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Refractive Eye Surgery
Is It For You?
You've heard of LASIK on the radio or TV, and the promise of getting rid of
your glasses or contact lenses is certainly appealing. Who doesn't want
20/20 vision? The latest technology has improved methods for corrective eye
surgery, and about one million Americans per year are opting to undergo the
knife - or laser - to see more clearly. However, it is best to have clear
vision about these procedures before you agree to undergo refractive eye
surgery.
What are the differences between the procedures?
LASIK (Laser-Assisted In Situ Keratomileusis)
Used for the most severe eye issues, LASIK involves a knife called a
microkeratome and a laser. The doctor makes a circular incision on the
surface of the cornea, leaving one side attached to create a flap. He lifts
up the flap to use the laser to remove the targeted tissue, then the flap is
replaced.
More recent technology has replaced the manual knife with a laser to cut the
flap, which cuts down on complications and errors. Since the equipment is
expensive, the price of LASIK surgery will depend on what kind of equipment
will be used. With LASIK, the patient usually experiences a faster recovery
time than with PRK, and can see well enough to drive home afterwards.
Because of the faster recovery time, and new technology making it safer,
LASIK is currently the more popular procedure.
PRK (Photorefractive Keratectomy)
This procedure uses computer-controlled ultraviolet beams of light,
targeting specific areas on the surface of the eye. By removing tiny
amounts in specific places, the cornea is gently reshaped.
Refractive eye surgery is an outpatient procedure. It is painless with an
eye drop anesthetic, though some patients experience a scratchy feeling.
The actual surgery usually only takes a few minutes. Following surgery,
patients are cautioned not to rub their eyes, but otherwise normal activity
can resume.
RK (Radial Keratotomy)
RK is an older procedure. The surgeon uses a calibrated diamond scalpel to
make manual radial incisions in the cornea, causing the change in pressure
to flatten the cornea and alter refraction. After RK surgery a patient can
experience a longer recovery time. People who have undergone RK and are
still experiencing eye problems are sometimes not qualified for other
corrective eye surgeries.
Who is a candidate?
A consultation with an ophthalmologist is the best way to determine whether
corrective eye surgery is best for you. These procedures were most commonly
performed on people with nearsightedness (myopia), but other conditions are
treatable as well. The following guidelines will help you know if you will
make a successful candidate. These lists are not complete, but will help
you decide whether to make a phone call for an appointment.
You may qualify if:
You are 18 years or older.
You have had stable vision for at least a year.
You have suffered no eye infections or injuries in the past year.
The corneas in your eyes are free of scarring.
You do not have an eye disease (refractive issues are considered disorders)
Your eyes are free of retinal problems
Your pupils do not dilate beyond 7 mm in the dark.
You have realistic expectations of the procedure and understand the risks
You probably will not qualify if:
You are pregnant or nursing
You have an autoimmune disorder, such as Lupus or Sjogren's Syndrome
You are taking Accutane, Cordarone, or Imitrex
You have a history of eye infections due to the herpes virus
You have dry eye syndrome
What are the risks?
The following are only some of the risks following refractive eye surgery.
Some risks are more common with either the LASIK or PRK procedures.
Infection - An infection in the cornea will only mean a longer healing
period, but it will not affect the outcome.
Undercorrection or Overcorrection - It is difficult to determine beforehand
how an individual's eye is going to react to surgery. Like focusing a
camera lens too close or too far from the subject, the surgery might either
go too far (overcorrection), or not far enough (undercorrection), requiring
more laser treatments, or the use of glasses or contacts.
Loss of Vision - Not blindness; in short, the patient's vision is worse than
before the surgery.
Corneal Haze - Most patients experience some haze after surgery, but
excessive haze may need another laser treatment.
Halo Effect - This can interfere with night driving. The halo effect
commonly goes away within a month, but might require glasses or an
additional treatment.
Flap issues (LASIK only) - After the surgery, the flap which the surgeon
cuts to target the cornea could melt, dislocate, or wrinkle, requiring
surgical treatment. When computer-operated lasers are used instead of a
manual instrument, flap-related complications are significantly reduced.
Dry eyes - This is the most common side effect which can last up to six
months. Dry eyes can be treated with medicated eye drops.
After surgery and healing, a patient may still have to wear glasses or
contacts some of the time. Even those who obtain perfect eyesight after
surgery may later need glasses for reading as they age.
What can you expect before, during and after the procedure?
Contact lenses change the shape of a cornea, so you should not wear them for
several weeks before the baseline evaluation, in which the doctor will take
measurements for the surgery.
You should not use makeup, lotion, aftershave, or perfume on the face or
eyes the day before surgery.
Because the doctor will probably prescribe a relaxant for the day of the
surgery, it is best to arrange for someone else to provide transportation to
the clinic. After surgery your vision will be blurry, so it is essential to
arrange for a spouse or friend to help you get home.
The surgery normally takes about half an hour. You can expect some mild
discomfort and pressure during the surgery.
After the surgery, the eye might feel itchy, burning, or like something is
in it. A shield is used to protect the eye from accidentally rubbing it, and
will need to be worn at night for at least a month afterwards. You should
also plan to:
Take two-three days off from work to recover
Stay away from all sports for the first three days, and all contact sports
for four weeks
Stay out of pools or hot tubs for two months
Wear no eye makeup for two weeks
You will have to determine if the potential visual freedom gained from
refractive eye surgery is worth it for you. If it is, find a doctor you can
trust, and whom others recommend, and throw away those glasses.
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