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Lasik eye surgery is currently the best method of correction of refractive errors. It is accurate, effective and safe.

In LASIK an ultra-thin (90 to 150 micron) flap of cornea is raised and then using computer guided Excimer Laser (mostly Argon Fluoride 193 nm) is delivered to reshape the corneal stroma into predetermined curvature. The flap is repositioned back. This leads to correction of myopia, hypermetropia, and astigmatism. The procedure is short and simple and being computer controlled is highly accurate.

Patient Selection for Lasik Eye Surgery

  • Case selection is an extremely important determinant of the results of Lasik surgery:
  • Refractive error:  -1.50  to -10.0 diopter of myopia
  • Up to +6.0 diopter hypermetropia
  • Astigmatism of up to 6 diopter
  • Minimum age 18 to 21 years (preferably 21 years)
  • Refraction should have been stable for at least a year.
  • Contraindications: Keratoconus, thin corneas, corneal inflammatory diseases, herpetic keratitis and autoimmune diseases.
  • Should not be performed during pregnancy - can be done 3 months after it.

Preoperative Preparation for Lasik Surgery

  • Refraction under cycloplegia
  • Corneal Topography
  • Pachymetry for corneal thickness
  • Aberrometry to measure higher order optical aberrations
  • Pupillometry to measure pupil size in low light conditions
  • Intra-Ocular Pressure (IOP) measurement
  • Detailed Retina Examination
  • Informed consent
  • Antibiotic eye drops to be instilled for about 2-5 days before surgery
  • Contact Lenses should be discontinued for at least 2 weeks (Soft Lenses) / 4 weeks (Rigid Lenses) before the surgery

  • Lasik Surgery Procedure

    LASIK is performed under topical anesthesia (Proparacaine Eye Drops) and the only cooperation required of the patient is to fixate at a blinking (green) light. Current LASIK machines have an advanced eye tracker device which realigns the Laser to any changes in the position of the eye thereby ensuring proper centration of ablation. The steps are:

    Lasik - Flap lifting

    Excimer Laser ablates the stromal bed to resurface it into desired curvature. What makes the Excimer laser so well suited for corneal ablation is its ability to remove tissue with accuracy up to 0.25 micron with each pulse. Often, only 50 microns of tissue are removed to achieve the proper amount of correction. The Excimer produces a non-thermal light beam that eliminates the possibility of thermal damage to surrounding tissues. In current Lasers employing flying spot technology a 1 mm spot ablates the tissue to correct the refractive error and to blend this area with surrounding cornea by creating smooth transition zones.

    During this step a clicking / crackling sound is heard and an odor of ablating tissue (similar to charring hair) is smelt and a light flashing close to the eye is seen. All this while patient needs to concentrate on the center of the blinking (target) spot of light.

    Lasik - Laser Ablation

    The corneal flap is then repositioned and allowed to dry for a few minutes. The flap self-seals without the need of sutures.

    Antibiotic drops are instilled and the patient is discharged from the hospital. The patient is advised to report back the next day. Eye drops are prescribed to be started on the same day. Analgesics are rarely required and that too for 1-2 days.

    Precautions to be Taken After Lasik Eye Surgery

    • Avoid swimming and splashing of water on the eyes for a month.
    • Avoid rubbing the eyes for a month.
    • Use sunglasses to avoid bright sun, dust, wind and air pollution.
    • Avoid excessive viewing of TV or computers for a week.
    • Use medicines regularly as advised.
    • Consult your eye surgeon in case of any problem
    • Avoid eye makeup for 1-2 weeks

    Complications of Lasik

    No surgical procedure is without any complications. However, LASIK is a relatively safe technique of correction of refractive errors. The possible complications can be:

    • Dry Eye
    • Under or over correction
    • Glare
    • Decentration of ablation
    • Astigmatism
    • Flap damage
    • Infection
    • Corneal infiltration
    • Diffuse Lamellar Keratitis (DLK or Sands of Sahara)
    • Corneal Ectasia (Keratoconus)

    Results After Lasik Eye Surgery

    Results are generally very satisfactory and it has been reported that in carefully selected cases more than 90 % achieve unaided visual acuity of 6/12 or better (i.e., 6/12 6/9 6/6 6/5).

    It is important to discuss with your surgeon about the expected results or prognosis in your case. Your surgeon will be able to explain the kind of results or problems likely in your case. A detailed discussion helps a lot in preparation for Lasik.

    Wavefront Guided or Custom Lasik

    Standard Lasik involves assessment of only refractive errors (myopia, hypermetropia or astigmatism) and correction of the same. But human eye may have some finer degrees of optical imperfections called aberrations. Standard Lasik does not correct these aberrations.

    Wavefront guided or custom Lasik measures aberrations present in the eye (aberrometry) and attempts to correct them. Moreover, the treatment maps generated are customized to the individual eye and maintain the natural prolate profile of the cornea. This prevents induction of any aberrations. All this leads to better contrast and night vision.

    Epi-Lasik or Lasek

    In patients with thin corneas it may help to lift just a thin epithelial flap as in Epi-Lasik or remove epithelium using alcohol as in Lasek. This leaves behind greater amount of tissue in the coneal bed to achieve higher refractive correction.

    Although it possible to correct greater amount of refractive error in these procedures but the recovery is rather slow and more uncomfortable than in Lasik and there are greater chances of development of corneal haze and regression.

    Femtosecond Laser

    Femtosecond Laser Intralase for Creating Flap ("No Blade" or Blade Free Lasik)

    Femtosecond Laser is a new method of creating corneal flap in Lasik - here instead of Microkeratome "Blade" or Disposable Microkeratome Head, a Laser is used to cut the corneal flap. Although it is touted as "No Blade" technique but that should not mean that there is no cutting of cornea to make a flap. The advantage is that the flap reproduceability is better i.e. there is less variation in flap thickness from patient to patient. This variation is slightly more in Disposable Microkeratome Head and significantly more with Reusable Heads & Blades. However, there are reports of increased risk of complications like DLK (Diffuse Lamellar Keratitis or Sands of Sahara) caused by disintegration of corneal tissue & collateral damage. The newer ultrathin 90 micron disposable microkeratome heads offer all the advantages of Femtosecond Laser without an increase risk of DLK. All these are relevant in thin corneas or high refractive errors where one is working close to the limits of safety.

    Time Involved

    An optimal time schedule is as follows:

    • Day 1 - Detailed eye examination (2 hours)
    • Day 2 or 3 - Lasik Surgery (3-4 hours in the center / hospital)
    • Actual time for Lasik is just few minutes!

    Discussion: Standard Lasik vs. Custom Lasik

    Standard Lasik
    This is the conventional type of Lasik Laser where only the refractive error (myopia, astigmatism or hypermetropia) is taken into account in the Laser protocol and corrected. It does not correct aberrations (finer optical defects in the eye).

    Custom Lasik
    In this Lasik treatment in addition to refractive error, finer optical aberrations are also taken into account. The Laser ablation protocol attempts to correct the aberrations as well.
    The information about the aberrations in the eye is provided by an instrument called aberrometer which forms an additional link in the treatment chain.

    Which is better & why?
    High levels of aberrations in the eye adversely affect contrast and night / low light vision. So if aberration level is high then certainly Custom Lasik is better as it provide better quality of vision, better contrast and better night vision by correction of aberrations along with the refractive errors.
    It may be noted that the vision in bright day light is the same after both forms of Lasik (standard or custom) and it's only in mesopic or low light conditions that there is a difference in the quality of vision. And the difference is very subtle & mild - not a dramatic difference

    Conclusion
    LASIK is major advance in the field of refractive surgery, which combines efficacy, safety, precision and accuracy. This technique is taking us on the path that, in the past, ophthalmologists feared to tread, towards the goal of unaided natural clear vision. However, it is prudent to have realistic expectations from this surgery and never hope for miracles (although results of Lasik are no less!).
    Lasik involves extensive computer analysis of the eye. Patient is then asked to come on the scheduled day for the laser treatment. Local anaesthetic eye drops are instilled in the eye to achieve a pain free procedure. The patient is now made to lie under the laser machine and asked to fix his gaze at a blinking light. The data of the patient is fed into the computer memory of the laser. A special machine called the microkeratome is used to pick up a thin corneal flap of 160 microns (equivalent to an onion skin). Laser is delivered to the cornea under this flap to correct the spectacle number. It takes 20 to 60 seconds to complete the laser delivery to one eye. The corneal flap is placed back in position where it holds strongly within two minutes due to its natural bonding properties. The entire procedure takes about 10 minutes.

    FAQs

    Expand/Collapse
    Does the Procedure Hurt?
    The laser procedure itself does not hurt. A slight pressure may be felt during the procedure. There is a possibility of some degree of discomfort after the procedure for 3 to 4 hours which is easily controlled by medication.
    What to Expect After Lasik Eye Surgery?
    Your eye or eyes (usually both are treated simultaneously) will likely be quite blurry immediately after your LASIK surgery. Do not be alarmed. This is natural and expected. You will likely awaken the next morning after your LASIK surgery with much improved vision. Your vision should also improve over the first two to three weeks following surgery.
    Will I be totally free from spectacles?
    95% of the people will be totally free from their spectacles. 5% will have mild variation from their zero targeted correction due to varying healing patterns in different individuals, but will have their dependency reduced on spectacles. With a little more lasering, an attempt may be made after 6 months to correct these individuals further.
    Are the results achieved from Lasik permanent?
    The effects of lasik on the cornea are permanent. Sometimes, internal changes within an eye may come with age and these may have some effect on the overall visual status. For example, a high myopia may progress even after the age of 18 years, or a person may require reading glasses after the age of forty like any normal individual
    When can I return to work?
    The results are often dramatic and very rapid, with most patients seeing well enough to drive a car without correction the very next day. However, the best post-operative visual acuity may not be obtained until 2 to 3 weeks, or in some cases, even a few months, after the procedure.
    How safe is this procedure?
    Lasik eye surgery is a very safe procedure but like any other surgical procedure it can have some complications which are extremely rare if a proper screening check is done prior to the procedure. This includes measuring the corneal thickness with an ultrasound, mapping the corneal topography and a retina check. Nobody in our surgical experience has ever lost sight due to this procedure.
    What is the worst possible complication?
    Infection is a serious complication and could lead to deterioration of the vision. Infection is usually rare and can be well controlled with medications with little or no loss of quality of vision. At our centre, we have had no case of infection till date.
    How would the eye behave after 10 to 20 years?
    The medical community can only speak of the future by accessing the data from the surgeries performed within the last ten years. The data reveals a very positive healing response of the eye giving doctors no reason to be concerned about effects beyond ten years.

    Can both eyes be done the same day?

    Yes, in most of the cases. However one eye may be done at a time by choice
    How long will I be on medications?
    Generally speaking a patient is on eye drops for 3 to 6 weeks. This is dependant of the level of correction attempted and the individual healing response.
    Have any lasik surgeon doctors had Lasik correction themselves?
    Yes, many in India as well in several other countries. This also includes Dr. Pooja Mehta (best lasik surgeon in delhi) herself 11 years back.
    If get my lasik done how long will the correcting effects last?
    The power corrected usually stabilizes over a period of few weeks. There are studies to prove that once stabilized it is usually permanent and lasts forever.
    If I am over 50 years, will the surgery will work for me ?
    Each of your eyes has two lenses - the cornea (the general focusing lens ) and the inside lens ( the fine focusing lens ). Laser surgery works effectively to correct the general focusing lens, no matter what your age. However, the inside fine focusing lens of your eye hardens and no longer provides clear reading vision after the age of 45 years. So, even after laser surgery, you would need reading glasses after 45 years of age. However, laser surgery will give you clear vision for all distance activities without spectacles.
    What is Excimer Laser?
    Since early 1970’s different surgical procedures have been developed to improve the refractive error (spectacle power) of people and improve their vision without the dependence on spectacles.

    Stop Hiding Behind Spectacles
    With the advent of lasers for these surgical procedures a new era for eye care has unfolded. The excimer laser procedure along with the creation of a small corneal flap “LASIK” (laser assisted in situ kerotomeliusis) is an excellent painless and an accurate procedure for this purpose.

    Millions of successful procedures have been performed world wide till date.

    The Excimer laser unlike other lasers doesnor cause thermal (heat effects) but acts by breaking the intermolecular bonds at the tissue level.

    • This vaporizes that specific tissue, only where it is being focus.
    • This unique ability of this laser makes it ideal to reshape the corneal tissue.
    • The vision correction achieved by these lasers is due to generalized correction of the shape of the cornea.

    Eye Trackers
    There are some fractional (saccadic) eye movements always, however small they may be. For the lasik procedure to be really precise it is important to detect these movements and incorporate them during application of the laser beam.

    The laser radar tracking system developed by NASA’s “Strategic defense system” is used to detect this micro eye movements (thousands of readings are taken per second).    
        
    These movements are detected. The laser beam is then synchronized such that it can be locked on to a fixed point on the cornea irrespective of the eye movements.

    Our centre is equipped with the above mentioned facilities with one of the world’s best and technologically most advanced state of the art machines.

    What to Expect?
    The patient may resume normal daily activities in a day or two with minimal restrictions.
    • Most of patients report an immediate improvement of vision with a few minutes.
    • Complete clearing up of vision may take a day or two.
    Do you wonder what life would be after lasik surgery?
    Wondering what life would be after lasik treatment? Consider yourself to be compeletly free from ugly glasses or cumbersome contact lenses for ever. Experience the freedom from burden & restriction of glasses to a clear vision. It really can change the way you look at life.

    “REDESIGN YOUR VISION; REDESIGN YOUR LIFE”

    Consider Lasik... Open new vistas for Yourself!!! 
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    Dr. Pooja Mehta
    MBBS, DNB , MNAMS
    +91-9818459728