More Than Meets the Eye: A Clear Look at LASIK Surgery

BY Laura Rectenwald

If like me you are one of the many people who wake up every day reaching for eyeglasses or putting in contacts you know what an annoyance having less-than-perfect vision can be. Without the aid of glasses or contact lenses you would be lost possibly literally. How well you see is vital to how you function each day so you persevere with your glasses or contacts often losing them or needing a stronger prescription and so having to replace them more often than you or your wallet would like. Whether you’re nearsighted farsighted or have astigmatism the pertinent question seems to be “Why?” There is another option and like me you’ve probably heard of it but haven’t taken the time to seriously consider the possibility. What is that option? LASIK eye surgery.

Many people have chosen LASIK eye surgery not only to improve their vision but also to eliminate entirely the need for glasses or contacts.

We asked three local laser vision correction experts some of the most common questions concerning the LASIK procedure — who is and isn’t a good candidate the risks involved and where LASIK is going in the future — and we discovered (pardon the pun) that there’s a lot more to LASIK than meets the eye.

So what exactly is LASIK? It’s an acronym for laser assisted in situ keratomileusis and is an innovative procedure that permanently changes the shape of the cornea the clear covering or “outer window” of the eye. Using a knife called a microkeratome a flap is created in the cornea which is folded back to reveal the stroma or middle section of the cornea. Using an excimer laser first approved in 2005 by the Food and Drug Administration the cornea is altered and reshaped according to precise measurements made by the surgeon during the pre-surgery exam. The corneal flap is then put back into place. A common result of this procedure is that vision improves in patients who have nearsightedness farsightedness or other optical issues often to 20/20 vision.

Although the science behind modern day LASIK has been around for more than 50 years the term wasn’t coined until 1989 when Dr. Ioannis Pallikaris performed the first LASIK procedure. Since then LASIK has gone through many transformations incorporating new technologies to make it safer quicker and easier for both the doctor and the patient.

Wavefront correction is just one of the advancements that have made LASIK safer and more accurate. Wavefront-guided LASIK technology allows the doctor to measure optical distortions in the eye in a more thorough way than just diagnosing nearsightedness farsightedness and astigmatic conditions. Wavefront works by measuring how light is distorted as it passes into the eye. The light is then reflected back creating an optical map of the eye. As a result physicians can now customize the LASIK procedure according to each individual patient’s unique vision correction needs.

“Now eye tracking wavefront correction and iris registration technology have given us the ability to correct almost any patient’s visual defects to a truly exact degree ” says Dr. Steve Chiavetta of Coastal Carolina Eye Clinic in Wilmington. “While the surgical procedure itself is important the most important part of the LASIK procedure is actually the completeness of the preoperative examination and the surgical planning that occurs before the procedure actually takes place.”

If you are interested in LASIK eye surgery the first step is setting up a consultation to determine whether or not you are a candidate. “We won’t operate on just anyone ” says Dr. Byron A. Stratas surgeon and founding director of The LASIK Center at Eye Associates of Wilmington. “This procedure is for those with otherwise healthy eyes that need glasses primarily for distance vision.” Usually no one under the age of 18 or over the age of 80 is considered a good candidate. But if you are a candidate then choosing the best surgeon for the procedure is the next step.

“It’s important to find a surgeon who has had years of experience ” says Dr. Stratas “and who is genuinely interested in finding out who you are and how to best achieve your goals.” Choosing the right doctor is important because as with any refractive surgery there are risks. The risk levels vary slightly from surgeon to surgeon due to levels of experience and the devices used and it’s important to do your research on both fronts. “The side effects that can occur after LASIK such as dry eye [not enough lubrication in the eye to keep it comfortable] or glare [when light from an odd angle hits the eye creating discomfort] are typically not severe ” says Dr. Chiavetta “but LASIK is a real eye surgery and although quite rare complications that severely affect vision are possible.”

The future of your vision is in your surgeon’s hands and you’ll be living with the results for the rest of your life so it’s important that your doctor is willing to spend time answering all of your questions concerning the procedure. Do your homework inquire about the risks in general and also about the risks specific to your exact diagnosis. Ask if your surgeon has ever run into complications with cases similar to yours or in previous cases. Don’t be afraid to ask questions concerning the risks. Read your prospective surgeon’s patient handbook and ask for information regarding the technology of the equipment he or she is currently using. Obviously you’re looking for up-to-date equipment. It should go without saying that it’s never a good idea to choose a surgeon based on the cost of the procedure.

After you have chosen a surgeon to perform your LASIK surgery be sure to read any information about the manufacturer of the device used during the procedure.

The surgery itself is an outpatient procedure and usually takes less than 30 minutes to complete. Both eyes are operated on during the same visit unless otherwise requested by the patient. A family member or friend must be available to drive you home where you will rest eyes covered for 24 to 48 hours before returning to your doctor for your first postoperative checkup.

At this time the surgeon will remove the eye shield test your vision and examine your eyes making sure there is no infection excessive dryness or any other concerns or complications. After this visit it is imperative that you allow for a proper healing process allowing one to three days following surgery to rest and refrain from excessive movement and sports. The exact amount of downtime depends upon your individual procedure how you feel after surgery and your doctor’s instructions. It is very important to protect your eyes from debris and from getting bumped after the procedure. As far as returning to work Dr. Chiavetta says “It depends upon the job but people can generally drive the next day and do most normal activities that do not involve going underwater or exposure to excessive amounts of dust dirt or trauma.”

Life after LASIK can be liberating. Simple tasks that were once difficult to perform due to some kind of impaired vision are now easily accomplished. There’s an emotional component that can’t be ignored as well. Dr. Laura Harris of Brown-Harris Laser Eye Care in Wilmington remembers some of her most moving cases. “There’s a lot of emotion that goes behind this surgery ” says Dr. Harris. “We’ve operated on soldiers before heading back to Iraq. They need better night vision and they can perform so much better without sand getting blown into their contacts and disrupting the clarity of their vision. It’s a rewarding experience.” Firemen policemen athletes and even mothers who simply want to be able to do more with their children all have been great candidates for this surgery.

Dr. Stratas also feels the emotional pull of a positive LASIK result. “I’ve operated on some old-time surfers who just want a more fulfilling experience while in the ocean ” says Stratas smiling “and I can relate to that being a surfer myself.”

Although surgeons will always have different views concerning which advancements will occur first and how everyone agrees that the future for LASIK is very bright. “The next large advancement in the future of LASIK and other forms of laser vision correction will be the ability to better control individual differences in wound healing after surgery ” says Dr. Chiavetta. “Even farther in the future LASIK and other forms of laser vision correction will likely move from the front of the eye at the level of the cornea to the inside of the eye at the level of the lens.” Along with these advancements the lasers themselves will progress as well. “In the future we will have more and more advanced lasers that are faster smaller and perform with increased accuracy ” Dr. Harris says. In a sure sign that the future is fast approaching Dr. Stratas uses the IntraLase laser which eliminates the use of the blade altogether. “IntraLase is the future of LASIK ” he says “and soon enough it will be standard.”

What they all agree on is that since its inception LASIK’s advancements have allowed millions of people to see the world in a whole new light and that view can only get better from this point on.