Important Information About the LASIK Procedure

Thank you for choosing Terry Alsheikh Eye Associates to perform your LASIK procedure. While the complexity of the LASIK procedure requires extensive training and a surgeon’s skill, the rate of complications is very low. We have years of experience in training that allow our skilled team of surgeons to safely and effectively perform your procedure.

We have been working with the excimer laser since the 1990s and have successfully completed thousands of LASIK procedures. We are prepared to ensure a successful outcome for your LASIK procedure.

As with any type of refractive surgery, LASIK does not have guaranteed results, although the success rate is extremely high. Some complications and side effects do happen in a small percentage of patients. In addition, surgeons and the equipment are not always perfect so we cannot give you the perfect eye with LASIK surgery. The goal through LASIK surgery is to provide you with a much better eye than you currently have. While we cannot promise results, we can show you statistics on the chances of improved vision once you have the procedure versus what will happen to your vision if you do not have the procedure. We do the very best we can with the latest technology available. After the procedure, you may need to wear glasses for a short amount of time until your vision adjusts, or for the natural loss of near vision for those over 40.

FDA Approval

The FDA has approved the excimer laser as well as the microkeratome, which is the instrument that creates the flap on the cornea. Both of these are used during LASIK surgery. The FDA has conducted many clinical studies throughout the nation to further expand the treatment parameters of the approved lasers. Currently, the parameters are so wide that it is rare a patient is not a candidate for LASIK surgery.

Post-Operative Side Effects

Topical eye drops provide anesthesia during the procedure making LASIK basically painless. Patients have reported experiencing some pressure when the suction ring is applied, which lasts for about 30 seconds. The healing time for the corneal flap is four hours and patients will experience tears, burning, or it feels like there is something in your eye. During this time, it is best to lay down with your eyes closed.

After the procedure, your eyes may be a little more sensitive to light during the first couple weeks. You may experience a glare during the day or night, but note this is only temporary.

Overcorrection

As with all refractive surgeries, you may experience a mild overcorrection. This will diminish over the coming weeks to months. In less than 1 percent of patients, a permanent overcorrection does occur. This can be fixed with contact lenses, glasses, or with LASIK surgery.

Ghost Images

While the cornea is healing, patients may experience a wavy configuration which distorts images. This wavy vision is known as ghost images or sometimes called double vision. The surface waviness goes away within a year. If for some reason it does not, gas permeable contact lenses can alleviate these symptoms. While wearing these contact lenses, the distorted images will not be noticeable; however, once the lens is removed the images will reappear. Only a small number of patients need to wear gas permeable contact lenses after a LASIK procedure as this outcome is rare.

Night Vision

Halos around bright lights are common following the LASIK procedure. This can last several weeks but usually diminishes after several months. Another thing patients have noticed after the LASIK procedure is a decrease in night vision quality.

Dry Eye

Dry eye is common following LASIK and the symptoms normally clear up within the first few months. For patients with persistent symptoms, artificial tears can be provided to make you more comfortable.

Subconjunctival Hemorrhages

Small blood vessels that have been broken on the whites of the eye is called subconjunctival hemorrhages. This condition happens because of the suction ring applied to the eye during the LASIK procedure. They are usually painless and do not cause any problems. They are gone within two weeks following the procedure.

Enhancement Procedures

Touch-ups or enhancements may be necessary after the LASIK procedure. If you experience regression, induced astigmatism, or under-correction, an enhancement may be needed. The higher your prescription is, the more likely you will need an enhancement. For example, a -13.00 diopter myope has a 30-40 percent enhancement rate. An astigmatism slightly increases the enhancement rate, especially for corrections over 3.00 diopters. Rarely the LASIK surgery will create astigmatism where none had existed before. This induced astigmatism can be reduced with a second LASIK procedure.

Enhancements are considered when the spherical component or astigmatic component are greater than 0.75 diopter. Anything less than 0.75 has too much of a chance of over-correction.

Enhancements are normally performed within 12 months of the original procedure and are completed at no additional charge. A full exam will be done to determine the necessity, and degree, of enhancement needed. Some enhancements can be performed after four to six months from the original LASIK date. Consult with Dr. Alsheikh for the correct time frame of your enhancement.

Infection

An extremely rare complication of refractive surgery is infection. Viruses and bacteria can leave scars on the cornea that can become uncomfortable. Dr. Terry will provide you with antibiotic and anti-inflammatory eye drops after the LASIK procedure. By following the instructions exactly, the incidence of infection is less than 1 per 3,500 cases.

Decrease in Vision

With LASIK surgery, there is a 0.5-2.0 percent chance of reduced correctable vision, with the highest risk in the myopic corrections over -7.00 diopters. Corneal haze is an incident that is very rare with LASIK, but causes a total loss of vision. All refractive surgery has some decrease in subtle shades of gray, also known as contrast vision. Rarely will a patient notice a significant decrease. In addition, some patients notice a decrease in their night vision which improves over a two year period.

Complications During the Operation

Complications during the operation are uncommon but can include the following:

  • Inability to seat the suction ring and/or inadequate suction
  • Incomplete microkeratome pass or irregular flap

These complications may prevent LASIK surgery from being completed or cause an inadequate flap on the eye. Rarely this could cause an astigmatism or inadequate correction. If this happens, the procedure will be rescheduled within three months.

Even more unusual is the creation of the cap, which requires suturing to be put back in place, or the loss of the cap. If the cap is completely lost, a partial or full-thickness corneal transplant will be required. After these procedures, vision without glasses or contacts is generally poor.

Laser-related complications can include decentered ablation (the treatment area is decentered) or the improper focus on the target. These complications can cause astigmatism and under correction, which require another LASIK procedure to correct it. It could also result in the loss of the best correctable visual acuity with the patient needing to wear gas permeable contact lenses.

Post-operative complications are uncommon but can include debris under the flap. This can be of no consequence, except in rare situations it may have to be irrigated underneath the flap. Another uncommon complication is a dislocated flap or folds in the flap. These will need to be lifted and replaced. Rarely epithelial growth (growth of the corneal surface epithelium beneath the flap) happens which requires the flap to be lifted and the epithelium to be removed. This procedure is relatively easy and can be performed several months after LASIK. Even more rare is when melting of the cornea from the epithelial in growth happens. This can be a serious problem as the growth must be removed and may need suturing of the flap. The other types of complications include: corneal haze, significant overcorrection, and irregular astigmatism. These are all rare complications of LASIK procedures.

Sources:

http://www.medicinenet.com/lasik_eye_surgery/page8.htm

http://www.allaboutvision.com/visionsurgery/lasik.htm

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