LASIK is the general catch-all term for laser eye surgery. However, there are currently three primary types of laser surgery for vision correction: conventional LASIK, Epi-LASIK and IntraLase LASIK (or IntraLASIK).
Candidates
Not all people are good candidates for a LASIK treatment. In fact, most eye surgeons turn down or advise a different treatment to their prospective patients. Thankfully, patients who may not be suitable for one kind of laser surgery may be good candidates for another. For conventional LASIK treatment, the ideal candidates are those above 18 years of age and have a stable lens prescription for at least 2 years, have sufficient corneal thickness, and do not suffer from any disease. Most disqualifications for a LASIK procedure are due to insufficient corneal thickness, a problem that is addressed by Epi-LASIK (does not create a corneal flap) and IntraLase LASIK (can make more exact cuts and adjustments).
Ensuring Safety
All patients are required to take a preoperative test to ensure their suitability for a treatment (of any type). The test is conducted by a qualified surgeon and staff. The quality of the surgical tools, especially the laser machine, is continually checked for optimal delivery. Doctors also ensure that the procedure is performed in an operating room with a controlled environment, including having a constant temperature and humidity. If necessary, different excimer laser platforms are used to ensure exact treatments are provided in each eye. Patients should make sure that their doctor can provide these to achieve the desired results with the smallest chance of complication.
Procedure
All operations are performed with the patient awake and mobile. The patient may be given a mile sedative and anesthetic eye drops to reduce discomfort from the treatment. The eyelids will be held so that the patient does not blink, while a tracker locks on the pupil so the lasers are pulsed accurately. In conventional LASIK and IntraLase LASIK, a corneal flap is created using a metal blade or laser; in Epi-LASIK, the epithelium is removed using an oscillating blunt blade without cutting any flap. The cornea stroma is then remodeled using the excimer laser – this corrects the patient’s vision. After this, the corneal flap is carefully repositioned over the treatment area, or the epithelium is covered with a special contact lens to protect it and allow it to heal.
Post-Operative Care
To verify that the treatment is working, the patient is requested to have post-operative appointments with the doctor. This is normally done on the day after the procedure, after a week, a month, three months and six months. In conventional LASIK and IntraLase LASIK, the patient can return to normal activities after a night’s recovery, but an Epi-LASIK patient may have to heal for 3 to 7 days. Patients are usually given a course of antibiotic and anti-inflammatory eye drops to help them with any side-effects of the procedure. Other measures are also subscribed by the doctors to ensure that complications are avoided and patients heal with the least discomfort possible.
Side Effects & Complications
Any type of laser eye surgery – as do all types of surgical procedure – carries some risks, although complications are considered rare. In general, Epi-LASIK is safer than conventional LASIK and IntraLase LASIK, although occasional complications have been observed. Diffuse lamellar keratitis (DLK), an inflammation beneath the corneal flap, is the most common side-effect of conventional LASIK and IntraLase LASIK. It is treated with anti-inflammatory eye drops, and gradually fades over 1 to 2 weeks. Epithelial ingrowth, like DLK, can also only occur in flap procedures. It happens when the epithelium is transferred underneath the corneal flap.
Side effects that result from all types of laser eye surgery include dry eyes, over- or under-correction, and glare and halos. Dryness in the eyes gradually resolves over four months; it is commonly treated with artificial tears. Even with accurate measures, the variability in biological tissues can lead to under-correction or over-correction. Minor mis-corrections are often unnoticeable, but major ones may require a secondary treatment. Glare and halos, which occur even in perfect, untreated eyes, sometimes worsen after a laser eye surgery. Haze is only observed in flapless procedures, such as Epi-LASIK. Most haze is of no visual significance. Pain and light sensitivity is also typical during the first few days after an Epi-LASIK procedure.
Statistics
Despite its side effects and possible complications, eye laser surgery is considered generally safe – even safer than most other types of surgical procedures. In one survey of the procedure by the U.S. Food & Drug Administration (FDA), 99% of patients reported their “quality of life as expected, better, or much better”; 91% reported “no complication at any time”; while 7% reported “complications seldom problematic” (although of these 91% said they would still have the surgery again).
In 2009, Dr. Kerry Solomon and colleagues conducted a comprehensive study, using over 1,500 articles from 20 countries, which showed that 95.4% of patients who has undergone any kind of LASIK procedure from 1988 to 2008 were “satisfied or very satisfied” with the results. Complications are always possible in any type of surgery, including LASIK. This is why it is important for anyone considering a LASIK procedure to understand the potential complications and side effects so you can make an informed decision.
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