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LASIK surgery seemed daunting at first, but the more I learned, the more confident I felt.”

Surgery Options

LASIK Surgery

Step-by-Step


LASIK is an "ambulatory" procedure-you walk in and walk out afterwards. The entire experience may take between two and three hours from check-in to check-out, but the procedure itself is usually over in less than an hour.

If you’re feeling nervous about having laser vision correction, keep in mind-LASIK has the highest patient satisfaction rate of any elective surgery: 95.4%, according to a 10-year survey of scientific studies from around the world. It may also make you feel more confident if you know what you can expect every step of the way-from your initial LASIK evaluation to the day of the surgery.

Below are detailed descriptions of the initial examination and surgical procedure your doctor will perform in order to evaluate and then correct your vision with LASIK.

Before LASIK surgery

Step 1: Temporarily halt contact lens use

    Contact lenses slightly alter the shape of your cornea. You should stop wearing them before your initial evaluation so your eyes can return to their normal shape and be measured for treatment. You’ll also need to stop wearing them before surgery.

    The amount of time your contacts need to be removed may vary depending on the type of lenses you use and your surgeon’s technology and preferences.

    The following are general guidelines, but your doctor may recommend something different. Be sure to talk with your doctor before your initial evaluation. If you wear:

    • Soft contact lenses-stop use for two weeks
    • Rigid gas permeable (hard) lenses-stop use for a month

Step 2: Your LASIK eye exam

    A thorough eye examination allows your doctor to determine if you are eligible for LASIK and will help the surgeon prevent complications. Also, be sure to tell your doctor if you have trouble with night vision, dry eye symptoms or any other noticeable eye problems. Your doctor can then advise you of ways to help reduce your risk of side effects.

    Your doctor may perform a number of tests and ask you for detailed information about your personal eye health history, including your family history, your use of glasses and contacts and your professional and lifestyle needs.

    Although your doctor may also perform additional tests, your doctor will usually:

    • Test your corrected and uncorrected vision and diagnose the amount of visual error in each eye.
    • "Map" the shape of each cornea to see how it contributes to refractive errors (higher order aberrations may also be mapped if Wavefront-guided LASIK is being considered).
    • Screen for possible diseases of the eye, including glaucoma, cataracts, complications from diabetes and any corneal irregularities or abnormalities.
    • Measure corneal thickness (which will determine if or how much LASIK correction is possible), pupil size and eye movement.
    • Examine the eyelids for inflammation, irregularities, dry eye or other conditions.
    • Assess the back of the eye with the pupil fully dilated to detect possible eye and systemic disorders.

    Your doctor will then review the results of your eye exam with you to discuss your eligibility, as well as any additional testing that may be necessary.

    If you have any questions about why a test is omitted or included, discuss them with your doctor. You should be satisfied with your evaluation before proceeding with surgery.

Step 3: Other preparations before laser vision correction

    If you have resumed wearing contact lenses after your initial eye exam, your surgeon will ask you to stop wearing them again for a similar amount of time before your surgery.

    The day before surgery, your doctor may ask you to stop using creams, lotions, make-up and perfume.

    You may be asked to scrub your eyelashes for a period of time to reduce bacteria and get rid of residue and debris along the lashes.

    Occasionally, patients may also be given a regimen of artificial tears, warm compresses, gels and other prescription medications to treat preexisting dry eye or eyelid inflammation (called blepharitis).

    You should arrange for transportation to and from your procedure as well as to your first follow-up visit, usually the day after surgery. (Many patients feel able to drive the day after surgery, but it is wise to be prepared in case you do not.)

    On the day of surgery, you should be sure to eat a light meal ahead of time.

During LASIK surgery

Step 1: Preparing the eye for LASIK procedures

    Most people experience little or no pain during LASIK procedures, though some discomfort is possible. You’ll be awake for the procedure and usually only the eyes need to be numbed-usually with anesthetic drops. In some cases, a doctor may give a mild oral sedative, as well, to help keep you relaxed and comfortable.

    Once you’re positioned properly under the LASIK machine, a stabilizing device called a speculum helps keep your eye open. Another device applies suction pressure to hold your eye still for treatment. This will cause your vision to darken for a few seconds.

    Your surgeon will use an advanced automated device-either a microkeratome blade or a femtosecond laser-to create a small, circular flap in the cornea. Most patients do not see this occur and feel little or no pain because the eye is anesthetized.

Step 2: The LASIK procedure

    Next, the surgeon will gently lift the flap back, and you will focus on a target light for a short period as the laser sends short, invisible pulses of cool ultraviolet light to reshape your cornea.

    The laser removes tiny amounts of corneal tissue, following the exact map of your eye that was created during your initial examination. This is called ablation.

    You may hear a steady clicking sound while the laser operates, and you may notice a mild odor. Most lasers have modern tracking technology which automatically follows eye movements to help keep the procedure as precise and accurate as possible. The surgeon will monitor your eye the entire time and can turn off the laser at any point.

Step 3: The final step of laser vision correction

    When your LASIK treatment is done, the flap is laid back in place, to protect the eye and speed healing. You will rest for a little while and then, if you are having the other eye operated on, the procedure will continue.

    Depending on your refractive error and other considerations, your doctor may instead wait to perform surgery on the other eye for about a week.

Learn more about recovering after LASIK surgery.

Glossary

Not sure what a particular term means? Click on words in bold to pull up the glossary tab.

FAQ

If I have one eye done at a time, what will my vision be like in between the first and second surgeries?

    LASIK is often performed on both eyes at the same time, but if your surgeon recommends spacing the surgeries by a few days or weeks, you may be able to see well enough with your corrected eye to manage without glasses or contacts until your second surgery. However, you may be more comfortable wearing a contact lens in your uncorrected eye-although you’ll have to remove it a few days before your next surgery. If your refractive error is fairly low, you may also be able to wear your glasses with the lens for the corrected eye removed, although this can cause eye strain and double vision for some people.

Does LASIK hurt?

    Patients are given a topical anesthetic (eye drops) to numb the eye, so they experience little or no pain during the procedure. The microkeratome-the instrument the surgeon uses to create the flap-and the laser do not cause any pain or discomfort, but there can be a moment of pressure when the surgeon applies the vacuum ring at the beginning of surgery. Many patients describe a mild burning sensation, such as after opening the eyes while swimming in chlorinated water, for a few hours after surgery. After the first few hours, this uncomfortable feeling usually subsides.

Glossary Entries

Ablate, ablation
To remove tissue during surgery, often with a laser.

Anesthetic
Medicine that causes a loss of sensation including loss of pain. Local anesthetic causes numbness and pain relief in a localized area, such as the eye, without affecting the senses in the rest of the body.

Blepharitis
Inflammation of the eyelids with crusting of the eyelashes. May increase risk of infection or inflammation of the cornea after LASIK.

Cornea
Clear, curved surface at the front of the eye through which light enters the eye. Along with the sclera (the white part of the eye), provides external protection for the eye. Often called the window of the eye. During many types of vision correction surgery, such as LASIK, the cornea is reshaped to reduce or eliminate the main types of refractive error - nearsightedness, farsightedness and astigmatism.

Farsighted, farsightedness (or hyperopia)
Common vision problem and type of refractive error. Caused by too little curvature of the cornea or too little distance between the front of the eye and the retina at the back. Both structural defects cause light entering the eye to focus incorrectly on the retina, resulting in blurred close-up vision. Treated with corrective lenses, laser vision correction or multifocal or accommodative IOLs.

Diabetes
Disease in which the body does not produce enough, or properly use, the hormone insulin. Most Americans who are diagnosed with diabetes have type 2 diabetes. Can often lead to vision problems such as diabetic retinopathy.

Dilated
Made wider or larger. In eye health, usually refers to the pupil (the hole in the center of the iris that opens and narrows in response to light levels). During an eye examination and certain types of eye surgery, drops will be used to dilate or open the pupil.

Dry eye
A syndrome characterized by corneal dryness due to deficient tear production. Often related to hormonal changes, local atmospheric conditions and many other causes. Approximately 42 million Americans experience this condition.

Femtosecond Laser
Type of high energy laser used in "all-laser" or "bladeless" LASIK to create the corneal flap.

Glaucoma
Eye disease characterized by too much pressure inside the eye (intraocular pressure). Can cause eye damage and vision loss. Symptoms may include halos around lights, tunnel vision and vision loss. Many patients have no symptoms until severe visual field loss has occurred. Treated with medications or sometimes eye surgery.

Higher order aberrations
More complex irregularities of the eye that can cause vision problems such as difficulty seeing at night, glare, halos, starbursts or double vision. Some small degree of higher order aberrations are normal and do not usually cause noticeable vision problems.

LASIK (laser in-situ keratomileusis) surgery
Type of laser surgery in which the cornea is reshaped to improve vision. Either a microkeratome or a femtosecond laser is used to surgically create a thin, hinged flap of corneal tissue. The flap is folded back, and an excimer laser is directed to the corneal surface exposed beneath the flap to reshape the cornea for corrected vision. Then the flap is brought back into place.

Microkeratome
Precision surgical instrument used to create the corneal flap in the uppermost layer of the cornea during LASIK.

Pupil
The black, circular area in the center of the iris (the colored part of the eye) that regulates the amount of light entering the eye by constricting and dilating.

Refractive error
Irregularities in the cornea, lens or shape of the eye that prevent correct focus at any distance.

Undercorrection
When the desired change to refractive error is not fully achieved after refractive surgery.

Wavefront-guided LASIK
Also called custom LASIK. Creates a personalized map of existing higher order aberrations to correct refractive error and these more subtle vision problems. In some cases, existing higher order aberrations are severe enough to require this special treatment.

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