THE MAINSTAY LASER EYE SURGERY FOR REFRACTIVE ERRORS
What is LASIK?
LASIK is the acronym for Laser-Assisted in Situ Keratomileusis, a type of refractive laser eye surgery performed by ophthalmologists for correcting myopia, hyperopia, astigmatism, and most recently, presbyopia.
What eye conditions does LASIK treat?
Most people know that LASIK laser eye surgery can help them to get rid of their glasses. Now, however, laser eye surgery is not the only option for people who are frustrated by their glasses.
Two structures focus light onto the back of the eye and create a clear image – the cornea and the lens. The cornea is the rigid window at the very front of the eye, and it is the cornea, which is sculpted in laser eye surgery. The lens is suspended inside the eye. For those patients that might have early signs of cataract, we might recommend lens replacement surgery to exchange the refractive lens in the cornea with an artificial lens.
Who is suitable for LASIK?
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How does LASIK work?
Today, most advanced laser eye surgeons perform blade-free LASIK using a femtosecond laser.
The LASIK eye correction surgery begins with anaesthetic drops applied to numb your eye and prevent pain during the procedure. A lid speculum is placed in the eye to hold the lids apart for the procedure, eliminating possibility of blinking. The cornea is marked with water-soluble ink to guide replacement of the flap.
The suction ring is placed on the eye and your vision will go dark for about 20 seconds. A precise flap-making instrument, the microkeratome is used to create a thin flap of the corneal tissue. The eye surgeon raises the epithelium layer of the cornea to expose the portion beneath and is lifted and reflected to the side.
Blade-free femtosecond LASIK or ‘all-laser LASIK’
While conventional LASIK is a safe and effective procedure, many patients prefer the idea of blade-free LASIK. Many clinics market blade-free LASIK as ‘IntraLASIK’. With that said, femtosecond laser manufacturers often claim that femtosecond lasers can reduce complications and improve accuracy of treatments.
At The Custom Vision Clinic, blade-free femtosecond LASIK is the standard of care.
Is laser eye surgery safer than contact lens wear?
Advantages and disadvantages of LASIK
Advantages of LASIK over other procedures
- Quick healing (driving vision the next day in most cases)
- Little chance of haze
- Enhancements can be easier
- Generally back to work or school within 48 hours
- Generally able to drive a car within 24 hours
Benefits of LASIK to the laser eye surgery patient
- Vision correction
- Minimal healing time
- Maximum convenience
With LASIK eye surgery the healing process is significantly reduced, in comparison to surface laser eye surgery, patients can typically return to routine work and leisure activities within a couple of days of treatment. In addition, vision correction is virtually instantaneous (the so-called “wow effect”) and both eyes can usually be treated on the same day.
Disadvantages of LASIK against other procedures
LASIK is one of the most successful surgical procedures invented. With that said, it’s not right for everyone. Here are some examples:
- Patients with thin corneas
- Patients with chronic dry eyes
- Patients who engage in contact sports or dangerous work
In the past we might have recommended surface laser eye surgery to people with thin corneas because these procedures are less invasive and leave more corneal tissue intact. Today, however, we offer ReLEx SMILE ™ to these patients, which enables us to perform keyhole laser eye surgery.
- Patients who have very severe hyperopia, myopia or astigmatism
- Patients with presbyopia (ageing eyes)
- Patients who have early signs of cataract
For these patients we may recommend lens replacement surgery to remove their natural crystalline lens to exchange it for an artificial lens. This lens can be specifically chosen to correct your refractive error (including astigmatism) or conditions associated with ageing eyes (presbyopia and/or cataract).
Patients with keratoconus or other contra-indicated conditions
For some patients, certain pre-existing eye or other conditions make any type of laser eye surgery an unsafe option. For patients with keratoconus, we might recommend corneal cross-linking or Kerarings ™ to halt the progression of keratoconus.
Options and alternatives to LASIK
The most common alternative to LASIK is to remain wearing spectacles or contact lenses. Surgical options of laser eye surgery include:
Frequently asked questions about LASIK
LASIK eye surgery involves raising a thin protective flap of epithelium and stroma from the cornea and applying the laser treatment beneath this. The flap is then repositioned. PRK is a form of surface laser (as is LASEK or epi-LASIK). In surface laser, the epithelium only is removed and this has to grow back after the laser has been applied. LASIK and surface laser are equally effective, but surface laser takes longer to settle down.
Laser eye surgery is one of the safest surgical treatments around. There are possible risks with any technique and we encourage you to discuss these with us. The risk of complications is less than one percent. In the rare circumstance that a complication occurs there will be a treatment to correct that complication. It is worth knowing that patients who have a complication at other laser clinics are referred to Mr Ball to have the complication treated. It is also worth knowing that there is a higher risk of infection from contact lens wear than there is from laser eye surgery.
There is no pain during laser eye surgery, although some patients may experience mild discomfort or a pressure sensation during their procedure. After LASIK you might experience mild grittiness and watering for the first 12 hours or so after your procedure. Surface laser patients experience more post-operative discomfort for three to five days while the epithelium heals.
Further information about LASIK
MORE USEFUL INFORMATION
Read more about laser eye surgery
New refractive surgery guidelines from The Royal College of Ophthalmologists, together with patient information on Laser Vision Correction, Phakic Intraocular Lens Implantation, Refractive Lens Exchange and a Checklist for patients will be published in April 2017. Click here for more information
Take this checklist to your consultation with your refractive surgeon performing the procedure. Discuss each item with your surgeon to help you make the decision that is right for you before having
refractive surgery. Click here for more information
The Royal College of Ophthalmologists’ Laser Vision Correction Patient Information booklet (PDF). Click here for more information
SMILE corrects myopia and astigmatism, or a combination of both refractive errors with only a very small incision at the corneal surface. This high-precision procedure is the latest development in the refractive laser treatments. Includes videos, treatment steps, and questions and answers.
Click here for more information
LASIK treats refractive errors by folding away the top layer of the eye and re-shaping tissue underneath. If a femtosecond laser is used, this type of procedure is called Femto-LASIK. Includes videos, treatment steps and questions and answers. Click here for more information
PRK/LASEK procedures remove a thin cell layer from the top of the eye so the laser can reshape the underlying cornea. This surgery may be an option for those who are not eligible for LASIK or those who look for the most economic option for refractive laser surgery. Includes videos, treatment steps, and questions and answers. Click here for more information
About the author
Mr James Ball | Consultant Ophthalmic Surgeon
MA (Cantab) MB BChir FRCOphth CertLRS
I am a Consultant Ophthalmic Surgeon at Custom Vision Clinic, St James’s University Hospital, and Nuffield Hospital. My major interest is in refractive surgery and finding the best treatment suitable for each patient.