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A Guide to Laser Vision Correction

Dr. Robert Maloney believes that a well-informed patient is key to successful vision correction surgery. He wants to be sure that you fully understand what you can expect from your procedure you choose.

He wants to help you care for and preserve your eyesight in the best way possible. Here, you can find the information that you need to help you make informed choices about health care for your eyes.

Your Consultation

Common Questions About LASIK

LASIK surgeons are accustomed to having patients ask questions. Part of the physician's role is to educate you as thoroughly as possible. Many LASIK centers offer written material designed to address your questions. Other LASIK centers show short videos that explain the procedure in detail. However, if you still have questions, or just want to discuss any reservations or fears, the consultation is the best time to do it.

Is LASIK Painful?
No. Before the procedure begins, your eye is numbed with eyedrops. You may feel a slight sensation of pressure as the corneal flap is being made, but the procedure should not hurt at all. After the surgery, any discomfort you experience will last only a few hours. Sleep and lubricating eyedrops, as well as acetaminophen or ibuprofen, are usually enough to take care of any discomfort.

How Long Does the LASIK Procedure Take?
Most patients are pleasantly surprised at how quickly LASIK is performed. Expect an experienced surgeon to complete the procedure in five to ten minutes per eye.

How Long Will It Take for My Eyes to Heal?
The healing process is remarkably fast, with few associated side effects. Most postoperative discomfort and visual side effects are quite minor. You may notice a burning sensation and may experience watery eyes in one or both eyes for a few hours after surgery, but usually by the very next day, you should not have any significant eye discomfort. The most common discomfort that sometimes persists is dry eye. This occurs because the nerves in the cornea are temporarily altered when the corneal flap is made during the procedure.

=Symptoms related to post-LASIK dry eye are usually minor, can be alleviated with lubricating eyedrops, and generally disappear within two to six months. In terms of visual acuity, most patients notice good vision the day after surgery. Visual clarity and crispness after LASIK tends to improve for two to six months and then stabilizes.

What Results Can I Expect?
Results vary. Finding a skilled and experienced surgeon maximizes your chances for the best possible outcome. However, with higher degrees of myopia, hyperopia, and astigmatism, results are less predictable and enhancement procedures are more common.

How Long Will the Correction Last?
Once your eye has stabilized, usually in two to three months, your correction is permanent. If you eventually need eyeglasses for reading after that, it would be the result of the normal aging process.

What about Risks and Complications?
It is not unusual for people considering LASIK to experience fear, nervousness, and uncertainty at first. Most patients feel a lot better about the procedure once they become fully informed. Knowing the statistical improbability of a serious complication goes a long way toward relieving your fears.

=Your doctor should inform you about the risks and potential complications associated with LASIK, ranging from very minor, short-term discomfort to serious complications, which are rare. He or she should also explain what you can do to avoid some of these risks. Fortunately, the incidence of serious complications is low in the hands of a competent surgeon.

Will I Be Able to Drive Immediately after LASIK?
State departments of motor vehicles typically grant unrestricted driving privileges to people with 20/40 or better vision. More than 90 percent of all patients who undergo LASIK have this level of vision or better the day after surgery.

When Can I Go Back to Work?
Most patients can return to work the day after their LASIK procedure. If you work in a very dusty environment, such as a construction site, wait a couple of days before going back to work.

=Although most patients can function normally at work the day after surgery, your vision may still be somewhat blurry and your eyes may be occasionally irritated, so we recommend that you not schedule any critical appointments or meetings for that day.

Will I Need Enhancement Surgery?
About 10 percent of LASIK patients require enhancement procedures. For example, if an eye is undercorrected or overcorrected with LASIK, you can undergo an enhancement procedure. Even in the hands of the most skilled surgeon, each person's tissue responds differently to the excimer laser, both during the surgery and while healing. If you do need an enhancement procedure, you must wait for your eye must stabilize, which usually takes three to six months after the original surgery.

=When an enhancement procedure is performed, the corneal flap will not need to be re-created. Instead, the surgeon, using a specialized instrument, gently lifts the preexisting flap and performs the additional laser treatment. Recovery time is similar to that of the original procedure. You may or may not be charged an additional fee for such enhance ment surgery. Keep in mind that enhancement procedures can also be performed years later if your eyesight changes over time.

If I Have Dry Eyes, Will It Affect My LASIK Surgery?
Many patients consider LASIK because they have dry eyes and cannot wear contact lenses. If you have significant dryness, your doctor may recommend treatment before surgery. Tear supplements and punctum plugs (tiny silicone plugs placed in the tear drainage openings of your eyelid) should keep your eyes moist.

=After LASIK, your eyes may feel drier. This condition typically improves from one week to six months after surgery. Symptoms of dry eyes can be particularly noticeable if you use a computer frequently, read for long periods of time, or drive extended distances. For many patients, it is useful to use lubricating eyedrops often, especially for the first few weeks after surgery.

=If you have external eye diseases such as meibomitis (inflammation of the inner lid) or blepharitis (debris at the base of the eyelashes), your doctor may want to treat these conditions prior to a laser vision correction procedure.

If I've Had Previous Eye Surgery, Am I Still a Candidate for LASIK?
Patients who have had certain types of eye surgery are sometimes candidates for LASIK as a second procedure to improve their vision. How ever, these are often more difficult surgeries and have less predictable results.
For example, LASIK has been used following an older form of refractive surgery, radial keratotomy (RK). With RK, the cornea is flattened by making small, spokelike incisions around its periphery to correct myopia and astigmatism. LASIK following RK can succeed as long as the patient's vision is relatively stable and there is no significant corneal scarring or epithelial debris in the incisions.

Patients who have had a corneal transplant can have a LASIK procedure to enhance results. This is especially effective for those who developed a high degree of astigmatism caused by the surgery. A clear corneal transplant will allow good vision only if it has a relatively round surface. Laser vision correction can smooth out astigmatic curves in the cornea.

If I Have Thin Corneas, Am I Still a Candidate for LASIK?
You may be if you have a mild refractive error. If your cornea is thin, removing the amount of tissue necessary to correct your vision may weaken your cornea. A careful surgeon will calculate the amount of tissue removed to ensure your cornea is not weakened. If too much tissue will be removed, the surgeon will recommend PRK or an implant able contact lens instead.

Can I Wear Contact Lenses after Surgery, If Necessary?
After surgery, if you still need correction in one or both eyes, you may elect to wear contact lenses. With LASIK, you may wear contacts within a few weeks. If you had no previous problems with contacts before LASIK, it is doubtful you will have problems afterward. Realistically, however, rather than returning you to contact lens wear, your surgeon will likely recommend an enhancement to sharpen your vision.

Could the Surgery Cause Problems Years from Now?
The chance of problems years down the road is very unlikely. LASIK is a form of lamellar refractive surgery, a type of surgery that has been performed since 1949. It's important to know that patients who have undergone earlier types of lamellar refractive surgery-much less accurate and more invasive than LASIK-have not developed any unusual problems during the past fifty years.

Will Having LASIK Prevent Eye Diseases?
No. LASIK does not prevent cataracts, glaucoma, retinal detachment, macular degeneration, or any other eye disease. Eye doctors refer to LASIK as disease neutral. That is, LASIK does not prevent diseases, and if you are diagnosed with a disease in the future, LASIK will not affect its treatment.

Are There New Developments I Should Know About?
Most doctors keep up with the latest technology and research in their field. Some attend conferences and lectures. Others immerse themselves in a lifestyle that includes lecturing, writing journal articles and textbooks, participating in clinical trials for new technology, and consulting for ophthalmology companies. Find out if there's any news that might impact your decision to have LASIK surgery.

Should I Have Both Eyes Done at the Same Time?
Some patients choose to have one eye treated at a time, because they worry, "What if something goes wrong?" These patients can have the other eye done as soon as a week later. However, our practice as surgeons is generally to do both eyes on the same day. We are extremely confident about the safety of LASIK, and none of us have had a patient lose vision in either or both eyes from the procedure. Having both eyes done together avoids making two trips to the surgery center and speeds the recovery. Correcting the eyes on separate days leaves you with an interim period of imbalanced vision during which only one eye is corrected. In the end, the choice is yours, and you should feel no pressure to do it one way or the other.

What is Monovision?
For monovision, the surgeon corrects one eye for seeing at a distance and the other eye for near vision, thereby reducing the need for reading glasses. When both eyes are functioning together, the brain naturally selects the image from the eye that has the clearer focus. Monovision is similar to stereo sound, where each ear hears a slightly dif ferent pattern of sound, but the brain synthesizes it into a sound field. Having eyes for different purposes might sound unsettling, but many patients do quite well with monovision.

You may wish to discuss monovision with your surgeon if you are in your forties or older. As mentioned earlier, patients approaching middle age begin to develop presbyopia, or difficulty with their fine (close-up) focusing. Patients over the age of forty who have both eyes corrected for distance with LASIK will still eventually need reading glasses to see nearby objects.

Disadvantages of monovision include some loss of depth perception and the possibility of impaired night vision. Monovision may not be a good option for people in certain professions-airplane pilot, bus driver, or professional athlete, for example. Some people also find monovision difficult to get used to. Discuss it with your doctor. He or she may be able to show you with contact lenses what monovision would feel like before you have to make a firm decision.

If you do try monovision and do not like it, you can have an enhancement procedure to make the vision in both eyes equal. Ideally, though, it would be better to make this decision beforehand, to avoid an additional procedure.

Informed Consent »

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