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Article

Uncovering The Mysteries of LASIK Surgery

July, 2010

Series 1

Peter T. Brazis III, M.D.

Are you, or someone you love, tired of dealing with eyeglasses and contact lenses? Do all the articles and ads for LASIK vision correction make you curious but confused about its possibilities?

Every day patients come to our clinic wanting to know about LASIK. Despite the barrage of media attention, many people still don't understand what LASIK is, what it can do, what it can't do and how it compares with other corrective techniques.

 There are many reasons to consider vision correction surgery. Some patients come to us because they can no longer wear contacts and they do not want to deal with glasses that fog up, fall off, scratch and break. Both glasses and contacts can limit career choices, since some professions require 20/20 eyesight. Those with active lifestyles might find corrective lenses make contact sports and other activities such as scuba diving awkward or difficult. There also are a number of safety issues since frames and thick lenses interfere with peripheral vision, and contacts can irritate eyes if dust gets under a lens, or a person has dry eyes or allergies.

The Eye At Work

To understand LASIK, it's important to understand how the eye works. The cornea takes the light that enters it and focuses it onto the retina in back of the eye. The shape of the cornea determines whether a person is nearsighted, farsighted, has astigmatism or enjoys normal vision.

 In LASIK (shorthand for "laser in-situ keratomileusis) procedures, the surgeon uses an FDA-approved excimer laser to reshape the front surface of the eye (the cornea) to allow images to focus properly on the retina. This reshaping is accomplished when the laser emits pulses of cool ultraviolet light to remove microscopic amounts of tissue from the cornea.

 Although LASIK was approved for use in this country in 1996, it has been performed around the world since 1991. Millions of people have had successful LASIK procedures.

Corrective Surgeries Vary

The LASIK laser treatment itself takes approximately 60 seconds or less depending on the amount of correction needed. It is pain free and performed on an outpatient basis. Patients are awake and comfortable throughout the surgery, thanks to a few drops of topical anesthesia. When they leave the surgical center their vision may be a little blurry but most patients generally return to work within 24 hours.

 Over the years, two other types of procedures have also been used to surgically restore irregularities of the cornea. Radial keratotomy (RK) is the oldest technique in which the surgeon uses a scalpel to make manual incisions to reshape the center of the cornea. In another procedure called photorefractive keratectomy (PRK), the surgeon removes a thin layer of the eye's outer membrane. Then a computer-guided laser vaporizes tissue on the cornea, correcting the irregular eyesight.

 Instead of scraping the outer membrane, as in PRK, the LASIK surgeon uses a motor-powered blade to create a hair-width flap of the cornea. The flap is folded back, the laser remolds the cornea, and the flap is put back into place; stitches are not needed.

Since cutting causes less trauma than scraping, the cornea heals almost immediately with LASIK. Vision is fully restored in a day or two versus several months with PRK.

 While RK, PRK or LASIK can be successful in correcting average nearsightedness, farsightedness or astigmatism, LASIK is the preferred treatment for extreme nearsightedness. This is because the healing process with PRK can interfere with overall results of this correction.

 LASIK Does Not Mean 20/20

The American Academy of Ophthalmology and surgeons practicing under its guidelines are very clear about telling prospective LASIK patients that all refractive surgery, including LASIK, is performed with the purpose of helping patients minimize their need for glasses and/or contact lenses. There is no guarantee that surgery will provide 20/20 vision. Therefore, patients should only undergo laser vision correction with the expectation of improved eyesight and not perfect eyesight.

 Having made this disclaimer, statistics tell us that 94% of LASIK patients do achieve visual acuity of 20/40 or better without glasses. This is good enough to pass a drivers license exam. Even better news is that 58% of the time patients' vision is 20/20 following LASIK surgery.

 As you might imagine, choosing the right surgeon for your LASIK procedure is critical since these lasers can cause true harm in the hands of inexperienced doctors. In our next column we will discuss how a surgeon should be interviewed, what should be expected from a competent surgical facility and the guidelines used by leading doctors to evaluate LASIK candidate patients.

 About the Author

Peter T. Brazis III is the corneal specialist at Wheaton Eye Clinic, Co-director of Corneal Services and Assistant Clinical Professor of Ophthalmology at Loyola University Medical Center and consultant at Hines Veterans' Administration Hospital. A pioneer in refractive surgery, Dr. Brazis performed the first radial keratotomy in Illinois in 1980 and has been performing surgery for nearsightedness longer than anyone in Illinois. Learn more ...