Laser Vision Correction Treatments

Laser vision correction is a safe and effective surgical procedure designed to reduce a person's need for glasses or contact lenses and includes LASIK and PRK. Through the procedure, an excimer laser is used to  reshape the cornea (clear covering of the eye) to help focus the light the way glasses or contact lenses would.

LASIK is a quick, usually painless, procedure. It is performed on a delicate part of the eye, and therefore an individual undergoing the procedure should understand the risks and the benefits, the importance of an initial screening exam by a physician, and have realistic expectations about the procedure's outcome.

Of all the patients who present for a consultation, we recommend LASIK to about 65% of patients and PRK to approximately 35%.  Your surgeon will discuss the risks and benefits and why you may be a candidate for one over the other at the time of your consultation.

With the advent of customized vision assessment and correction, combined with technologies such as a wave-front-guided LASIK, topography guided LASIK and the renowned expertise provided by Emory Vision, your vision may improve dramatically in both quality and quantity after LASIK.

According to the Eye Surgery Education Council Medical Advisory Board, many millions of LASIK procedures have been conducted, and less than 1% of patients have experienced serious vision problems. Complications are rare and usually represent delays in full recovery and resolve within a few months of surgery.

Some LASIK patients may require an enhancement (re-treatment) to achieve the optimal outcome. This may be done about three months after the original procedure. The post-operative period lasts about 12 months after surgery.

The 12-month post-operative period includes:

• Post-operative visits related to the refractive surgery at no charge. Typically, this is one day, one month and one year.
• The post-operative period does not include other medical conditions that may require additional examinations and treatment during this period, including significant dry eye.
• If a retreatment is needed during this 12-month period to achieve your optimal vision, it is covered by the initial costs of the procedure.

Referring to the respected Eye Surgery Education Council Medical Advisory Board "LASIK Surgery Screening Guidelines for Patients," the ideal candidate meets the following criteria:

• 18 years of age with stable glasses or contact lens prescriptions for at least two years
• Sufficient corneal thickness (measured by a technician)
• Does not suffer from any disease, vision-related or otherwise, that may reduce the effectiveness of the surgery or the patient’s ability to heal properly and quickly
• Is thoroughly informed about the benefits and risks of the procedure by thoroughly discussing the procedure with their physicians and understanding that, for most people, the goal of refractive surgery should be the reduction of dependency on glasses and contact lenses, not their complete elimination

Many factors exist that preclude a candidate from being ideal for LASIK surgery. In many of these cases, a surgeon may still be able to perform LASIK, or, at Emory Vision, we may suggest one of several refractive surgery options that can safely reduce your dependence on glasses or contact lenses.

The key is to work with a physician who is motivated solely by the goal to provide the highest quality vision and long-term satisfaction for you.

Certain conditions and circumstances completely preclude individuals from being candidates for LASIK surgery. Non-candidates include individuals who:

• Have conditions such as cataracts, advanced glaucoma, corneal diseases, corneal thinning disorders (keratoconus or pellucid marginal degeneration), or certain other pre-existing eye diseases that affect or threaten vision
• Do not give informed consent

People with myopia, or nearsightedness, have more difficulty seeing distant objects as clearly as near objects. People with hyperopia, or farsightedness, have more difficulty seeing near objects as clearly as distant objects. Astigmatism is a distortion of the image on the retina caused by irregularities in the cornea or lens of the eye. Combinations of myopia and astigmatism or hyperopia and astigmatism are common.

Current FDA-approved laser vision correction methods, such as LASIK, have a higher predictability of the final result with a lower incidence of complications. Additionally, older non-laser techniques typically involved manually performed incisions rather than automated lasers for correction.

Only an eye care professional can determine whether or not an individual is eligible for LASIK treatment. In general, a good LASIK candidate is at least 18 years old, has healthy corneas, and has maintained a stable eye prescription for the last 12 months. Because hormonal levels can affect the shape of the eye, women who are pregnant or nursing should not undergo LASIK treatment. The procedure may not be appropriate for patients who:

• Have glaucoma, cataracts or dry eyes
• With collagen vascular, autoimmune or immunodeficiency diseases
• Show signs of keratoconus (an eye disorder in which there is thinning of the cornea that results in blurred or distorted images)
• Take medications with ocular side effects (such as Accutane® or Cordarone®)

The initial exam will help the physician determine whether LASIK will be successful on patients with these conditions.

The FDA recognizes LASIK as proven, safe and effective. According to guidelines recently released by the Eye Surgery Education Council (ESEC), fewer than 1% of patients who have received LASIK to date have experienced serious, vision-threatening problems. Most LASIK complications can be treated and usually resolve within several months of surgery. There are no known cases of blindness resulting from LASIK.

Although no one knows the exact number of complications, studies suggest that the incidence of minor difficulties such as dry eyes and nighttime glare is around 3% to 5% from combined LASIK and PRK procedures. These minor complications include:

• Halos - Some patients will notice glare, halos or starburst around objects in low-light conditions. For the vast majority, these symptoms are temporary. However, others will continue to experience them for several months or longer. During pre-operative evaluation, the refractive surgeon can determine whether or not a person is at high risk for seeing long-term halos.
• Dry eyes - There is increased dryness of the eyes typically for several months following LASIK, though some patients may experience dryness for a longer period of time. It is important to use lubricating drops frequently. If the eyes remain dry for prolonged period, there are other drops or techniques that can help. Pre-operative evaluation will help determine whether or not a person is a likely candidate for experiencing dry eyes.
• Infection - This is an extremely rare occurrence, with a 1 in 2000-3000 chance (similar to any eye surgery). Fortunately, firmly established protocols exist which minimize the risk of infection.

Before a surgeon will perform LASIK, preoperative tests are performed to screen for glaucoma, cataracts and other disqualifying conditions. The surgeon may also use an instrument called a corneal topographer to photograph and electronically map the eye in order to gather more information about the individual's eyes prior to treatment.

Because contact lenses change the shape of the cornea, LASIK candidates are required to switch to eyeglasses before their baseline evaluation is taken and continue wearing only eyeglasses between 2-4 weeks before LASIK surgery. Not leaving contact lenses out long enough for the cornea to assume its natural shape before surgery can cause inaccurate measurements and poor vision after surgery.

Once the surgeon has conducted all pre-operative examinations, the eye is anesthetized with numbing eyedrops, the area around the eye is cleaned, and an instrument called a lid speculum is used to hold the eyelids open. The surgeon will then use a specialized instrument, called a microkeratome, to cut a thin, circular flap - the outermost 20 percent of the thickness of the cornea - to expose the portion beneath. This part of the procedure is called keratectomy.

While the inner cornea (the stroma) is exposed, the surgeon will ask the patient to fixate on a specific light source above the patient. This is to ensure that the laser beam is aligned precisely with the center of the patient's eye. Once the eye is in the correct position, the laser treatment is performed. The computer-controlled excimer laser removes the tissue under the flap and reshapes the cornea of the eye. In less than 60 seconds, ultraviolet light and high-energy pulses from the excimer laser reshape the internal cornea with accuracy up to 0.25 microns, or 1/4000 of a millimeter.

After the pulses of laser energy vaporize the corneal tissue, the flap is put back into its original position. The surgeon will observe the eye for three to five minutes to ensure bonding. Because the cornea bonds quickly, healing is rapid, and the eye does not require stitches.

The procedure is painless, however, most people experience 4-6 hours of mild irritation after their LASIK procedure.

The laser treatment itself usually takes less than a minute, while the entire procedure takes around 15 minutes per eye.

In most cases, people can return to work within 1-3 days following LASIK surgery. People cannot drive until after the 24 hours post-op visit or until a doctor says it is alright to drive. Makeup can start being worn within two to three days of treatment; however, only new cosmetics are advised in order to decrease risk of infection.

The vision correction is permanent. However, a person's vision may change naturally with time and LASIK does not affect visual conditions that may develop with age. Also, LASIK does not prevent presbyopia and the eventual need for reading glasses. Depending on the cause, retreatment may be a viable solution to later vision changes, and other treatment options also exist.