What keeps the flap down following the procedure?
The first effect that helps the flap stick is called capillary action (similar to putting a piece of cellophane on a drop of water on a window). Following this, the flap is subjected to a suction gradient across the cornea, created by the endothelium, which is constantly pumping fluid out of the cornea. During the first 24 hours, the flap edges heal over, restoring more strength. And finally, molecular adhesions form between the epithelium and stroma over the following month.
Will I experience nighttime starbursts or halos?
Nighttime starbursts and halos around lights occur when light is scattered from the peripheral edge of the laser zone through a pupil which is enlarged due to dim illumination. The larger the nighttime pupil and the larger the treated prescription, the more chance that one will experience these side effects and the more obvious they might be. Routinely, most patients experience a month or two of mild nighttime starbursts and halos. For those with larger pupils or higher prescriptions, an enlarged laser zone is used to minimize these effects. Ultimately, we will turn away some patients whose risk of having debilitating nighttime symptoms is too great.
Should I wait for new technology?
As we all know, there will always be something new and better coming along. So the simple answer is that if you want to wait for new technology, you will wait the rest of your life. Thus, one needs to consider the potential benefits of waiting for new technology versus the drawbacks of not getting to enjoy the freedom from glasses and contact lenses as one waits. If we choose excellent candidates, today's technology will allow great results. So if you are a good candidate today, there is no need to wait. Future technology will allow us to successfully treat those who are not good candidates today.
Will I experience dry eyes after the procedure?
Patients have different risk in experiencing post-operative dry eye. Typically, most patients experience mild dryness of the eyes (usually upon awakening or after extended reading) for a month or two. Artificial tear drops are usually all that is needed to relieve these symptoms. Patients with pre-operative dry eyes are treated aggressively before surgery to help minimize their dry eye symptoms following surgery. Occasionally, patients are turned away because their eyes are too dry for the procedure.
What if my cornea is not thick enough?
LASIK is specifically designed to help those who have corneas that are too thin for LASIK. It is extremely unusual to have corneas that are too thin for LASIK.
Can I go blind?
This question is in the back of everyone's mind who is undergoing this procedure. While the answer is "yes", the odds are extremely remote. The cause would be from an infection that went untreated. We make elective decisions every day that involve risk: driving a car, walking on a sidewalk, flying in an airplane, getting a cavity filled. We know that the benefit of these activities far outweigh the chance of something bad happening. Deciding to have LASIK is similar. One must weigh the benefits of seeing without the aid of contact lenses or glasses versus the very rare event that one gets an infection and that it goes untreated. As a reference, the chance of getting an infection following LASIK is less than that if one wears extended-wear contact lenses.
Does a person's age have any relevance?
Typically, we would not recommend anyone younger than 18 years old having the surgery, as their eyes are still growing. There is no upper age limit, as long as one's eyes are still healthy. However, older age groups do tend to experience a little longer visual recovery and have to consider strategies to correct their reading vision (see below).
What happens if I need cataract surgery when I get older?
Having vision correction surgery today will neither promote nor prevent the development of cataracts. Should one develop cataracts in the future, cataract surgery could be performed just as it would on someone who had not had previous vision correction surgery.
What are my chances of seeing 20/20 following the procedure?
Visual outcomes have several determinants, including age, level of prescription, best-corrected vision with glasses prior to surgery, and how one's cornea responds to the treatment. While most quotes you hear are for 20/40 or better vision, most patients seem to be happy only with uncorrected vision of 20/25 (one line bigger than 20/20) or better. Many patients can in fact reach 20/15 vision, which is better than 20/20. Unfortunately, there is no 20/20 button on the laser to push. We work very diligently on getting your best prescription prior to treatment, and this is what we program into the laser. In general, the older the age and the higher the prescription, the lower the chance of getting to 20/25 or better with the first treatment (see enhancement below). In the majority of patients this chance is not lower than 90%. And in many it is even higher than this. Also, one needs to realize that if they do not see 20/20 with their best glasses prior to surgery, they will not be able to see 20/20 following surgery.
What does 20/20 mean?
In simple terms, 20/20 is what most normal eyes see. The "20" means 20 feet, the normal testing distance of an eye chart. It makes more sense when you compare it to an eye that does not see this well, for example 20/40. The smallest detail that a 20/40 eye can see from 20 feet away can be made out by a 20/20 eye standing 40 feet away.
When can I go back to work?
Typically, it takes a day or two to obtain functional vision following LASIK. While some patients can go back to work the next day, most feel more comfortable waiting a few days. As far as activities, one just needs to be careful not to get the eye hit for a few weeks. Thus, while jogging, biking, and lifting weights are fine beginning the next day, one must avoid contact sports in this healing period.
When can I fly following my procedure?
Altitude has no effect on the vision or the healing of the eye after LASIK. So, you can actually fly the next day if you like. However, be aware, that the air blowing from the vents above you may make your eyes feel more dry. Just bring your teardrops with you.
If I had to, would I be able to wear contact lenses following LASIK?
Theoretically there is the possibility that one might not be able to wear contact lenses comfortably after having had LASIK, due to the shape change of the eye. However, in practice, this is very rare. Additionally, in nearly all cases, if one felt the need to still wear contact lenses to improve vision, we can usually similarly improve vision with an enhancement.
Will I have to wear reading glasses after my treatment?
If you are 40 or younger, you will not need reading glasses after your treatment. You will, however, need them at some point in the years to come. After the age of 40, if you treat both your eyes for clear distance vision, you will immediately need reading glasses. For patients in this age group we present the option of monovision and let them try it out prior to surgery. In monovision, the dominant eye is corrected for clear distance vision, while the other eye is corrected for better near vision. While it may sound strange to some, at least half of the patients in this age group test well with the monovision and elect to have it performed in the surgery.
I am very nervous about the procedure. Can you just knock me out?
While everyone is nervous on the day of treatment, certainly some are more nervous than others. While being knocked out sounds like a good option for the very nervous, we would not be able to perform the surgery without you being alert. We need your concentration on the fixation light during surgery. Your fixation helps to keep the laser treatment centered on your visual axis. We do offer Valium to help patients relax prior to surgery.
How long will the effects of the surgery last?
As far as we can tell, the effect of LASIK is permanent. However, if one's eye is still growing and changing, some of the effect may be lost. Typically, the eye, just like one's feet, stops growing at a certain age. The age that this occurs is different for different people, but usually occurs in the early twenties. At that point, one can wear the same prescription from year to year, short of some minor fluctuations that occur about a baseline prescription.
I am planning on getting pregnant in the future. Should I wait till after I deliver?
While there is theoretical information to suggest that the hormone changes of pregnancy may alter the corneal curvature and therefore the prescription, this in fact is uncommon. In addition, the same information also suggests that once the hormone status returns to normal, so should the prescription. Thus, any potential prescription changes during pregnancy should reverse back to normal following pregnancy. Thus, one need not wait till after pregnancy to enjoy LASIK. Indeed, those early morning hours with the new baby might just be a little more tolerable if you don't have to find your glasses or put on contact lenses.
How do I choose a surgeon to perform my LASIK?
Choosing your surgeon is a very personal decision. For most, surgeon qualifications take priority. Salient features include a refractive surgery fellowship (advanced subspecialty training in LASIK and other refractive surgeries), practice devoted exclusively to refractive surgery (no general eye care), many thousands of surgeries performed, performing the most state-of-the-art refractive procedures, and ownership (and not renting) of the latest equipment. Beyond that, it becomes a matter of preference in what one likes in a doctor to make them feel comfortable: Do you like to see your doctor running advertisements in the newspaper, or do you prefer a more professional approach? Do you like to meet your doctor for the first time on the day of your treatment, or do you prefer to meet him prior to surgery, when you can have all your questions answered and become comfortable with him as a person?
Why is there such a broad range of prices offered?
As much as some of us hate to think about it, LASIK is a commercial field. The offered price is purely of economical determination: how many surgeries that surgeon currently performs and what is his desired volume, how much money that surgeon wants to make, what is the practice overhead, how much money is put into advertising, whether the surgeon own his own equipment or rents it, how many duties the surgeon delegates to other persons, reputation of the surgeon (i.e. word-of-mouth referral business), and whether someone is just starting out and needs to increase their business. If you are someone who is price-sensitive (as many of us are to one degree or another), you need to consider all this information along with the surgeon qualifications and the feeling you get about the surgeon after meeting with him. Only after such research can you feel confident about your choice of surgeons and price.