What is LASIK eye surgery?

Laser-assisted in situ keratomileusis (LASIK) is a surgical procedure that reduces the need for eyeglasses or contact lenses. It can correct a wide range of visual problems: nearsightedness (myopia), farsightedness (hyperopia) and astigmatism. It won't correct presbyopia so you can't have the same eye corrected to see both distant and near objects, if that was a problem before. However, LASIK can be used to correct one eye for distance and the other for near vision. If you can adjust to this correction, it may reduce or eliminate your need for reading glasses. Some people need surgery on only one eye.

Is LASIK eye surgery for me?

LASIK isn't for everyone. You should be at least 18 years old (21 for some lasers), since the vision of people younger than 18 is usually still changing. Also, you shouldn't be pregnant or nursing, because these conditions might change the measured refraction of the eye. Here are some things to consider:

• You shouldn't be taking certain prescription drugs, such as AccutaneŽ or oral prednisone.
• Your eyes must be healthy and your prescription stable. If you're myopic, you should postpone LASIK until your refraction has stabilized because myopia may continue to change in some patients until their mid- to late 20s.
• You should also be in good general health. The procedure may not be recommended for patients with diabetes, rheumatoid arthritis, lupus, glaucoma, herpes infections of the eye or cataracts. Discuss your health with your surgeon.

Are the results from LASIK permanent?

The effects of LASIK are permanent, but a person's eye can still change internally. That's why many surgeons recommend having the procedure done after the major eye changes have occurred. LASIK isn't recommended on children. Their eyes change a great deal as they grow, and they often need their vision corrections fine-tuned or adjusted. If LASIK is done after age 18, the chance of long-term stable correction is more likely. However, the eyes can still be changing even after 18.

What should I be asking my ophthalmologist?

Discuss the risks and benefits of the procedure with your eye doctor. Also, find out how much experience the doctor has with the procedure. Here are some questions:

• How do you define success? What's your success rate? What are my chances, with correction, to achieve 20/20? How many of your patients have achieved 20/20 vision or 20/40 vision? How many patients return for enhancements? (In general, 5 percent to 15 percent of patients return.)
• What laser will you be using for my surgery? Make sure your surgeon is using a laser approved by the Food and Drug Administration (FDA).
• What's involved in after-surgery care?
• Who will handle after-surgery care?

How do I prepare for LASIK surgery?

Before surgery, you'll need a complete eye exam by your surgeon. Take your eye prescription records with you to the exams. You'll be asked to sign an informed consent form after a thorough discussion of the risks, benefits, alternative options and possible complications.

If you qualify for surgery, your doctor may tell you to stop wearing your contact lenses for a while before the surgery because they can temporarily change the shape of the cornea (eyeball). Your cornea should be in its natural shape the day of surgery. Your doctor also may tell you to stop wearing makeup, lotions or perfume for a few days before surgery. These products can interfere with the laser treatment or increase the risk of infection after surgery.

How is the procedure done?

LASIK is an outpatient surgical procedure. The only anesthetic used is an eye drop that numbs the surface of the eye. The surgery takes about 10 to 15 minutes for each eye. Sometimes, both eyes are done during the same procedure. But often surgeons wait to see the result of the first eye before doing the second one.

A special device cuts a hinged flap of thin corneal tissue off the outer layer of the cornea and the flap is lifted out of the way. The laser reshapes the underlying corneal tissue, and the surgeon replaces the flap, which quickly adheres to the eyeball. There are no stitches. A shield, either clear plastic or perforated metal, is placed over the eye to protect the flap.

What happens after the surgery?

Healing is relatively fast, but you may want to take a few days off after the surgery. You may have a mild burning or other sensation for a few hours after surgery. Do not rub your eye. Your doctor can prescribe a painkiller, if needed, to ease the discomfort. Your vision will probably be blurry the day of surgery, but it will improve a lot by the next day when you return for a follow-up exam.

If you have aggravating or unusual side effects, report them to your doctor right away. Don't drive until your vision has improved. Avoid swimming, hot tubs and whirlpools for two weeks after surgery or until your surgeon gives you approval.

What are the risks of LASIK surgery?

Some risks and possible complications include:

• Over- or under-correction. These problems can often be improved with glasses, contact lenses and enhancements.
• Corneal scarring, irregular astigmatism (permanent warping of the cornea), and an inability to wear contact lenses.
• Corneal infection.
• Loss of "best corrected visual acuity." That is, you wouldn't be able to see as well after surgery, even with glasses or contacts, as you did with glasses or contacts before surgery.
• A decrease in contrast sensitivity, crispness or sharpness. That means even though you may have 20/20 vision, objects may appear fuzzy or grayish.
• Problems with night driving that may require glasses.
• Flap problems including irregular flaps, incomplete flaps, flaps cut off entirely and the growth of cells under the flap.

Side effects are possible, but usually go away. They rarely are permanent. Side effects include discomfort or pain, scratchiness, dryness, glare, halos around lights seen at night, light sensitivity, and/or small pink or red patches on the white of the eye.

Are there surgical alternatives to LASIK surgery?

Yes, several surgical alternatives to LASIK include:

• Photorefractive keratectomy (PRK) was the first surgical procedure developed to reshape the cornea using a laser. PRK uses the same type of laser as LASIK to reduce myopia, hyperopia and astigmatism without creating a corneal flap.
• Astigmatic keratotomy uses a knife to make incisions in the cornea as a technique to reduce astigmatism.
• Intrastromal corneal rings are clear, thin, polymer inlays placed on the eye to correct low myopia only.
• Conductive keratoplasty (CK) transmits radiofrequency (RF) energy into the eyes to correct damage caused by aging. CK is the first non-laser procedure approved by the FDA to correct farsightedness and astigmatism.