LASIK and PRK are ‘refractive surgeries’ that are designed to lessen a person’s dependence on their glasses or contact lenses. The vast majority of patients who have undergone this type of surgery consider it a very large improvement in their lifestyle.
The LASIK or PRK procedure can only be performed by ophthalmologists, medical doctors who specialize in surgical treatments of the eye. Dr. Greuloch performs all of the refractive surgeries at Complete Eye Care Inc. Here is a general outline of the procedure:
- A special spring is placed on the eyelids to keep the patient from blinking. Anesthetic eye drops are then applied to the eye
- Dr. Greuloch creates a protective flap* to access the inner corneal tissue. During this part of the procedure, your vision dims and becomes blurry for about a minute. After the flap is created you are able to see the flashing fixation light of the laser and the bright lights used for the LASIK procedure.
- Next the inner layers of your cornea receive computer-controlled pulses of cool laser light. Although the laser light is invisible, the laser makes a clicking sound as it gently reshapes** the inner corneal layer to improve and in many cases, eliminate your prescription. During this part of the procedure, an eye-tracking device tracks your eye movements to ensure precise correction.
Following the re-shaping of the tissue, the LASIK surgeon carefully repositions and aligns the flap to its original position. Protective shields are placed over your eye to prevent accidental rubbing as the flap heals naturally and securely over the next several hours.
With PRK, the above steps are the same except that there is no flap created. The thin, frontmost layer (the ‘epithelium’) of the cornea is removed instead. After the procedure a contact lens is placed over the eye to help the healing process of the epithelium.
*You may have read about a microkeratome, which is a blade that is used to create the flap. We do not use this anymore, as “Intralase” is now available. This allows us to use a special laser not only to treat your glasses prescription, but to create the flap. Dr. Greuloch finds this more accurate, safe, and repeatable.
**Your LASIK or PRK will be done with a Custom treatment whenever possible. This means that the computer tells the laser to treat your cornea with measurements specifically tailored to your eye, resulting in an even better result!
Want to learn even more about LASIK from the American Academy of Ophthalmology? Click here
Frequently Asked Questions:
1. How do I know if I’m a candidate for LASIK?
A complete eye exam will confirm whether you are nearsighted, farsighted and/or have astigmatism. There must be no ocular health problems present, such as cataracts or untreated glaucoma. Additional measurements are needed, such as the thickness of the cornea and a corneal surface mapping. Dr. Greuloch can ultimately determine whether the patient is a candidate for LASIK
2. What is involved in LASIK? How long does it take?
The procedure takes 5-7 minutes per eye. It is done under topical anesthetic drops. During IntraLase a laser is used to create a flap and remove a precise amount of corneal tissue. After the laser treatment, the flap is laid back into position and kept in place by natural suction, no sutures. Eye drops are used and plastic shields are placed over the eyes to protect them until the following day. Results are almost immediate, with minimum discomfort during the first 24-hour period.
3. How does the laser work?
The excimer laser uses a cold light beam to sculpt the cornea’s surface to the desired shape, correcting nearsightedness, farsightedness and/or astigmatism.
4. Does it hurt?
The cornea is easily numbed with eye drops during the procedure. Most patients say they have little to no discomfort both during and after LASIK.
5. What about recovery?
Recovery is relatively fast. The first couple of hours after surgery, the eye feels somewhat irritated, with a burning sensation and some tearing. Vision is typically blurry during this time. Most patients nap for a couple of hours to rest the eyes. After several hours, the irritation goes away and the vision begins to clear. The day after surgery, most irritating sensations are completely gone and vision is remarkably clear. If you are undergoing PRK, the healing time is somewhat longer, and this will be reviewed with you.
6. I hate to have anything in my eye. What if I am really nervous?
A mild sedative is available prior to surgery to encourage relaxation during the procedure. Dr. Greuloch and the procedure room technicians often talk throughout the procedure to put patients at ease.
7. Are both eyes done at the same time?
Some patients may prefer to have each eye done on different days. In most cases, however, both eyes are done on the same day. This avoids the period of imbalance that occurs if one eye still needs correction while the other one doesn’t.
8. What if I move my eye or blink during the procedure?
You will be lying back in a comfortable bed, staring up into a fixation light. During the procedure, a speculum, or lid separator, is used to hold the eyelid open and to prevent blinking. The surgeon has complete control of the laser at all times and, if the need should arise, can stop the procedure until the patient can focus on the fixation light.
9. Will I need glasses after the surgery?
With any medical procedure, there is not a guarantee of perfect vision. Almost everyone experiences improved vision, however, and most see well enough to pass a drivers’ test without corrective lenses. It is important to know that LASIK does not eliminate the need for reading glasses. Beginning at around the age of 40, a condition called presbyopia usually appears, requiring reading glasses or bifocal correction. The laser cannot correct presbyopia at this time; however, there are some promising treatment options on the horizon.
10. How long will I need to take off work?
Most patients return to work within two days. We will examine you on the first day after surgery and determine how quickly you may return.
11. Will LASIK interfere with my lifestyle?
Active sports should be postponed for two weeks or until the eye is fully healed, unless protective eyewear is approved by the surgeon. Swimming, hot tubs and saunas should be avoided, as well. After full recovery, normal activity can resume, and the ability to play sports without glasses makes them more enjoyable for many patients.
12. How long will the correction last?
LASIK is a permanent procedure. In some cases, however, an enhancement procedure may be required. Some patients’ eyes may change throughout their lifetime, which can happen with glasses or contact lenses as well.
13. Is it true that it takes six months to improve vision after LASIK? What about PRK?
Fluctuation can occur, but visual improvement is almost immediate following the procedure. Most patients feel that major fluctuations have stopped after two weeks. At the same time, it may take additional time for all of the swelling in the eye to resolve and fluctuations to cease. Many patients do have healing that, in a minor sense, may continue to improve over six to nine months. PRK more commonly takes 6 months or somewhat longer to attain maximum vision correction.
14. How safe is the procedure? Are there risks?
The procedure is very safe, and that is why it has been so readily accepted. With any surgical procedures, however, there may be complications. Vision-threatening complications do exist, but they are extremely rare. These include infections (an incidence of 1 in 5,000) and irregular healing processes that can lead to something called “irregular astigmatism” that glasses cannot correct and contact lenses or further surgery may be required to improve. There are also complications, which may lead to temporary blurriness, temporary dependence on glasses or contact lenses or a need for additional surgery. In most cases, the patient can still do well and recover with good vision; however it should be known by the patient that serious problems can occur, albeit rarely.
15. What is the success rate?
Success depends on several factors, the most important being the degree of nearsightedness, farsightedness or astigmatism. Depending on the prescription, the surgeon can help determine the likelihood of reaching 20/40 or greater vision. Approximately 95 percent of eyes treated with LASIK reach 20/40 or better vision with one procedure, which is the requirement for driving legally without correction. If a patient does not achieve his or her goal with one procedure, additional correction often improves their vision to a satisfactory level.
16. I am farsighted. Can LASIK or PRK correct my vision?
In the low and moderate ranges, LASIK can treat farsightedness. For high levels of farsightedness, LASIK does not work as well and other refractive procedures may provide a better level of correction.
17. What about astigmatism?
The laser can treat most levels of astigmatism. The laser does this by removing more tissue in one direction of the eye than another to make it more round.
18. I have dry eyes. Is LASIK or PRK still an option?
Many patients who desire LASIK surgery have dry eyes. They have become intolerant of their contact lenses because the dryness makes them uncomfortable. LASIK occasionally worsens dry eyes, but typically, this is temporary and usually treated with frequent artificial tear lubrication. In special cases of severely dry eyes, special punctal plugs that are placed in the lower eyelid tear ducts can be inserted with a significant improvement in dryness. These are easily removed in the office once the dryness resolves, or they can be left in place permanently. Additionally, the prescription eye drop called “Restasis” can be beneficial.
19. I need reading glasses. Can LASIK correct my vision?
LASIK only corrects the distance vision. If LASIK is performed such that distance glasses are not needed, and the patient is over 40, it is likely that they will need to put on a pair of glasses to read. The exception to this is when patients opt to have monovision, when one eye is corrected fully for the distance and the other is left nearsighted. Only about 10 to 20 percent of patients opt to have monovision correction, and it is only recommended in patients who have tried it with contact lenses and liked the results, as there is a slight decrease in depth perception with monovision.
20. Will insurance cover LASIK?
Most insurance companies do not cover LASIK. Some special employee programs, however, do cover a certain percentage. Patients should inquire with their insurance representatives to determine benefits and coverage. Complete Eye Care Inc. offers financing plans to try to make this life-changing procedure as easily attainable for our patients as possible.