Whenever I read or hear about LASIK eye surgery, I get a little squirmy. The idea of the procedure, in which a laser is used to reshape the cornea under a small flap made in the eye’s surface, makes me viscerally uncomfortable. But then again, I have a thing about eyes—I also can’t watch people put in contact lenses.
My issue with laser eye surgery is no big deal, though, since I’m working with a minor nearsightedness that only requires prescription glasses for driving and movie-theater viewing. If my measure of visual acuity were any worse, however, LASIK would probably become a serious consideration. Some form of more significant vision correction is definitely in my future, as it is for most people.
To get over my phobia sooner rather later—and answer some common questions of prospective patients—I decided to become as knowledgeable about LASIK eye surgery as one can be without an MD. (Or an ophthalmology residency. Or the experience that comes from performing hundreds of such procedures. There’s only so much time in the day, you know.)
First things first, how does LASIK work?
You’re in luck, we’ve already done an article about the eye surgery’s mechanics, plus a video showing what the procedure looks like. Basically, the laser precisely vaporizes microscopic amounts of corneal tissue to reshape the curvature of the cornea based on your precise prescription. The goal is to create a shape that better focuses light onto your retina, which improves vision.
If you are nearsighted, LASIK flattens your too-steep cornea; if you are farsighted, your too-flat cornea is shaped to be steeper.
How do you know if you’re a candidate for LASIK?
A doctor will determine whether you’re qualified for the procedure. LASIK treats nearsightedness, farsightedness, and astigmatism—to a certain point. Generally, if you have healthy corneas of normal thickness, most doctors treat nearsightedness of up to -9D or -10D or farsightedness of up to +4D or +5D (these are similar to the prescriptions that appear on your contact-lens boxes). Those with higher prescriptions might be candidates for other forms of vision correction.
There are a few conditions that could prevent you from being qualified for LASIK eye surgery, including thin corneas, chronic dry eye, glaucoma, cataracts, eye infections or injuries, and autoimmune disorders. While some of these will merely delay your surgery until they’re treated, others will disqualify you altogether. If you’re pregnant, breastfeeding, or taking medication that affects your vision, you’ll have to wait until your vision stabilizes.
LASIK cannot treat presbyopia, or age-related farsightedness, which generally starts to occur around age 40. It’s not uncommon to need reading glasses even if you’ve had LASIK.
What sort of results can you expect? Is it permanent?
“More than 90 percent of people who have LASIK achieve somewhere between 20/20 and 20/40 vision without glasses or contact lenses,” according to the American Academy of Ophthalmology. Results can be seen in a couple days, but your optimal vision improvement is realized about 3–6 months after the surgery.
Even with those extremely good odds, don’t go in with unrealistic expectations. LASIK is intended to help you perform most everyday tasks without additional vision-correction measures. You still might need to wear glasses or contacts for nighttime driving and similar activities.
The AAO also reports that about 10.5% of LASIK patients in the US require a second treatment—or enhancement—to achieve the desired results. This is more common in those who required more intensive vision correction to begin with. (So no, we can’t call LASIK a permanent solution, though it’s a highly effective one.)
Should you do anything to prepare before the surgery?
Again, a doctor will advise you of their recommendations, but in general:
Stop wearing contact lenses and switch to glasses a few weeks before. Contacts can affect the cornea’s shape and cause inaccurate measurements.
Don’t wear eye makeup, facial lotion, or perfume on the day before and the day of your surgery. You might want to skip the eye makeup for a while afterward.
Arrange for transportation. LASIK is an outpatient procedure, but your vision will be too blurry afterward to drive yourself home.
What does it feel like? Is LASIK painful?
The entire surgery takes about 30 minutes or less for both eyes. You can be given medicine to help you relax—sounds like an option for me—and numbing drops are placed in your eyes. After that, you’ll likely feel some pressure from the suction ring used before the corneal flap is created. Your vision might briefly dim. You won’t feel the laser itself, but you may detect an odor similar to burning hair as the corneal tissue is ablated. (There goes that irrational squirmy feeling … .)
Afterward, you’ll likely experience itching, burning, and watering for about 4–6 hours, and your vision will be blurry. These symptoms can be eased by pain medication or eye drops from your doctor, and most patients choose to sleep after the procedure so they don’t focus on the discomfort.
Are there other vision-correction options besides LASIK?
There are! PRK, or photorefractive keratectomy, is similar to LASIK eye surgery. The primary difference is that there is no corneal flap created during PRK; instead, the cornea’s entire outer layer is removed. This leads to a longer, more painful recovery time, but the end results are similar, plus the method is suitable for those with thinner corneas or those who would be at risk for flap complications if they got LASIK. (That latter group includes people who are heavily involved in activities where they could be hit or poked in the eye.)
Implantable contact lenses are another option. They work to correct nearsightedness exactly like regular contacts, except from within your eye, rather than on its surface. (Clinical trials are ongoing for approval to treat farsightedness.) Implantable lenses are good for patients who are too nearsighted to qualify for LASIK or PRK as they can correct up to -20D of nearsightedness.
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