ANSWERS TO COMMONLY ASKED QUESTIONS ABOUT REFRACTIVE SURGERY
1. WHAT IS LASIK?
LASIK (Laser In Situ Keratomileusis) is a surgical method of correcting a broad range of nearsightedness, astigmatism, and farsightedness. It is an outpatient procedure that takes about 15 minutes to perform. During LASIK, a corneal flap is first produced. This is temporarily folded back and the laser is applied to the inner layers of the cornea to reshape it. The flap is then closed and it heals naturally and securely. This procedure can allow patients to reduce their dependence on glasses or contact lenses and in some cases eliminate the need for them.
Custom LASIK involves measuring the eye from front to back, using what's called "wavefront" technology, to create a three-dimensional (3-D) corneal map. The information contained in the map guides the laser in customizing the treatment to your individual visual irregularities, beyond myopia, hyperopia, and astigmatism. This can help in terms of contrast sensitivity and fine detail. There is a reduced risk of post-LASIK complications, such as glare, halos and difficulty with night vision.
2. DO I HAVE OTHER OPTIONS FOR REFRACTIVE SURGERY?
Yes, another option is the Visian Phakic Refractive Lens, which is an implantable artificial lens that is placed in front of the natural crystalline lens of the eye. This lens allows the natural ability to focus the eyes for objects that are close and is an excellent choice for patients younger than 40 with thin corneas, dry eyes, or a high prescription (over 8 diopters of myopia). Patients older than 40 with thin corneas, dry eyes, or a high prescription could be a good candidate for a Clear Lensectomy (also called Refractive Lens Exchange), which is the removal of the natural lens with an implanted artificial lens used to correct the refractive error. Conductive Keratoplasty (CK) is a procedure that creates a slightly nearsighted eye to help with reading on a person with good uncorrected distance vision. This can be simulated with a contact lens in our office to see if adapting to this type of vision will be a problem. Astigmatic Keratotomy (AK) uses small incisions at the edge of the cornea to reshape the eye to reduce astigmatism.
3. AM I A CANDIDATE FOR REFRACTIVE SURGERY?
Good LASIK candidates are at least 21 years old, in good general health, and have no eye diseases such as significant dryness, glaucoma or cataracts, and do not have very large pupils. The thickness of the cornea, which can be measured in our office, is also important because very thin corneas may not be sufficiently thick to allow removal of enough tissue for complete correction of the vision. Good candidates also have realistic expectations about what results to expect. Drs. Whitling and Diehl can give you individual advice as to which (if any) of the refractive surgery procedures would be best for you.
4. WILL I STILL NEED READING GLASSES OR BIFOCALS AFTER THESE PROCEDURES?
The need for reading glasses or bifocals as you get older is a condition called presbyopia and this typically occurs between the ages of 40 and 45. The lens of the eye loses flexibility that makes it difficult to read. The laser has no effect on the focusing muscles attached to the lens. When you have laser vision correction, one eye can be left slightly nearsighted and the other eye can be fully corrected for distance (Monovision). This can allow for short-term tasks such as reading a menu or looking at your watch, but reading fine print or for a prolonged period of time may require additional reading glasses. Gaining this near vision with monovision means giving up some distance sharpness so for some people monovision might be contraindicated.
5. DOES LASIK HURT?
The procedure is comfortable because anesthetic eye drops are used just before the surgery. After the surgery, there may be a foreign body sensation or irritation for the first day, but most patients are comfortable after the first day. Dryness in the eyes can last for several days to weeks.
6. ARE THERE RISKS INVOLVED WITH LASIK?
The chance of a vision reducing complication is generally less than 1%. Dryness is common for the first few weeks after the procedure and is helped with the use of artificial tears and prescription Restasis post-operatively for three months if necessary. Night glare can be a problem for some patients and this tends to decrease to minimal levels within six months. Infection is a possibility but if the prescribed eye drops are used is very rare. Under and over-correction is a possibility, especially with higher prescriptions. Enhancement procedures 2-4 months after the initial procedure often help this problem if it develops. There is a 5-10% chance that an enhancement may be necessary.
7. WHAT IS MY LIKELY VISUAL RESULT AFTER THE PROCEDURE?
Individual results can vary based on the chosen surgical procedure, surgeon and the pre-operative status of your eyes. Drs. Whitling and Diehl can give you an idea as to the results expected or you can call the surgical facility for more information. Well over 90% of all patients with lower prescriptions (less than 6.00 D sphere and 2.00 D astigmatism) will end up with 20/40 vision and approximately 85% of patients having custom LASIK with Intralase will have 20/20 or better uncorrected vision after the procedure. The percentage of persons needing an enhancement varies. Please call or discuss this with the surgical center.
8. WHAT KIND OF FOLLOW-UP CARE WILL BE NEEDED?
Follow-up care and eye medications are just as important to your results as your actual procedure. Drs. Whitling and Diehl can perform this care. Periodic examinations are required to ensure that your eye is healing as expected and that there is no evidence of infection or complications and also to measure your visual progress. After LASIK, patients are usually seen for appointments the day after the procedure and at 1 week, 2 weeks, 1 month, 3 month, 6 month, and 1 year. If an enhancement procedure is performed this schedule is started again.
9. WHAT OPTIONS DO I HAVE BESIDES REFRACTIVE SURGERY?
Besides the obvious option of eyeglasses, daily wear and extended wear contact lenses are available for most ocular conditions. Recently, extended wear contact lens material have been greatly improved and there are some contact lenses that can be worn for up to 30 days without removal. These lenses have much less risk than previous extended wear contact lens designs.
10. WHAT IS THE COST?
The total cost of the procedure varies depending on the doctor and clinic actually performing the procedure. As of April 2014, the cost of LASIK, Custom LASIK, PRK and CK is $2,100 per eye at Laurel Eye Clinic in Brookville, PA. Bladeless LASIK is $2,500 per eye. There is no additional SURGICAL FEE if an enhancement is required in the first year, however, because more post-operative visits will be necessary, a $100 co-management fee will be assessed to the patient. The surgical fee for refractive lens exchange (RLE) or implantation of the Visian refractive lens (ICL) is $ 4,400 per eye. This fee would also include a LASIK touch-up if needed after the surgery. These fees are subject to change at anytime. Please contact the Laurel Eye Clinic directly with additional questions on pricing and financing options.
The pre-operative examination typically takes about one hour and includes a refraction to determine your current glasses correction, a dilated examination to check the health of the eyes, tests for dry eyes, corneal mapping to give a very accurate curvature reading of the cornea before the procedure, corneal thickness measurement (if it has not already been done), and measurement of your pupil size. We also discuss completely what to expect before and after your surgery.
Each of the post-operative visits includes an assessment of the eye health, a refraction to determine any residual refractive error, and regular corneal mapping to check for irregularities in the cornea. Reports will be sent to the clinic where the procedure was performed after each visit. There are typcially six scheduled post operative visits at regular intervals over the course of the year following your surgery. However, this plan may be altered by the doctor on an individual basis.
11. IS THE PROCEDURE COVERED BY INSURANCE?
Most insurance companies do not cover refractive procedures but you can check with your insurance provider. If your company has a flexible benefits program or if you have an HSA, refractive procedures can usually be included.
12. WILL MY ACTIVITIES BE RESTRICTED AFTER REFRACTIVE SURGERY?
Many patients can return to work the next day others may take up to a few days. Normal activities can be resumed quickly except that you will not be able to swim, go in a hot tub, wear eye makeup, be in a dusty environment, or rub your eyes for one week. It is a good idea to avoid contact sports for about a month.
13. WHERE CAN I GET MORE INFORMATION?
Dr. Whitling or Dr. Diehl will be happy to answer any questions you have. Please visit the LASER Vision Centers by clicking on the links below to get specific information on their clinics.
Laurel Eye Clinic www.laureleye.com
TLC LASER Eye Centers www.tlcvision.com