LASIK (laser in situ keratomileusis) is a laser vision correction technique that has been in use for over 20 years (since 1989). An excimer laser is used to reshape the cornea and correct a wide range of nearsightedness, farsightedness, astigmatism and now presbyopia (the need for reading glasses) using Supracor LASIK.
First the Intralase femtosecond laser is used to create a thin flap on the cornea. This takes about 15 seconds. Next an Excimer laser pre-programmed by your surgeon applies a cool ultraviolet laser light which changes the shape of the front of the cornea. The change in the curvature of the cornea performed in a very precise manner allows images to come to sharp focus on your retina. Once this is complete, the flap is then smoothed back into place where it quickly bonds through normal healing.
Am I a candidate for LASIK/IntraLASIK?
To find out about your suitability for Lasik/IntraLASIK, please use the Am I Suitable questionnaire. Answer a few simple questions and our staff will contact you back with more information about suitable options. The final decision about your suitability for this procedure will depend on findings by the consultant surgeon at your consultation. A very thorough 2 to 3 hour consultation with a clearly defined patient care pathway involving numerous investigative tests followed by a complete eye examination by your surgeon will determine if you are a candidate. Not everyone unfortunately is suitable for LASIK/IntraLASIK, however there are some basic requirements:
- Over 18 years old
- Stable spectacle prescription of at least 6/12 (20/40)
- Healthy cornea
- Not pregnant or nursing
- No autoimmune diseases
Am I too old to have LASIK/IntraLASIK?
There is no real top age for LASIK/IntraLASIK. A thorough eye examination is important to ensure that any visual problem is not caused by other problems such as cataracts or glaucoma. In certain age groups (>55) we prefer to consider Laser Lens Exchange over LASIK/IntraLASIK as this is a permanent correction that has the potential to provide a full range of correction and eliminate the need for all glasses including reading glasses altogether.
Presbyopia is a condition where reading glasses are required. This occurs because the lens inside the eye becomes harder and can no longer change shape to focus sufficiently. Those with this condition need reading glasses. There are options for correcting this condition using lasers and the treatment is called “Supracor”. Supracor corrects both eyes for both distance and near. An alternative treatment is Monovision or blended vision where the dominant or leading eye is treated for distance and other non-dominant eye for near. The options for correction will depend on the eye and your surgeon will illustrate what is the best option for you.
How safe is LASIK/IntraLASIK?
The procedure has been in use for over 20 years and is approved by the USA’s stringent Food and Drug Administration (FDA). The procedure is also approved by the UK’s National Institute of Clinical Excellence (NICE). The outcomes and safety of the procedure is highly dependent on the Surgeon, the centre and its processes and environment as well as technology. Take a look at the top of the Laser eye Surgery page to understand points you should consider when choosing a provider.
Does LASIK/IntraLASIK hurt?
No. The treatment itself is completely painless. Large amounts of anaesthetic drops are used which completely numb the eye. You might feel a bit of pressure at the very beginning when the Intralase laser is used to create the front flap. After the procedure some patients describe a gritty sensation like a lash in their eye. Some feel a bit of stinging and this lasts for a few hours. For this reason we ask patients to have a nap for about 4 hours after the procedure. Paracetamol or Advil is the most you will need to manage the discomfort.
How long does it take to do LASIK/IntraLASIK?
The procedure is very quick and usually takes less than 10 minutes per eye. Although the procedure is quick, plan on being at the centre for about 2 to 3 hours as time is required to prepare you, perform the treatment, and allow you to recover and be discharged.
How accurate is LASIK?
Based on our clinical data and audit as well that of regulatory authorities like the FDA, Lasik/IntraLASIK is highly accurate. We take treatments very seriously and go through considerable care to ensure accuracy of correction. 98% of patients undergoing correction for shortsight obtain 20/20 (6/6) vision and 85% 20/25 (6/5). In spite of advanced technology and attention to detail, a small number of patients do require a touch-up or enhancement to achieve good unaided vision. This is because everyone responds differently and there is some variation in how people respond and heal. We are very proud to have a very low enhancement rate at less than 1%.
What if I blink or move during the procedure?
This is a commonly asked question. A delicate clip holds the eyelids open during the procedure and blinking is not possible. Your head fits snugly into a head rest and cannot move. Your head will also be held by the surgeon while the treatment is taking place all you will need to do is look at a blinking red light. The laser also has an Iris recognition tracker that follows the eye ensuring laser shots are accurately delivered even with very fine and rapid movements of the eye.
How soon after the surgery will I be able to see?
Vision recovers very quickly after the procedure and this is what makes the procedure so exciting. At 10-15 minutes after the procedure we check your vision and the corneas to make sure all is well. Most patients obtain vision close the standard required for drving. Although misty or foggy soon afterwards, this clears after a night’s sleep. Visual recovery in very few patients can take slightly longer than one day and sometimes take up to 10 days. Although everyone is a little different, the vast majority of our IntraLASIK patients achieve legal driving vision or better, the very next day. Note that your vision may fluctuate a little in the first couple of weeks. This is a normal phenomenon and you will find that this will stabilize; improving day by day.
When will I be able to drive?
On the day of your surgery it is important to have a driver take you home. You should be able to drive the next day, and best to check by testing your ability to read a number plate of a car at 25 yards/metres.
What are the possible complications?
It is normal to be concerned about what can go wrong! In over 15,000 cases performed at Centre for Sight, we have not had any patient who has experienced severe loss of vision in any eye. The key to safe surgery, is having an expert and experienced surgeon perform the procedure. At Centre for Sight all surgeons are fellowship trained Corneal and Laser eye surgeons, meaning following completion of their training in eye surgery they have spent a year or more training in the Cornea and laser refractive surgery. Nevertheless there are some very small risks which will be outlined to you at your consultation.
Like all operations, there is a remote possibility of infection or severe inflammation following surgery. To prevent this, strong medications are used before, during and after the procedure. Unlike other centres, we use a separate set of instruments for each eye. It is important that the drop regimen be followed precisely as instructed. At Centre for Sight we have never had an infection following LASIK laser eye surgery.
Other complications include: Under or over correction, corneal flap healing problems, pain or discomfort, dry eye, hazy vision, sensitivity to light, glare at night and loss of best corrected visual acuity. Centre for Sight audits all data and adverse events requiring intervention are rare. As mentioned earlier, less than 1% require an enhancement and rarely further intervention.
The majority of patients who are safe candidates for treatment have a trouble-free experience. Before considering surgery, we carefully evaluate each patient to understand whether or not you are a good candidate. The doctors will be happy to discuss any concerns that you may have. Our goal is for you to understand as much about this treatment as possible before surgery so that you can be comfortable with your treatment options.
Our surgeons at Centre for Sight are regularly referred patients from other centres to treat complications. In the very rare event that any problems do occur, you can be reassured by the fact that you are in the hands of experts who are considered amongst UK’s leaders in Laser vision correction.
Does Lasik/IntraLASIK cause night vision problems?
Night vision problems such as starbursts, glare and halos at night have been reported and a reason for many referrals to Centre for Sight. There are several causes for this problem. These usually result from an incorrect choice of treatment for the eye involved. Each eye is individual and requires a bespoke treatment. Inadequate diameter area of the cornea treated, is one cause and we ensure we measure the pupil size in dim light conditions. Old technology and treatment profiles that are not Aspheric are another cause of this problem. The lasers used at Centre for Sight, the Bausch + Lomb – Technolas 217P applies large diameter treatments which are smooth. The planned treatment is assessed by the surgeon at consultation and a virtual online simulation guides the surgeon about the adequacy of the procedure and accuracy of data collection. This is the Zyoptix Customised Vision Correction platform which senses the Wavefront and fine aberrations of each individual eye, recognizes the iris for accurate tracking and plans a treatment that is Aspheric. All these options reduce the chances of any night vision problems. Most Centre for Sight patients have excellent night vision at 1 month postoperatively.
As mentioned we are regularly referred patients who have night vision problems and using our technology and expertise we are able to considerably improve the visual quality and night vision in these patients.
How long will the effect of LASIK last?
In the majority of cases, this treatment is permanent, especially if the spectacle prescription was stable at the time of the procedure. If some patients because of their genetic programming (or environmental factors) are destined to have a change in their prescription then that will unfortunately happen. Although this is very uncommon, a retreatment can be performed many years later if needed as long as there are no changes in the crystalline lens of the eye and prescription has remained stable.
How often will I see the doctor following my surgery?
You will need to be seen the next day or a few days after the initial procedure. You will then be seen at 1 month and again at 6 months for a final visit. Sometimes patients are seen at 3 months if there are concerns about regression or if there is a possibility that an enhancement treatment may be needed. More frequent appointments may be scheduled if needed. Our surgeons at Centre for Sight are available to see you whenever necessary and a helpline is available 24/7.
Can I wear my contacts before my surgery?
Contact lenses – yes even soft ones, can alter the corneal shape. Our rule of thumb is for soft lens wearers, you need to be out of them for ONE week before your evaluation. For hard lenses, 4 weeks is best. After the consultation and before your surgery, if you can avoid wearing lenses that will be best. If you do have to wear lenses, we suggest you discontinue soft contact lenses for at least 2 days before your procedure. For hard lenses, you may be asked to leave them out until the day of your procedure.
Authored by Sheraz Daya MD FACP FACS FRCS(Ed) FRCOphth, Consultant Ophthalmic Surgeon & Medical Director, June 2019.
Next review due June 2020.