Surgical Procedures 2017-03-23T14:54:34+00:00

Surgical Procedures

LASIK (Laser Assisted In-Situ Keratomileusis)

Laser Vision Correction

Laser Assisted In-Situ Keratomileusis, or LASIK, has become the leading procedure in the Laser Vision Correction field allowing patients less dependency on corrective lenses. LASIK combines the precision of the excimer laser with the benefits of Lamellar Keratoplasty (LK) to treat wide ranges of refractive needs.

In the United States the excimer laser was first approved for treatment on the “surface” of the cornea which was called Photorefractive Keratectomy (PRK). LASIK consists of making a small hinged flap of tissue and treating the deeper corneal tissue. LASIK has shown faster visual recovery, minimal discomfort, less risk of haze and ease of enhancement (or touch up) without an increased risk of adverse results. It has become the procedure of choice for the use of the excimer laser.

How Successful is LASIK?

The majority of patients who undergo LASIK are able to see 20/40 or better right away and are able to pass the driver’s license test without glasses or contact lenses.

Because some people treated have high degrees of correction and/or astigmatism, it is occasionally necessary to fine tune or enhance the primary treatment to obtain the best final result. Statistically, each patient has about a 95% chance of only requiring a single treatment to achieve their desired visual outcome.

Approximately, less than 5% return to the laser for enhancement of any residual astigmatism, or a slight over or under-correction.

How is LASIK performed?

LASIK is a painless procedure performed in an outpatient setting with topical anesthesia.

The eye drops are used to completely numb the eye but not the eyelids. The eyelids are held open with a small instrument to prevent blinking. The patient feels the sensation of the instruments around the lid area but does not feel any pain. A suction ring is placed on the eye and the patient feels a little pressure while the vision goes dim for a brief period of seconds. A microkeratome slides across the cornea in less than 15 seconds to create a thin lamellar corneal flap. After proper alignment, the high-energy pulses from the excimer laser are delivered to reshape the surface.

By adjusting the pattern of the laser beam it is possible to treat myopia, hyperopia and astigmatism. After the laser treatment has obtained the proper contour the corneal flap is replaced in its original position.

A protective eye shield is placed over the eye and worn for the first 12 to 24 hours as well as when sleeping for the next 3 to 4 days. The cornea has rapid healing qualities and no sutures are needed. However, fluctuation in vision and intermittent dry eyes are not uncommon for the first several weeks and months.

Postoperative recovery is quick and easy. Most patients feel minimal to no eye irritation during the first two hours and many patients see a dramatic improvement in vision by the first day. However, fluctuation in vision and intermittent dry eyes are not uncommon for the first several weeks.

What can I expect after LASIK?

Many patients are somewhat nervous before the procedure so a small dose of Valium is given to most patients to help take the edge off. This also relaxes you so that you are able to go right home and go to sleep, at least for a few hours.

Don’t expect your vision to be clear the first day. It’s somewhat like looking under water. Since the flap is repositioned by floating back into place, a minor amount of swelling occurs. Plus, we protect your eyes with plastic shields which can also blur your vision. But, after a good nights rest, most patients are ecstatic with their new vision.

You must then use antibiotic drops and mild steroid drops for the next few days and lubricating drops as needed for the dry eye feeling.

What about dry eyes after LASIK?

Dry eye symptoms are the most common complaint after LASIK. Everyone has dry eyes after LASIK surgery, but some notice it more than others.

In this type of laser vision correction, a thin corneal flap is created on the surface of the eye. When the flap is made, the abundant supply of corneal nerves are also cut.

This results in a partially anaesthetized corneal surface. It requires 3-6 months for these nerves to re-grow and provide the cornea normal sensation. As a result, the normal tear production is also interrupted and everyone experiences some degree of dryness, especially the first 2-4 weeks.

There are numerous artificial tears and lubricating drops available as over-the-counter products. We initially recommend the preservative free products to prevent any unnecessary toxic response. But, as your eyes improve, switching to the more convenient bottles of preserved products is allowed. If the frequent use (at least every hour) of artificial tears does not improve your symptoms, then temporary or permanent closure of a tear duct can provide added relief. Since this is a temporary condition (3-6 months) in most cases, many patients do extremely well by simply lubricating their eyes with artificial tears.

How do I know if I need an enhancement?

The schedule of routine post-op visits includes a 1 day, 1 week, 1 month and 3 months visit. Since the vision may fluctuate as the cornea heals, we recommend waiting a minimum of 3 months to reevaluate your visual results.

When we reevaluate, we look at such things as your vision without glasses & your prescription where we measure any residual astigmatism or mild over or under-correction. We ask about your night time driving and your reading vision.

If your vision is not as good as you think it should be, and if there is a minor residual correction that can be treated with the laser, than an enhancement is discussed. Enhancement surgery is actually easier than the initial procedure because a flap is already present.

In most cases, our surgeons simply identifies the edge and lifts up the original flap without cutting a new one. Because the cornea heals this layer very slowly, it can easily be lifted up to 1-2 years after surgery. In some instances a new flap is required and your surgeon can explain why it might be best in your particular situation. Either way, with LASIK touchup surgery is easy and usually requires much less laser energy to fine tune your vision. However, the healing process is the same and requires another 3 months to determine the final result.

Laser Vision Correction FAQs

Dr. Blaze will be involved by determining whether you are a candidate or not for Laser Vision Correction (LVC). He will also do all pre- and post-op care. Typically Dr. Blaze will be there the day of your surgery to assist. Then he will see you at his office the day after. Post-operative follow-up visits will include 1 week, 1 month, 3 months, 6 months, and 12 months after surgery. From there, Dr. Blaze will monitor medications and assure proper healing.

Dr. Blaze works with a few top LVC Surgeons and Laser Centers who have proven themselves through quality outcomes and who practice responsible medicine.

He will not be there the day of the surgery.

Yes, if you’re at least 21 years old, in good general health, and have good eye health with no diseases such as cataracts or glaucoma. Laser vision correction can treat a wide range of nearsightedness, farsightedness, and astigmatism.

Make sure the vision is stable for the past 2 years. Patients with a history of dry eye should be treated for it before surgery.

Dr. Blaze will review your history and prescription during a consultation to determine your candidacy. He will explain what to expect so that you can make an informed decision. Most patients are good candidates, but some are not candidates for the procedure, and others are candidates but with higher risk. Dr. Blazes optometric opinion about laser surgery will help you make a more balanced decision, with realistic expectations.

While LVC has proven successful in reducing dependence on glasses and contact lenses, the degree of improvement will vary among individuals. Individual healing responses and the degree of prescription are the most important variables.

We do not promise 20/20 vision, however, more than 85% of laser patients with mild to moderate prescriptions do achieve 20/20 vision or are within 1 to 2 lines of 20/20 vision on an eye chart. This level of accuracy will allow you to drive or play sports without the need for correction.

Re-treatment procedures are needed about 5% to 10% of the time, and are usually performed after a minimum of three months of healing and when stability is achieved. The most common need for re-treatment occurs in those who have very high prescriptions. Retreatment for those whose vision is still changing”

The most common questions about LVC are “Will LVC stop my eyes from changing in the future?” and “What do long-term studies show about the effectiveness of LVC?” There is no guarantee that your eyes will stop changing in the future. That is it is best to wait for relative stability before proceeding with other correction. In addition, since 1987, many clinical studies have analyzed the long-term effects of the excimer laser on the cornea. Every study performed so far has shown that there are no long-term negative effects of the laser on the eye’s integrity or strength.

Today, most experts around the world are confident that they will discover no long-term problems with laser vision correction. They also believe, based on the excellent results seen to date, that laser vision correction will become the most commonly performed refractive procedure in the world. This is why Dr. Blaze believes he can help offer you three options with confidence: Contact lenses, spectacles, or LVC. However, it is important that you consider your prescription when making your decision on which option is best for you.

Most insurance companies do not cover laser vision correction, but we encourage you to check with your provider. In the U.S., if your company has a flexible benefits program, you can usually use this for laser vision correction.
The LASIK procedure is basically painless. Anesthetic drops are used to numb the eye just before surgery begins. The microkeratome ring creates pressure on your eye and will dim your vision temporarily. After your procedure, your eye may feel a foreign body sensation or irritation for a few hours. You will be given drops for your eyes to counteract the potential dryness you may experience for several days following the surgery.
Most LASIK patients usually see reasonably well the day following their procedure and may be able to resume most of their normal activities, but patients with higher prescriptions may recover more slowly. It is important to stay out of direct sunlight without UV protection, sunglasses and jacuzzi or pods for the first few weeks.
It is important to note that the chance of having a serious vision-threatening complication is much less than 1%.

In general, most of the risks following the LASIK and PRK procedures are the same. However, while LASIK does offer a faster and easier visual recovery, it also has specific risks due to the creation of the corneal flap.

Refractive Complications

Refractive problems that may be encountered include too much correction, too little correction, a prescription imbalance between eyes, aggravation of muscle imbalance problems or a loss of effect from regression. LASIK may result in overcorrections and undercorrections due to the variability in patient healing patterns and other surgical variables, leaving patients nearsighted, farsighted, or with astigmatism. This may or may not require patients to wear spectacles, contact lenses or undergo further surgery.

Incidence of significant overcorrection: 1 in 100
Incidence of significant undercorrection: varies with prescription

Infection

This is probably the greatest risk during the first 48 to 72 hours following the procedure. You will receive antibiotic drops, both before and after the procedure, to help prevent an infection. Most minor infections are treated and quickly eliminated.

Incidence of serious infection: 1 in 5000 for LASIK, 1 in 1000 for PRK

Post-Treatment Haze

Healing haze is the term for the collagen protein that develops on the surface of your eye following the procedure. Almost everyone develops trace degrees of haze, only seen at high magnification by a trained observer.

It is invisible to the naked eye and very rarely affects your vision. Most patients are not even aware that they have haze. Although treatable in most cases, haze usually clears gradually over many months following the procedure.

Incidence of serious haze: 1 in 1000 for LASIK, 1 in 100 for PRK

Regression

Regression refers to the tendency of the eye to bounce back somewhat towards your original prescription following Laser Vision Correction. If your vision regresses, you may require an enhancement procedure or a thin pair of glasses. In most cases, the regression experienced is minimal and is accounted for when planning your procedure. In some cases, glasses for night driving may be all that is required by a patient who experiences regression.

It is essential that you understand as much as possible about the risks associated with the excimer laser procedure. The risk of having a serious vision-threatening complication is much less than 1%, however, the excimer laser procedure, like all surgical procedures, has limitations and risks.

Night Glare

Even before having Laser Vision Correction, many people experience poor night vision or night glare (haloes, starbursting) when wearing glasses or contact lenses. Night glare is common immediately following the procedure and will typically last for three or four months. By the time both your eyes are treated or six months have passed, your night glare tends to decrease and you should be back to where you began. However, you may still require glasses for driving at night.

Incidence of significant glare: 1 in 50

Post-Treatment Discomfort

You should have very little, if any, pain during the laser procedure itself. With new techniques, a relatively small number of patients experience significant discomfort following the procedure, which can usually be eased with medication. Most patients experience some irritation, sensitivity to light, and watering or swelling of their eyes for a few days following the procedure.

Incidence: 1 in 50 for LASIK, 1 in 10 for PRK

Loss of Best Corrected Vision

A small number of patients experience a slight loss of visual sharpness or crispness following Laser Vision Correction (compared to when they were wearing glasses before the procedure). In these cases, one or 2 lines (20/20 or 20/25) on the bottom of the chart are not readable. In some cases, the sharpness returns over a period of six to 12 months. This means that after the procedure, even with glasses or contact lenses, you may not be able to see as clearly as you did prior to the procedure.

Incidence: 1 in 100

LASIK Flap Complications

While only about 1% of patients have complications with their LASIK procedure, even fewer experience a serious flap related complication. This may result in loss of best corrected vision.

Incidence: 1 in 500

Corneal Flap Complications

The primary benefits of LASIK are related to the creation of the protective corneal flap. The corneal flap must be of clinically adequate quality, thickness and size to proceed with laser treatment.

LASIK will permanently thin the cornea. As a result, it can weaken the integrity of the cornea and cause corneal ectasia within 1 week to several years following the procedure. It is important that the patient is evaluated to determine if there is enough corneal thickness to correct vision before the LASIK procedure. Patient who have keratoconus or pellucid marginal degeneration are not good candidates for this procedure.

In cases of corneal ectasia, spectacle glasses may no longer be enough to give adequate vision. In this situation, contact lenses may be the best option to give the best vision.

Corneal flap complications range in severity from those that simply require the procedure to be postponed by 3 to 6 months, to those that create permanent corneal irregularities resulting in blurred vision. The rarest and most severe LASIK complication is that of corneal perforation which has been reported several dozen times worldwide.

Corneal flap complications that occur after the LASIK procedure during the recovery period include displacement and wrinkling of the corneal flap and epithelial in-growth.

Corneal flap problems include but are not limited to:

Corneal flaps of inadequate size, typically too short, preventing laser treatment, and requiring the LASIK procedure to be repeated in 3-6 months.

Typically no serious visual disturbance although glare and shadowing may occasionally be produced

Corneal flaps of inadequate thickness, may or may not be adequate for laser treatment, and may result in the procedure being stopped and repeated after 3-6 months.

A thin corneal flap may result in a slow visual recovery over weeks to months and possibly permanently blurred vision with or without laser treatment.

Corneal flaps of inadequate quality or smoothness include a variety of corneal flap problems which may produce serious permanent corneal irregularities and significant visual blurring.

Corneal flap irregularities may be produced because of inadequate suction pressure, inadequate orbital size, inadequate patient cooperation, malfunction or problems with the microkeratome, blade or suction apparatus.

Corneal flaps are routinely hinged either nasally or superiorly beneath the upper eyelid.

A corneal hinge is not required for a good visual result, but a hinged corneal flap is more secure and typically heals faster and more smoothly. It is possible depending upon the corneal shape, the suction ring alignment and the microkeratome, that a free corneal cap may be produced which is not hinged to the cornea.

Although the laser treatment can still be performed, if any irregularities in flap quality or thickness are noted, the corneal disc is immediately replaced and allowed to heal. If the free corneal cap is of excellent quality then the procedure is completed, but special care must be taken during the first 24-48 hours not to displace or lose the corneal cap. Loss of the corneal cap may result in scarring, and permanent corneal irregularity and the need for more invasive surgery.

Corneal flap displacement, partial or complete, occurs during the early post-operative period, typically during the first 12-24 hours, but may occur days to weeks later with trauma.

Care should be taken to protect the eyes from trauma, as well as avoiding rubbing the eyes or forcefully closing the eyes during the first week following LASIK. Partial displacement of the corneal flap may result in corneal striae or wrinkles, which blurs vision both qualitatively and quantitatively.

Most corneal striae are treatable but some may be resistant to treatment especially in highly nearsighted patients. Complete displacement of the corneal flap is often painful and requires urgent replacement. There is a higher risk of epithelial in-growth and infection with corneal flap displacement.

Epithelial In-growth

Epithelial in-growth occurs during the first month following LASIK and is more likely to occur in patients with an abnormal or weakly adherent protective layer, for which age is a factor. Epithelial in-growth is produced when epithelial surface cells grow underneath the corneal flap during the healing of the corneal flap incision. Epithelial in-growth is more common with any trauma or breakdown of the epithelium, which is more common in LASIK enhancement procedures and long-term contact lens wearers. Treatment of this condition involves lifting the flap and clearing the cells away. Although most small areas of epithelial in-growth need only be monitored, untreated large areas of epithelial in-growth may distort vision and may actually damage the flap integrity if severe and progressive.

Implantable Contact Lens (ICL)

LASIK is highly effective method of treating moderate amounts of myopia (nearsightedness) and low amounts of hyperopia (farsightedness), but is not effective for larger amounts of myopia or even moderate amounts of hyperopia.

Clear Lensectomy, discussed elsewhere, is a viable alternative, particularly in the age group that requires bifocals or reading glasses.

For those patients below the age of 40 however, a new alternative is available. This alternative is the “Implantable Contact Lens“.

The Implantable Contact Lens or “ICL” is an extremely thin lens made of a new material called “Collamer”. It is inserted surgically into the eye in a five minute procedure. It can be made in any power, therefore it can correct even extremely high amounts of refractive error.

We are watching the development of the ICLs. There the simplicity and reversal make this procedure promising.

Clear Lens Replacements

This procedure uses the same highly advanced technique practiced during routine cataract surgery. This accurate process involves the surgical removal of the clear, natural lens of the eye. It is then replaced with an artificial lens implant calculated specifically for the necessary amount of nearsightedness or farsightedness.

This surgery does involve a slightly greater degree of surgical intervention so it is usually reserved for those patients who do not fit the criteria for LASIK. These are patients with higher degrees of nearsightedness or farsightedness which are not safely treated with laser vision correction or those patients with early cataract changes.

Surgeons perform cataract procedures with artificial lens implantations that can correct both far and near vision, working best for those with advancing cataracts. The newest multifocal ReStor and ReZoom intraocular lens has allowed many patients minimal dependence on their spectacles. This exciting advancement in lens technology allows patients to see both distance and near, even for those patients over the age of forty who might otherwise need bifocals or reading glasses. One added benefit: these patients will never need cataract surgery since the natural lens that turns cloudy with a cataract has already been removed!