to wear off a little over time (infrequent but it does happen), an enhancement can usually be performed. The surgeon will locate and lift the original flap, then apply the appropriate retreatment.

The contact lens question - since contact lenses may have subtle to moderate effects on the shape of the cornea, it is necessary for the patient to have not worn contact lenses for several weeks prior to the procedure. For soft contact lens wearers this interval is three weeks. For oxygen permeable, gas permeable, or hard contact lens wearers this interval may be several months or even longer, depending on the duration of lens wear.

(As an aside, many patients have asked me why I have not undergone LASIK surgery - i.e. "If it's good enough for me, doc, why is it not good enough for you to have had it done?" The answer has nothing to do with having LASIK done - but everything to do with not wanting to wear my glasses for several months continuously before LASIK, as I am an oxygen permeable contact lens wearer and have been for 20 years!)

Many factors may potentially make a patient a poor LASIK candidate. Some are:

  • Presence of a systemic medical condition affecting healing - one example is Lupus.

  • A corneal irregularity, dystrophy, or other problem - detected through a pre- operative eye examination

  • A medical eye condition such as cataract or macular degeneration.

  • Significant dry eye or tear film problems.

  • Psychologically unrealistic expectations of the results.

    A prescription that is out of range on the high side (rare, but there are limits) or on the low side (there are also lower limits - but even if a patient is within the accepted range, I have extensive discussions with patients with lower prescriptions to make sure their expectations are reasonable.)

  • Corneal thickness that is insufficient for the correction to be applied. This is measured with an ultrasound instrument at the pre-operative evaluation. If this were true, either 1) the procedure would not be performed or 2) the patient would be given the option of a partial treatment (sounds anti-climactic, but for patients with extremely high prescriptions even this may be a substantial visual improvement).

  • Patients without equal best-corrected vision in each eye - for example, if a patient has a "lazy eye" that sees 20/60 vision while the good eye corrects to 20/20, LASIK is not able to be performed on either eye. This patient should be in safety lenses at all times to protect the good eye.

  • Someone who rubs their eyes a lot (rare, but the flap can be dislodged).

  • Patients who play a high amount of rough, contact sports (same reason)

    There are certainly other reasons, but these are the most common.

    That's it for our introduction. Next week will conclude our LASIK discussion and cover the following topics: Post-operative care, Different variations of LASIK, Price ranges, $299 per eye?, Side effects, Complications, What is the real value of LASIK?, and address any questions our readers have.

    I invite your questions and feedback

    Or Contact Dr. Lee Newton at:
    3720 E. Wilder Road, Bay City, MI
    (989) 667-9393



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    Dr. Lee Newton, Eye Care

    Dr. Lee Newton has provided eye care services in Bay City ever since graduation from professional school. He and his family consider the Bay City area a great place to live, work, learn, and play!

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