Lasik (Laser-assisted in situ keratomileusis) is a form of refractive surgery that involves the creation of a corneal flap by the use of an excimer laser beam for the reshaping and ablation of the midstromal tissue of the eye. The procedure is performed by a trained ophthalmologist to surgically realign the cornea in eyes. The primary purpose of this surgery is to remove the need for corrective lenses or glasses.

Overview

Lasik surgery is a procedure to change the shape of corneal flap (main front flap of the eye) for better vision. The Lasik surgery for eyes uses a tool called a Microkeratome, to cut the main flap, then an excimer laser readjusts the tissue of cornea below the flap. After the adjustment of tissue, the flap is then again joined back by the use of an excimer laser. The main conditions this surgery corrects are:

a) Farsightedness: This is a common condition in which the vision is affected in such a way that one sees the distant objects clearly but the nearby objects seem hazy. This condition develops over time, initially affecting the near vision and then at a later stage of life, the distant vision. Lasik surgery can be a good option in this case in lieu of glasses or contact lenses.

b) Astigmatism: In this type of abnormality, the overall vision of the eyes is blurred, both near or far vision. This condition can benefit from Lasik surgery in order to repair the uneven surface of cornea. While contact lenses are beneficial in terms of correcting the blurred vision, in order to make the curvature of cornea in the correct shape, Lasik surgery is recommended.

c) Nearsightedness: This is the case when you see near objects clearly and the objects far away are blurry. This normally occurs if the cornea has sharp edges and light rays falling on the retina make the distant object blurry. Lasik can be a good solution.

Can you see right after Lasik?

Generally it takes about 5 to 10 hours for most of the patients to have shown improvement in their vision. This has improved due to the Lasik technology's continuous improvement.

Many people have reported to have satisfactory results even decades after surgery. In most of the situations, people enjoy the normal life activities many years after surgery.

As all parts of body naturally age, it is expected that vision will eventually degrade and the patient may feel the need for glasses or contact lenses at night or most environments, again. This is due to the refraction of the eyes that may start degrading again and cause low sight in dim lighting situations.

It is important that the patient allows time for the eyes to heal and take proper care of eyes during the recovery period just as with with other surgical procedures.

Lasik surgery: Is it right for you? 

Eye diseases:

It is best you take an informative decision before proceeding for Lasik surgery for your eyes. Your surgeon will ask you about some of the following problems you may currently have, which may lead to complications after surgery.

Keratoconus: This is a continuously advancing disease that can appear at any stage of life and even hereditary. It is best to avoid surgery with this disease due to the thinning of cornea.

Glaucoma: This is a disease in which the main optical nerves are damaged and require repairing to maintain pressure within the eye. The surgeon may not recommend Lasik, but cases vary from one to another.

Lid disorder: The opening and closing of eye lids is carefully examined as it may lead to complications during the surgery.

Large pupils: If you have large pupils that may lead to more complications such as glare after surgery. This will happen because the refractive lights will not be distributed through the cornea creating multiple light spots instead of one.

Dry eyes: It is a condition in which ample lubrication is not adequately available for eyes. This occurs in the absence or low quantity of tears. It depends upon the case, but if the risks are low, the Lasik surgery can be performed. However, it may take 5 to 10 months to fully recover from dry eyes.

Commonly occurring Diseases:

Commonly occurring diseases can also affect your decision to whether go for Lasik surgery. You have to decide based upon your normal reading habits and use of complete vision. If you have a high refractive error, the Lasik surgery will not be recommended and for a low refractive error, you can add glasses and contact lenses to when needed.

Sportsman: If you are in sports and have the need for doing physically challenging sports like martial arts, you need to only get contact lenses as surgery is not recommended in this case.

Diabetes: Surgery is only recommended if in the past three months the blood sugar levels are in normal range. If the blood sugar levels are elevated or at extremely low ranges, the surgery may become difficult and the recovery period may last many months.

Auto-immune disorder: If you are taking any kind of medication that helps your immune system, and your auto immune system in not working properly, you will be exposed to multiple diseases after the surgery.

What should I do before Lasik surgery?

Stop wearing contact Lenses:

The first thing to do right after your decision to go through with the surgery is to remove the contact lenses before your operation. In order to carry out the daily life, start wearing glasses at all the time. The cornea will take few to several weeks in order to regain its natural position after you switch to glasses. This is required so that the accurate dimensions can be taken before the surgery. The correct time for switching to glasses will be confirmed by your eye surgeon, but  normally four weeks are required before you go for initial measurements. Your surgeon will guide you to all the necessary pre-operation drops or antibiotics you may need for the day of surgery. 

Medical History:

It is really important that you describe the true history of your eyes to your surgeon for him to better decide your candidacy for this procedure. Be sure to describe all the drops, medications and eye test you have taken over the past years. Always discuss with one or more surgeon, to get a better idea of the problem and evaluate your decision against any other alternatives to Lasik surgery. It is best to discuss realistic results with your surgeon as well, in order to avoid any misconception.

General Health:

It is recommended that you drink lots of water to keep your skin hydrated at all times.

Arrange for transportation for yourself for the return from the hospital to your home as you will not be able to go through with driving on your own right away.

It is best you do not use any chemical fragrances, lotions, eye makeup or cosmetics before surgery as it may complicate the procedure and increase the risk for more infections after surgery.

It is best you wash your eyes with water before the surgery.

What tests are done before Lasik?

Before the Lasik surgery, your candidacy for the surgery is evaluated through a series of following tests.

Dilation test: In this process, the eye is dilated in order to clear the eye completely. This allows the doctor to see more clearly. The process takes place in a few hours during which the dilation process is repeated until the corneal thickness is visible and the refraction can be measured by machine. The pupil size is also checked during the exam. After this test, the vision will be blurry for 6-10 hours and its best to avoid bright lights during this time. 

Corneal topography: This test is performed in order to further evaluate the eye for the refractive error. The main purpose is to know the stability and time period for the refractive error, which should be more than 12 months. A topographer is used during this process which further takes the measurement of the curvature of the cornea for the main surgery. If the cornea is too thin, the patient becomes ineligible as it requires other laser eye operative procedures for satisfactory vision. 

Wavefront analysis: Wavefront analysis of the cornea is considered the final verdict of the exam, as it takes into account the refractive errors and wavelengths. In normal situations, the surgeon has to rely on the answers of the patients to see how well they see. But with the help of wavefront analysis, the patient suggestion is no longer needed. This analysis makes a blueprint for the cornea and makes suggestion to correct the errors during the surgery, hence it gives a more reliable approach towards analysis.

Complications of Lasik surgery:

After the Lasik surgery, the following complications may be expected. While most side effects are minor, very rare sight threatening cases have been reported. Also, if your age is above 40, the chances of these complications increases, in which case your surgeon may recommend simply wearing contact lenses. But, the overall reception of Lasik surgery has been very positive.

Flap Issues: The main operation in surgery is the creation of a thin flap above the cornea which is hooked and replaced after the Lasik surgery is complete. The flap, when fitted back to the cornea, may form wrinkles above the cornea. These microscopic wrinkles ‘striae’ will create problem in proper vision further so it has to be perfectly placed back. These complications are in a minor occurrence and it can be further reduced by choosing an experienced eye surgeon. 

Epithelial ingrowth: The cells above the cornea and below the flap grow inside creating disturbance in vision and causing blurry sight. In this case, another surgery is required to correct the flap position and removal of the cells.

Dry eyes: This problem can occur in few cases as well where the lack of tears can cause friction between the eyes causing blurred vision. This problem is usually tackled by use of eye drops or other methods to keep the eyes lubricated. After  recovery from surgery, the dry eye condition is expected to be resolved.

Low light low vision: An ablation which is out of center from the eye can cause low vision during the night times after the surgery. These occur due to remaining refractive errors in the cornea or due to incorrect measurement of the blueprint of cornea from the topography. If the aberration is too high, re-treatment using the topography is recommended.

In many cases the main purpose for the Lasik surgery is to provide relief from wearing glasses and contact lenses but in some cases due to some of the above-mentioned complications, you may have to temporarily wear glasses, again.

Frequently asked questions about Lasik Surgery:

1. Is Lasik surgery painful?

The Lasik surgery is not painful. Due to the numbing eye drops, you will not feel any pain during the surgical procedure.

2. Can Lasik go wrong?

Rare long term side effects include infections and chronic pains. More common complications  are glares and halos.

3. Can I watch TV after Lasik?

It is totally normal to view TV followed by some rest. It has been observed that the mobile screens may cause irritation if used right after the procedure, so it is best to wait a few days before you use mobile devices.