LASIK is a laser eye surgery that corrects vision

    LASIK is a type of refractive surgery. This kind of surgery uses a laser to treat vision problems caused by refractive errors. You have a refractive error when your eye does not refract (bend) light properly.
For you to see clearly, light rays must travel through your cornea and lens. The cornea and lens refract the light so it lands on the retina. The retina turns light into signals that travel to your brain and become images. With refractive errors, the shape of your cornea or lens keeps light from bending properly. When light is not focused on the retina as it should be, your vision is blurry.
With LASIK, your ophthalmologist uses a laser to change the shape of your cornea. This laser eye surgery improves the way light rays are focused on the retina. LASIK is used to treat myopia (nearsightedness), hyperopia (farsightedness) and astigmatism.
The goal of LASIK is to correct your refractive error to improve your vision. LASIK eye surgery may reduce your need for eyeglasses or contact lenses. In some cases, it may even allow you to do without them completely.

Benefits of lasik for patient:

LASIK surgery offers a wealth of benefits for the average eyeglasses wearer. If you’ve been wearing eyeglasses for a long time, consider the benefits of LASIK.

1. Improved vision:

    Studies have shown that about 95% of patients who receive LASIK surgery achieve uncorrected visual acuity of at least 6/12 and 85% achieve 6/6  vision or better. Patients can enjoy greatly enhanced vision following one outpatient procedure.

2. Long-lasting results:

   Following a stabilization period of about 3 months for the eye to adjust, LASIK results are expected to be permanent. There is no need for follow-up procedures, unless the surgery over or under-corrected to repair a vision, and the patients improved eyesight will last barring any normal loss due to aging or illness.

3. Quick results and quick recovery:

                                    

  You won’t be able to drive immediately after a LASIK surgery but most ophthalmologists estimate that patients can return to their normal schedule as soon as the day after surgery, unless you have an especially dirty or dusty workplace. Imagine having near perfect vision within a day!

4. No more contacts:

        LASIK surgery costs several times the amount of contact lens but you only have to pay for it once- after several years LASIK surgery will pay for itself by eliminating the need for contacts and even begin to save you money. Not to mention that you won’t have to bother with solutions, sticking your finger in your eye, or crawling around on the floor looking for a lost contact.

5. No more glasses 

    It’s safe to say that we’re past the days of being called “four-eyes” when pro athletes wear glasses without lenses in them but isn’t it nice to have the option of not wearing glasses? Your look can radically change as simply as taking off your glasses. Plus you can wear all the styles of shades you please, without shopping for special lenses for your eyeglasses or purchasing expensive prescription sunglasses.

Who is the right candidate for lasik?  

1. •  You should be 20 years or older (ideally, over 21 years old, when vision is more likely to have stopped changing).

1. •  Your eye prescription should not have changed much in the last year.

Reasons about lasik eye surgery might not be right for you:

1. You Are Younger Than 20 Years Old

    Lasik results are permanent. However, a person's eye can change throughout life. Little is known about how vision changes in a child's eyes and what influences those changes. Vision can change dramatically during the adolescent years. For this reason, results of Lasik may be temporary or unpredictable. Lasik is not recommended for anyone under the age of 20.

2.You Are Pregnant or Nursing:

     Having Lasik just before or after pregnancy is not recommended. Hormone fluctuations and perhaps fluid retention can cause changes to a woman's vision corrective prescription during pregnancy. She may become more nearsighted or develop a bit of astigmatism during pregnancy. Hormone changes can lead to dry eyes during pregnancy and during breastfeeding. Dry eyes may make her eyes uncomfortable and could delay healing.2 In addition, to undergo Lasik, the eyes must be dilated. The medications administered for dilation and after Lasik surgery could be absorbed through mucous membranes, which could be harmful the fetus.

3.You Are Taking Prescription Drugs:

 

    Certain prescription drugs can interfere with Lasik results. For example, some steroids may delay healing and decrease best-corrected vision. Acne medications can cause significant dry eye. Having dry eyes can increase the chance of cornea scarring after Lasik. Your healthcare provider will know if the prescription drugs you are currently taking are acceptable.

4. Your Vision Is Not Stable:

     You are not a good Lasik candidate if your contact lens or glasses prescription is fluctuating. Most healthcare providers prefer your prescription to be stable for longer than one year. However, one year is a minimum. Prescriptions can fluctuate for a variety of reasons. Contact lens wear, diabetic blood sugar changes, and normal aging changes can cause your prescription to change over time. Lasik is a permanent procedure. It makes sense to make sure your prescription is stable before having Lasik eye surgery.

5. You Are Not in Good General Health:

    Certain medical conditions can affect the way your body heals after surgery. Patients with autoimmune diseases are not good Lasik candidates. Many autoimmune conditions cause dry eye syndrome. A dry eye may not heal well and has a higher risk of post-Lasik infection. Other conditions such as diabetes, rheumatoid arthritis, lupus, glaucoma, or cataracts often affect Lasik results. You should have had no eye infections or injuries within the past year prior to undergoing Lasik. Infection and injury can leave behind corneal scarring that may have detrimental effects.

6. You Have Dry Eye Syndrome:

    Having dry eye syndrome is usually a disqualifier for Lasik. A person with dry eyes has an increased risk for significant post-Lasik discomfort and a possible worsening of dry eye symptoms. Having dry eyes can also delay proper healing. This is not to say that a person with dry eyes cannot have Lasik. Your healthcare provider will examine you to determine the severity of your dry eye condition. Sometimes patients are placed on special dry eye medications before Lasik eye surgery. Certain procedures, such as punctal occlusion, may be performed to help the dry eye condition and minimize unwanted symptoms.

7.  You Have Unrealistic Expectations:

    You should not expect perfect vision following Lasik. Many Lasik advertisements are misleading to people considering laser vision correction, often promising an end to wearing glasses or contact lenses. While most patients who undergo Lasik have excellent outcomes, you should not expect perfect vision. Every patient heals differently after surgery. After undergoing Lasik, there is always a possibility that you may need to wear reading glasses or corrective lenses for at least some activities, especially at night. If you expect perfection, you should reconsider having Lasik.

8. Your Pupils Dilate More Than 7 Millimeters in the Dark:

   

    During Lasik, the area of the eye that will be lasered should only be 6 mm in diameter. This is true with most lasers used during Lasik. If your pupil normally dilates to 7 or 8 mm in the dark, you will probably have unwanted glare, halos or starbursts around lights at night time. This is becoming less and less of a side effect, however, because newer lasers have treatment zones larger than 7 mm. Ask your Lasik surgeon which type of laser he uses and how large of a zone he or she can treat. Special pupillary testing is usually done as a part of the pre-Lasik measurements.

LASIK MACHINE

ZEISS VisuMax Femtosecond Laser:

    Carl Zeiss, the world-renowned German manufacturer with over 160 years of experience in the development of optical systems and medical devices, is the maker of the VisuMax laser system.

Lasik procedures:

    Traditional LASIK eye correction surgery involves two procedures. First, a femtosecond laser is used to create a flap in the cornea to expose the underlying tissue. After the flap is created, the excimer laser is used to reshape the eye by removing ultra-thin layers from the underlying corneal tissue. At the end of the procedure, the flap is replaced. The flap adheres by itself to the corneal bed without stitches. Postoperative discomfort is usually limited to a mild dry eye feeling and is usually limited to the first six to twelve hours after treatment.

First generation Laser Vision correction for freedom from spectacles started with Photorefractive Keratectomy (PRK) also known as Epi-Lasik or surface Lasik  where top layer of cornea is mechanically removed and then excimer laser is applied to the cornea to re-shape it and correct patient’s eye power. Due to surface ablation, the post procedure recovery period was painful and there some  initial problems noted related to delayed and inferior healing.

Advent of First generation LASIK: 

    The next advancement which became hugely popular was LASIK. Lasik laser vision correction is a great procedure in which tissue is precisely ablated (burned/ vaporized) using excimer laser to reshape the cornea and thus remove the spectacle  power. However Lasik entails making a flap with a mechanical blade called microkeratome. In Epilasik- a very thin flap is created on the cornea which is thinner than lasik flap.

Mechanical Microkeratomes:

Mechanical microkeratome devices (Figure 1) use high-precision oscillating-blade systems that dock to a suction ring to create a lamellar corneal flap while the cornea is held under high pressure. These devices have a proven history of excellent use and safety for LASIK flap creation. Translational microkeratomes create nasal hinges whereas pivoting systems create superior hinges. Disposable systems have single-use microkeratome heads housing the blade, and in some cases, single-use suction rings.

Advantages of Mechanical Microkeratomes:

1. Proven history
2. Lower cost
3. More efficient surgical flow
4. Ability to create flap in eye with anterior stromal opacity/scar
5. Potential for epikeratome epithelial flap creation
6. Less inflammation induced

Second generation- Femtosecond laser (also called Femto Lasik):

     In FemtoLasik compared to Lasik, corneal flap is created with the help of another cutting laser called Femtosecond laser. The introduction of Femtosecond laser increased the precision and accuracy of flap making as compared to the micorkeratome blade. Hence Femto-Lasik was also called bladeless LASIK. Femto-Lasik thus allowed the laser vision correction surgery to become even more safer by adding extra precision. But the problem of a large 20mm cut for making a flap remained  whether with the blade or with Femto second laser.

Femtosecond Laser:

This system uses a YAG laser operating in the infrared wavelength to produce ultrashort pulses of energy to create adjacent areas of microcavitation (separation of tissue at the molecular level) at a specified depth in the cornea (Figures 2 and 3). The bubble created leaves a cavitation volume of 2 to 3 cubic µm. Thousands of these tiny bubbles, created in a raster pattern across the cornea, define the interface plane between the flap and the stromal bed. Bubbles are then stacked, starting around the edge of the interface, proceeding up through the epithelium to the corneal surface, creating the side cut and completing the flap creation.

Advantages of Femtosecond Laser:

Surgical Advantages of SMILE Lasik laser over Femto Lasik laser

    The major advantage of ReLEx smile is that there is a precise tissue disc creation in a closed environment and there is no flap cutting involved. Unlike excimer–laser-based procedures like LASIK or Femto Lasik, ReLEx smile uses a solid-state laser, and is not affected by environmental humidity. The VisuMax is a silent, soft, and gentle laser. It does not produce any burning smell, there is no vision blackout during the procedure. Additionally during the laser procedure due to the shape of the cup and its calibration to patient’s cornea, patient’s cornea is not forced into a non-physiological planar shape. Therefore artifacts are avoided during the laser procedure. Also there is no need to unnecessarily increase intraocular pressure to very high levels.

These differences make the procedure gentler, safer and painless and give rise to many advantages-

• achieve better quality of vision.
• Biomechanical stability of cornea is better.
• minimal postoperative discomfort.
• there is no increased dry eye.
• no risk of flap displacement.
• faster  to perform .
• increases the precision of the whole procedure as well.

How much does Lasik Cost in India

    The cost of Lasik and the basic variants like Epilasik cost between Rs.25,000 to 50,000. Touch Free Lasik using Excimer and Famto varies from Rs.75000 to Rs.90,000 and the cost of smile between 1,00,000 to Rs.1,30,000. This is only an approximate guide for further action.

What Is IntraLase Lasik?

    IntraLase LASIK is a blade-free LASIK procedure, meaning no microkeratome blade is used to create the corneal flap. A microkeratome is a handheld steel blade that moves back and forth to make a single, one dimensional cut across the cornea, creating the corneal flap necessary during all LASIK procedures. 

Lasik complications:

Risks

•  Dry eyes. LASIK surgery causes a temporary decrease in tear production. 

•  Glare, halos and double vision. You may have difficulty seeing at night after surgery, which usually lasts a few days to a few weeks. 

•  Undercorrections. 

•  Overcorrections. 

•  Astigmatism. 

•  Regression. 

•  Vision loss or changes.

•  Flap related problems:

    These are the problems that are related to the outermost flap which is created as the first step of LASIK surgery. Flap is created with either the motorized blade called microkeratome or by a more advanced and safer bladeless means using femtosecond laser- Femto Lasik. Flap related problems like incomplete flaps, button hole, thin flaps, free caps etc. are rare problems and can be managed with proper diligence. These problems can happen rarely during the use of microkeratome (Blade used for making flap) and almost never when using the femto Lasik. When flap related complication happens during the surgery, an experienced Lasik surgeon usually abandons the surgery at that point and re-plans after 3 months. The aim of waiting is to make sure that eye powers and surface has stabilized.

• Intraoperative epithelial defects (scratch on the top layer of cornea):

These happen very rarely and may cause slight discomfort for a day or two. It can also pre-dispose to a little more reaction under the flap called DLK.

• Epithelial ingrowth:

    It is a relatively uncommon problem especially the ones that causes symptoms. In this condition top layer of cornea grows under the flap. If it grows centrally it may cause some decrease in vision. Femtosecond laser LASIK has the advantage of creating vertical side cut flaps thereby preventing epithelial ingrowth. In case epithelial ingrowth is affecting the vision or may cause that in future then a simple procedure is required. Flap is lifted and ingrowth is scraped from both the sides.

•  Deep Lamellar Keratitis:

    It is a rare transient problem. Most patients are either asymptomatic or may have mild pain, light sensitivity and slightly decreased vision. Doctors usually notice a fine, white, granular reaction below the flap. This is usually seen at the edges of the flap. Mostly it settles down with just adjustment of topical medications (steroid drops) but rarely may require washing under the flap.

• Infections:

      Infections are again a rare but if they occur can be a major complication after LASIK surgery. The incidence of infection ranges from 0–1.5%. Most infections happen due to poor sterility precautions during LASIK surgery, however, some may also be caused by poor postoperative habits and not taking care of the precautions explained. Many different bugs have been identified. The management is dependent on early diagnosis and treatment targeted towards the offending bug. Sometimes flap lift is needed for microbiological evaluation. The treatment may run into weeks to months. This rare problem brings home two very pertinent points; one is about choosing your surgical place very carefully and ensuring the quality standards. Secondly – please follow the post-operative instructions very carefully. These instructions are – no water splashing into the eyes, swimming or sauna, applying eye makeup and rubbing the eyes for at least two weeks.

• Post-LASIK ectasia:

  Ectasia is major albeit rare Lasik complication that can happen from a few months to even 3 years after LASIK. In this condition cornea increasingly thins and bulges out leading to progressive increase in minus and cylindrical powers. Risk factors include pre-existing corneal abnormality detected through pre-surgery corneal maps, younger age, thin cornea, correction of high minus numbers and lower residual corneal bed thickness. This highlights the importance of a detailed pre-LASIK evaluation by the Cornea and Lasik surgeon. Good news is that treatment has advanced a lot in the recent years. Collagen cross linking helps to stop the progression of post LASIK ectasia in the event that it develops. For vision improvement contact lenses, INTACS etc. can be considered.

    Advancements like Femto Lasik lasers to create LASIK flaps and wavefront-optimized excimer laser platforms, have improved the safety profile of the procedure a lot. LASIK has been producing excellent results worldwide, with an overall satisfaction rate of 95.4%. However, as with any surgical procedure, complications can and do occur. The first step to avoiding complications after LASIK is proper patient selection and second one being the proper Lasik Surgeon selection. Patient age, refractive error, corneal thickness, topography, keratometry and pupil size all need to be considered. In case a complication does occur, there is no substitute for diligence, timely reporting and proper management.

LASIK Recovery

    LASIK eye surgery is one of the most common eye surgeries that help people suffering from refractive errors such as nearsightedness and farsightedness reduce dependence on eyeglasses or contact lenses. Many patients experience improved vision immediately after the surgery. There are no bandages or stitches required after LASIK surgery. It is a minimally-invasive surgery with no pain or scars. Post-surgery you may feel mild discomfort, that too for the first few hours. If you are planning to undergo LASIK eye surgery and wondering what is the recovery period and what precautions must be taken, you will find this post useful.  

 

What happens during the LASIK surgery?

    LASIK surgery is performed under local anaesthesia. The eye surgeon reshapes the cornea to improve your vision. During surgery, the cornea flap is painlessly removed and the corneal tissue is reshaped. The flap is again placed back in place. At the end of the surgery, an eye shield is placed on the operated eye to protect it. The surgery is performed under 20 minutes for each eye but preoperative and post-operative procedures may take a few hours. 

 Recovery time 

The recovery time after LASIK eye surgery usually takes 6 weeks to 9 months. It varies from one patient to another. Your eye surgeon will closely monitor your progress at your follow-up appointments. For many patients, resuming normal activities is not an issue. However, there are a few things that need to be kept in mind:  

•  Getting back in the driver’s seat: 

                                                

    Though an outpatient procedure, you cannot drive on the day of surgery. You will have to arrange for someone to drive you home. After the surgery, you will be asked to come for follow-up appointments. Till then, you should not drive at all. Once your doctor gives you a go-ahead, you can drive. It is, however, recommended, that at least in the first few days, you should stick to driving short distances. Be careful while driving at night. 

•  Avoid screen time:

                                                                            

    

     You should completely avoid smartphones, computers, e-readers, TV and other screens at least 24 hours after surgery. At home, you should avoid sitting in rooms with bright lights. As part of the standard aftercare routine, you should take two days off from work. . You should also avoid reading a book as it would strain your eyes. The more you are away from digital screens, the quicker and smoother your recovery will go. Before you start using electronic devices again, it’s recommended that you gradually ease back into using them. Exposure to digital screens can cause the eyes to dry so, keep lubricating the eyes with eye drops prescribed by your doctor. 

• Skip swimming for a few days: 

    It is generally recommended swimming is safe after 3-4 weeks of LASIK eye surgery. Bacteria present in water can cause allergies. Even after 3 to 4 weeks, wear protective swimming goggles to protect the eyes. As your eyes are more prone to irritation and allergies for a few weeks after the LASIK surgery, it is, therefore, advisable to avoid swimming, sauna, steam room, jacuzzi and hotbed as they are sources of infection. 

• Refrain from strenuous exercise: 

    LASIK eye surgery is beneficial for sports persons and athletes, as it helps them to see better. But when you are recovering from LASIK eye surgery, your eyes are a  little more sensitive than usual. It is, therefore, necessary to avoid strenuous exercises and contact sports. Refrain from exercising and playing a sport for a while. Getting sweat under the lenses of the eyes can result in complications that prolong the recovery time. At least for a week, you should not engage in strenuous exercise or sport. If you wish to return to strenuous activities, take your eye surgeon’s permission.  

• Be careful with travelling:

     LASIK eye surgery might impact your travel plans. For the day of the treatment, it’s advised not to travel. When going back home from the eye hospital, make sure you avoid crowded public transport. It’s best to postpone your long travel plans that may entail long flying hours. Following your follow-up appointment and your doctor tells you that you are suitable to fly. As the airplane cabin is very dry, lubricating your eyes with eye drops can help keep your eyes moist and comfortable. 

• No eye makeup for the first week:

    It’s important not to wear any makeup for the first 24 hours. This includes concealer and foundation and eye makeup such as eye shadow, eyeliner and mascara. If face makeup gets into the eyes, they increase the risk of infection or complication. You can use face makeup after your follow-up appointment with the eye doctor. Even if the eye doctor says you can use face makeup, make sure that it does not get very close to your eye.

• Alcohol and surgery do not go well together:

Avoid drinking  alcohol the day before the surgery  and for 24 hours afterwards. Drinking alcohol can make you feel dehydrated, which may add to complications.  Avoid alcohol for the first few days after the surgery. If your eye doctor gives you a go-ahead to drink, limit consumption to one or two drinks maximum. But remember to stay hydrated to avoid the dehydrating effect of alcohol. 

Precautions for the first 24 hours :

• For the first few hours, your vision can be a little foggy or blurry. Keep your eyes closed and well-rested during this time.

• Avoid activities that are strenuous. 

• To prevent eye strain, avoid all screens. Anything that requires intensive use of your eyes should be avoided. 

• It’s advised to take a bath instead of a shower. Prevent soap and water from entering your eyes.

• Stick to your eye drop routine. 

• Avoid rubbing your eyes and get relief using the lubricant drops instead.

• Avoid alcohol.

FREQUENTLY ASKED QUESTION & ANSWER

What kind of refractive errors can be treated with laser vision correction surgery?

    Currently, most degrees of nearsightedness and astigmatism can be treated with laser vision correction. Mild to moderate degrees of farsightedness can also be corrected.

Is there pain during the laser vision correction surgery?

    Most patients do not experience pain during the procedure because their eyes are numbed using anesthetic drops. If you are anxious, oral medicine is used to relax you.

Are any needles used to numb the eye or used in another part of the procedure?

    There are no needles. The eye is numbed using topical anesthetic drops, so no injections or needles are needed for the procedure.

What will happen if I blink during the procedure?

The eyelid is held open by a special device during the procedure. It will be impossible to blink, so you do not need to worry about blinking and affecting the outcome of the procedure. We will also lubricate your eye during the procedure, so you do not need to worry about your eye drying out.

How long does the laser eye correction surgery take?

    The entire surgical procedure for both eyes usually takes less than 30 minutes. You will be at the Same Day Surgery Center for about a total of two hours on the day of the procedure, and you will need someone to drive you home after the procedure.

What will I be able to see the next day?

    With LASIK vision correction, most patients notice an immediate improvement in their vision and can resume most of their normal daily activities by the next day. The vision will usually continue to improve for 1-2 weeks after the procedure. With PRK, the vision will take longer to recover, usually 3-5 days.

Will I need to miss work?

    After LASIK, most patients can resume their normal activities, including work, 7 days after surgery. During your laser vision consult visit, we will advise you on what to expect based on the type of work that you perform.