Everything You Need to Know About Laser Surgery

What is LASIK?

When we talk about eye surgery we are always invariably referring to LASIK Eye Surgery. Laser-Assisted in SItu Keratomileusis, commonly referred to as LASIK, is a laser-assisted eye surgery which is used to correct refractive errors of the eye. Lasik procedure uses a computerized laser to change the shape of the outer covering of the eye, the cornea. This allows the eye to focus light on the retina so that a clear image can be formed. Lasik is a blessing for those who are virtually blind without the glasses and are highly dependent on the contact lens as the means for avoiding glasses.

Ideal Candidate for Lasik:

You are an ideal candidate for LASIK if you are older than 18, have a stable eyesight or there have been no changes in the eyesight for at least one year. You have blurred vision without glasses and are either short sighted, far sighted with and without astigmatism and low night vision. Being older than 18 is important because before we reach that age, our eyes undergo a number age-related changes that can disrupt the changes brought about by the LASIK within a few months thereby rendering LASIK useless.

Patients with the end scale refractive errors such as short sightedness of more than −10 diopters, far sightedness of more than + 4 diopters and an astigmatism of more than 5 diopters are not considered good candidates LASIK. Some people might even have very thin corneas which also makes them unsuitable to undergo the procedure since it involves removing a small section of cornea further thinning it. There are certain eye diseases that make an individual unsuitable for surgery such as Glaucoma, in which the intraocular pressure in the eyes is raised, Strabismus, which consist of misalignment of the eyes or Herpes infection of the eye.

LASIK – Preoperative Assessment:

At Focal Point Vision (https://focalpointvision.com/), we meet with our patients to assess the need for LASIK and to answer all your questions and queries, so that you will be comfortable with the procedure as well as your surgeon. As part of the preoperative assessment, you will be asked to give a detailed ophthalmological history as well as undergo a complete eye examination. A number of eye test will also be done to look for any eye diseases, size, shape and the thickness of the cornea, as well as measuring the size of the pupil and the eye movements.

LASIK – Procedure:

LASIK procedure consists of anesthetization of one or both eyes undergoing the procedure. After anesthetizing the eye, an eyelid speculum is placed in the eye to keep the eye open for the duration of the procedure. The cornea is marked and the pupil is fixated with a suction ring. After that, a femtosecond laser is used to create a corneal flap. After the creation of the flap, it is moved away from the side. An excimer (ultraviolet) laser is used to reshape the eye centered around the pupil by removing the tissue around the cornea and the raised corneal flap is replaced.

LASIK – Post Operative Care:

The whole procedure, including the preoperative procedure, the surgery itself takes approximately 30 to 45 minutes. Immediately after the surgery the patient might feel mild discomfort for the first 4 to 6 hours and is recommended to close their eyes and rest or take a nap. Patients are also asked to avoid rubbing their eyes and looking directly into bright lights. The patient might also be prescribed antibiotics and steroids for 4 to 10 days. For dry eyes, artificial tears might be used for 2 to 3 months. In the follow up the patients are seen the day after the treatment and then one week later and further on a month later.

Recovery:

A difference can be felt immediately after the surgery and complete correction might take 3 months depending on the degree of refractive error and the amount of the tissue removed. For a higher degree of refractive errors and astigmatism sometimes a retreatment is required after the stabilization of the previous procedure. In this procedure, the flap is lifted again and ablated further. This procedure is known as Enhancement.

What are Refractive Errors?

Refractive errors of the eye are conditions in which the shape of the eye becomes fixed and does not bend the light adequately to form an image on the retina. This consists of 4 type of refractive errors and includes myopia (https://www.aao.org/eye-health/diseases/myopia-nearsightedness), hyperopia, astigmatism, and presbyopia. Myopia, also known as short or near -sightedness is the eye condition in which the near or close objects are clear and the distant objects are blurred. This is because the cornea becomes thick and the image is formed in front of the retina (the eye film) instead of on it.

Hyperopia (https://nei.nih.gov/health/errors/hyperopia) or far sightedness is a condition in which the cornea is too thin and bend light beyond the retina, which is why the far objects appear clear but the near objects appear blurry. Under normal conditions, the surface of the cornea is smooth and symmetrical to bends the light rays at one point on the retina on which a clear image is formed. Astigmatism (https://www.aoa.org/patients-and-public/eye-and-vision-problems/glossary-of-eye-and-vision-conditions/astigmatism) is another one of the refractive errors in which the shape and the surface of the cornea is irregular and therefore the image gets distorted.

Presbyopia consists of the age-related changes in the eye. They are also known as the aging eye condition. The lens in the eyes consists of fibers that are flexible and change while focusing on near or distant objects. As we age these fibers become stiff and do not fully focus on objects thus causing blurred vision. There is no treatment for presbyopia as no treatment and or surgery can halt age-related changes and the individual will require glasses as the vision continues to deteriorate.

Contact Us:

If you have more question about LASIK surgery, visit us at https://focalpointvision.com/laser-cataract-surgery/. To learn more about Focal Point Vision, or to schedule an appointment, please call us at (210) 614-3600.

WHAT IS THE DIFFERENCE BETWEEN CATARACT SURGERY AND LASIK?

At Focal Point Vision, our ophthalmologists, or eye surgeons, are fellowship-trained and perform both cataract and LASIK surgery. Often during the discussion of cataract surgery, a patient asks, “are you going to be doing LASIK on my eyes? What is the difference between cataract surgery and LASIK?”

Essentially, cataract surgery involves removal of the lens and placement of an artificial lens while LASIK involves reshaping of the cornea.

Before we discuss the nuances of each procedure, it is important to review the basic anatomy of the eye. As you can see in the picture below, the cornea is the clear, spherical “front” of the eye, analogous to the windshield of the car.  Behind the cornea is the iris, or colored part of the eye that can open and close depending on the amount of ambient light, and behind the iris is the lens.  The cornea and lens focus light to land on the retina, which works like the film in a camera, changing light into nerve impulses that travel to the brain.

 

Thus, we’re born with a clear crystalline lens that works very well when we are young, expanding and contracting to see both far and near without reading glasses.  Around the age of 45, the lens becomes more rigid and harder to flex, necessitating reading glasses.  As the number of birthday candles increases, the lens gets more rigid and cloudy, and when it becomes mostly cloudy, we call it a cataract. Cataract surgery is an exchange of the cloudy, dysfunctional natural lens with an artificial lens made of acrylic.

On the other hand, LASIK is eye surgery in which we use a laser to reshape the cornea and eliminate the need for glasses or contacts.

Again, cataract surgery involves exchange of the lens, while LASIK involves reshaping the cornea. Both procedures can change somebody’s refractive error, or “prescription,” and lessen the need for reading glasses.

LASIK is commonly performed in patients between the age of 20 – 40, while cataract surgery is more often performed in patients above the age of 55.

Over the past few years, we have started to use a LASIK femtosecond laser at the time of cataract surgery to make incisions, divide the cataract, and treat astigmatism. This is called “laser cataract surgery,” and we will address this in future posts.  Thanks!  James Lehmann, MD.

LIVE LIFE NOW WITH LASIK AND FACE YOUR #FOMO!

Angle closure glaucoma is a serious condition that can, if untreated, lead to permanent vision loss and even blindness. Patients who are at risk for this type of glaucoma have “narrow angles,” meaning the front fluid-filled compartment of the eye is particularly small. Such patients are often far-sighted, or “hyperopic” and at least 1/3 have a family history of a close relative with the condition.

An episode of “acute angle closure” in a patient like this can cause rapid elevation of the pressure inside the eye, with symptoms of a headache, eye pain, eye redness, blurred vision, nausea, and vomiting. Any person with these symptoms should alert an eye care professional as soon as possible, since prolonged elevation of eye pressure can cause severe and permanent damage to the eye.

Focal Point Vision doctors always assess the risk of angle closure glaucoma for each new patient they see, utilizing a variety of tools including special prisms called gonioscopy lenses and an imaging device called an anterior segment optical coherence tomographer (ASOCT). These examination tools help our doctors determine which patients might benefit from a preventative laser procedure known as Laser Peripheral Iridotomy (LPI).

Any patient having an “acute angle closure” episode, and those patients at high risk for such an episode, should have LPI performed. The procedure is done quickly in the office with minimal discomfort, excellent success rate, and extremely low risk to the patient. The laser procedure essentially removes the future risk of angle closure episodes, and should be performed on both eyes, since patients with narrow angles are typically at risk for glaucoma in both eyes. Narrow angle patients who also have cataracts are sometimes treated with cataract surgery, which eliminates the risk of angle closure glaucoma, and improves the vision at the same time.

Don’t hesitate to call 210-614-3600 and make an appointment with the doctors at Focal Point Vision if you or someone you love may have a risk of angle closure glaucoma.