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All About LASIK Eye Surgery

• New Guidelines for LASIK Surgery
• Learning About LASIK
• What to expect before, during, and after surgery
• LASIK Surgery Checklist

New Guidelines for LASIK Surgery

Here are some new guidelines for consumers considering LASIK surgery to correct blurry vision that were published in June 2002. Please consult your eye care professional for further information or clarification.

Profile of the Ideal Candidate:

• Over age 18 with a stable prescription for glasses or contact lenses for at least two years.
  
• Has a thick cornea.
  
• Doesn't have vision too bad for today's lasers to treat. LASIK is approved for nearsightedness up to minus-12 diopters; astigmatism up to 6 diopters; and farsightedness up to plus-6 diopters. A diopter is a precise measure of vision error; a 1- diopter blur drops someone from 20/20 vision to roughly 20/40.
  
• Has no other eye diseases or conditions that hinder surgical healing, such as certain medications or autoimmune disorders.
  
• Is fully informed about the surgery's risks, and that they may still need to wear glasses or contacts.

The Less-Than-Ideal Candidate, who may still choose LASIK but must understand the risks:

• Has dry eyes, which the surgery may seriously worsen.
  
• Is being treated with steroids or other drugs that delay healing, or has other diseases that do the same.
  
• Has a scarred cornea.

Not A Candidate:

• Has cataracts, glaucoma, corneal diseases or a thin cornea or certain other diseases that affect vision.
  
• Has unrealistic expectations. Candidates must understand there is a risk of serious vision-altering side effects.
  
• Anyone who is under 18, has unstable vision, is pregnant or nursing, or had ocular herpes within the last year is temporarily not a candidate but might be treated later.

Every potential candidate must undergo comprehensive eye exams that could rule out surgery. Ensure your exam includes:

• A history of vision, including past eye disease or injury, and amount of correction needed.
  
• A discussion of contact lens use. Contacts change the cornea's shape, and thus cannot be worn for at least three days, and sometimes for several months, before LASIK.
  
• Mapping the cornea's shape and thickness. Zapping a cornea that is too thin or has too few cells lining its back surface can seriously harm vision. Irregularities in shape also can produce poor outcomes. Accurate shape measurements are vital to determining how much correction to attempt and where to aim the laser.
  
• Measuring pupil size in both dim light and room light. People with large pupils are more prone to glare and other problems, particularly with night vision, after surgery.
  
• Dilating the eye to examine the retina, optic nerve and surrounding blood vessels for disease. Other exams must ensure eye muscles, eyelids and the eye's outer surface are healthy, and rule out cataracts and glaucoma.

Learning About LASIK

LASIK is a surgical procedure intended to reduce a person's dependency on glasses or contact lenses. The goal of this Web site is to provide objective information to the public about LASIK surgery. See other sections of this site to learn about what you should know before surgery, what will happen during the surgery, and what you should expect after surgery. There is a glossary of terms and a checklist of issues for you to consider, practices to follow, and questions to ask your doctor before undergoing LASIK surgery.

LASIK stands for Laser-Assisted In Situ Keratomileusis and is a procedure that permanently changes the shape of the cornea, the clear covering of the front of the eye, using an excimer laser. A knife, called a microkeratome, is used to cut a flap in the cornea. A hinge is left at one end of this flap. The flap is folded back revealing the stroma, the middlesection of the cornea. Pulses from a computer-controlled laser vaporize a portion of the stroma and the flap is replaced.

What should I expect before, during, and after surgery?

What to expect before, during, and after surgery will vary from doctor to doctor and patient to patient. This section is a compilation of patient information developed by manufacturers and healthcare professionals, but cannot replace the dialogue you should have with your doctor. Read this information carefully and with the checklist, discuss your expectations with your doctor.

Before Surgery

If you decide to go ahead with LASIK surgery, you will need an initial or baseline evaluation by your eye doctor to determine if you are a good candidate. This is what you need to know to prepare for the exam and what you should expect:

If you wear contact lenses, it is a good idea to stop wearing them before your baseline evaluation and switch to wearing your glasses full-time. Contact lenses change the shape of your cornea for up to several weeks after you have stopped using them depending on the type of contact lenses you wear. Not leaving your contact lenses out long enough for your cornea to assume its natural shape before surgery can have negative consequences. These consequences include inaccurate measurements and a poor surgical plan, resulting in poor vision after surgery. These measurements, which determine how much corneal tissue to remove, may need to be repeated at least a week after your initial evaluation and before surgery to make sure they have not changed, especially if you wear RGP or hard lenses. If you wear:

• soft contact lenses, you should stop wearing them for 2 weeks before your initial evaluation.
• toric soft lenses or rigid gas permeable (RGP) lenses, you should stop wearing them for at least 3 weeks before your initial evaluation.
• hard lenses, you should stop wearing them for at least 4 weeks before your initial evaluation.

You should tell your doctor:

• about your past and present medical and eye conditions
• about all the medications you are taking, including over-the-counter medications and any medications you may be allergic to

Your doctor should perform a thorough eye exam and discuss:

• whether you are a good candidate
• what the risks, benefits, and alternatives of the surgery are
• what you should expect before, during, and after surgery
• what your responsibilities will be before, during, and after surgery

You should have the opportunity to ask your doctor questions during this discussion. Give yourself plenty of time to think about the risk/benefit discussion, to review any informational literature provided by your doctor, and to have any additional questions answered by your doctor before deciding to go through with surgery and before signing the informed consent form.

You should not feel pressured by your doctor, family, friends, or anyone else to make a decision about having surgery. Carefully consider the pros and cons.

The day before surgery, you should stop using:

• creams
• lotions
• makeup
• perfumes

These products as well as debris along the eyelashes may increase the risk of infection during and after surgery. Your doctor may ask you to scrub your eyelashes for a period of time before surgery to get rid of residues and debris along the lashes.

Also before surgery, arrange for transportation to and from your surgery and your first follow-up visit. On the day of surgery, your doctor may give you some medicine to make you relax. Because this medicine impairs your ability to drive and because your vision may be blurry, even if you don't drive make sure someone can bring you home after surgery.

During Surgery

The surgery should take less than 30 minutes. You will lie on your back in a reclining chair in an exam room containing the laser system. The laser system includes a large machine with a microscope attached to it and a computer screen.

A numbing drop will be placed in your eye, the area around your eye will be cleaned, and an instrument called a lid speculum will be used to hold your eyelids open. A ring will be placed on your eye and very high pressures will be applied to create suction to the cornea. Your vision will dim while the suction ring is on and you may feel the pressure and experience some discomfort during this part of the procedure. The microkeratome, a cutting instrument, is attached to the suction ring. Your doctor will use the blade of the microkeratome to cut a flap in your cornea.

The microkeratome and the suction ring are then removed. You will be able to see, but you will experience fluctuating degrees of blurred vision during the rest of the procedure. The doctor will then lift the flap and fold it back on its hinge, and dry the exposed tissue.

The laser will be positioned over your eye and you will be asked to stare at a light. This is not the laser used to remove tissue from the cornea. This light is to help you keep your eye fixed on one spot once the laser comes on. NOTE: If you cannot stare at a fixed object for at least 60 seconds, you may not be a good candidate for this surgery.

When your eye is in the correct position, your doctor will start the laser. At this point in the surgery, you may become aware of new sounds and smells. The pulse of the laser makes a ticking sound. As the laser removes corneal tissue, some people have reported a smell similar to burning hair. A computer controls the amount of laser delivered to your eye. Before the start of surgery, your doctor will have programmed the computer to vaporize a particular amount of tissue based on the measurements taken at your initial evaluation. After the pulses of laser energy vaporize the corneal tissue, the flap is put back into position.

A shield should be placed over your eye at the end of the procedure as protection, since no stitches are used to hold the flap in place. It is important for you to wear this shield to prevent you from rubbing your eye and putting pressure on your eye while you sleep, and to protect your eye from accidentally being hit or poked until the flap has healed.

After Surgery

Immediately after the procedure, your eye may burn, itch, or feel like there is something in it. You may experience some discomfort, or in some cases, mild pain and your doctor may suggest you take a mild pain reliever. Both your eyes may tear or water. Your vision will probably be hazy or blurry. You will instinctively want to rub your eye, but don't! Rubbing your eye could dislodge the flap, requiring further treatment. In addition, you may experience sensitivity to light, glare, starbursts or haloes around lights, or the whites of your eye may look red or bloodshot. These symptoms should improve considerably within the first few days after surgery. You should plan on taking a few days off from work until these symptoms subside. You should contact your doctor immediately and not wait for your scheduled visit, if you experience severe pain, or if your vision or other symptoms get worse instead of better.

You should see your doctor within the first 24 to 48 hours after surgery and at regular intervals after that for at least the first six months. At the first postoperative visit, your doctor will remove the eye shield, test your vision, and examine your eye. Your doctor may give you one or more types of eye drops to take at home to help prevent infection and/or inflammation. You may also be advised to use artificial tears to help lubricate the eye. Do not resume wearing a contact lens in the operated eye, even if your vision is blurry.

You should wait one to three days following surgery before beginning any non-contact sports, depending on the amount of activity required, how you feel, and your doctor's instructions.

To help prevent infection, you may need to wait for up to two weeks after surgery or until your doctor advises you otherwise before using lotions, creams, or make-up around the eye. Your doctor may advise you to continue scrubbing your eyelashes for a period of time after surgery. You should also avoid swimming and using hot tubs or whirlpools for 1-2 months.

Strenuous contact sports such as boxing, football, karate, etc. should not be attempted for at least four weeks after surgery. It is important to protect your eyes from anything that might get in them and from being hit or bumped.

During the first few months after surgery, your vision may fluctuate.

• It may take up to three to six months for your vision to stabilize after surgery.
• Glare, haloes, difficulty driving at night, and other visual symptoms may also persist during this stabilization period. If further correction or enhancement is necessary, you should wait until your eye measurements are consistent for two consecutive visits at least 3 months apart before re-operation.
• It is important to realize that although distance vision may improve after re-operation, it is unlikely that other visual symptoms such as glare or haloes will improve.
• It is also important to note that no laser company has presented enough evidence for the FDA to make conclusions about the safety or effectiveness of enhancement surgery.

Contact your eye doctor immediately, if you develop any new, unusual or worsening symptoms at any point after surgery. Such symptoms could signal a problem that, if not treated early enough, may lead to a loss of visio

LASIK Surgery Checklist

• Know what makes you a poor candidate
  
• Career impact - does your job prohibit refractive surgery?
  
• Cost - can you really afford this procedure?
  
• Medical conditions - e.g., do you have an autoimmune disease or other major illness? Do you have a chronic illness that might slow or alter healing?
  
• Eye conditions - do you have or have you ever had any problems with your eyes other than needing glasses or contacts?
  
• Medications - do you take steroids or other drugs that might prevent healing?
  
• Stable refraction - has your prescription changed in the last year?
  
• High or Low refractive error - do you use glasses/contacts only some of the time? Do you need an unusually strong prescription?
  
• Pupil size - are your pupils extra large in dim conditions?
  
• Corneal thickness - do you have thin corneas?

Know all the risks and procedure limitations

• Overtreatment or undertreatment - are you willing and able to have more than one surgery to get the desired result?
  
• May still need reading glasses - do you have presbyopia?
  
• Results may not be lasting - do you think this is the last correction you will ever need? Do you realize that long-term results are not known?
  
• May permanently lose vision - do you know some patients may lose some vision or experience blindness?
  
• Development of visual symptoms - do you know about glare, halos, starbursts, etc. and that night driving might be difficult?
  
• Contrast sensitivity - do you know your vision could be significantly reduced in dim light conditions?
  
• Bilateral treatment - do you know the additional risks of having both eyes treated at the same time?
  
• Patient information - have you read the patient information booklet about the laser being used for your procedure?

Know how to find the right doctor

• Experienced - how many eyes has your doctor performed LASIK surgery on with the same laser?
  
• Equipment - does your doctor use an FDA-approved laser for the procedure you need?
  
• Informative - is your doctor willing to spend the time to answer all your questions?
  
• Long-term Care - does your doctor encourage follow-up and management of you as a patient? Your preop and postop care may be provided by a doctor other than the surgeon.
  
• Be Comfortable - do you feel you know your doctor and are comfortable with an equal exchange of information?

Know preoperative, operative, and postoperative expectations

• No contact lenses prior to evaluation and surgery - can you go for an extended period of time without wearing contact lenses?
  
• Have a thorough exam - have you arranged not to drive or work after the exam?
  
• Read and understand the informed consent - has your doctor given you an informed consent form to take home and answered all your questions?
  
• No makeup before surgery - can you go 24-36 hours without makeup prior to surgery?
  
• Arrange for transportation - can someone drive you home after surgery?
  
• Plan to take a few days to recover - can you take time off to take it easy for a couple of days if necessary?
  
• Expect not to see clearly for a few days - do you know you will not see clearly immediately?
  
• Know sights, smells, sounds of surgery - has your doctor made you feel comfortable with the actual steps of the procedure?
  
• Be prepared to take drops/medications- are you willing and able to put drops in your eyes at regular intervals?
  
• Be prepared to wear an eye shield - do you know you need to protect the eye for a period of time after surgery to avoid injury?
  
• Expect some pain/discomfort - do you know how much pain to expect?
  
• Know when to seek help - do you understand what problems could occur and when to seek medical intervention?
  
• Know when to expect your vision to stop changing - are you aware that final results could take months?
  
• Make sure your refraction is stable before any further surgery - if you don't get the desired result, do you know not to have an enhancement until the prescription stops changing?

(This information was last updated by the FDA October 1, 2002)

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