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Who is a candidate / Is it right for me?

If you are over 21 years old and have hyperopia (farsightedness) or myopia (nearsightedness), with or without astigmatism, you may be a candidate for refractive surgery. Refractive surgery can reduce and even eliminate refractive errors in some patients. Depending on the degree of farsightedness or nearsightedness, the chances of seeing 20/40 or better after surgery (legal to drive without glasses) may exceed 90%. While results are good in most patients, no one can promise that you will be able to "throw away your glasses" after surgery. If, however, your goal is to reduce your dependency on glasses or contact lenses, then refractive surgery may be for you.

 

If you elect to have refractive surgery, several conditions are necessary to maximize a good result. Your refractive error (spectacle prescription) should not have changed significantly over the previous year - this ensures that your correction is stable and that the treatment will be effective for a long time in the future. Your eyes must be healthy without conditions such as keratoconus (a progressive thinning of the cornea), or corneal scars. Because the results of refractive surgery depend to a large extent on normal healing, patients should not have any eye diseases (such as glaucoma or dry eye) or medical illnesses (such as lupus or rheumatoid arthritis) that may interfere with recovery. Your suitability for the procedure can be determined following an examination of your eyes and a consultation here at West Texas Eye Associates . We appreciate that the decision regarding refractive surgery is a very individual one and believe that it should be made only after you are fully informed about your options.

 

Preoperative Preparation:

Before the procedure, you will have an examination of your eyes to determine if you are a good candidate. As contact lenses may temporarily change the curvature of the cornea, we ask you to discontinue soft lens wear for two weeks and rigid gas permeable for five weeks prior to the screening examination. This allows the cornea to return to its "normal" shape. Patients who are pregnant may also have temporary corneal changes, and therefore we do not recommend refractive surgery until several months after delivery. If after the screening examination your are determined to be a good refractive surgery candidate, an appointment will be made for the surgery.

On the day of your procedure, you will be shown the laser room, and all the events of the procedure will be explained to you. You will also be asked to listen to the different sounds of the equipment so you will be prepared for the noises that you will hear in the laser suite. Anesthetic eye drops will be placed in your eyes, and a small instrument will be placed between your eyelids to help you keep them open during the treatment. Dr. Khater will then perform the procedure.

You can return home immediately after the procedure. We ask that you arrange for transportation to and from the office, as it is usually not advisable to drive for the first few hours after the surgery.

Postoperative Care:

Following your procedure you will be given drops to use in the evening and for several days afterward. You can expect some discomfort following the procedure, but this is highly variable depending on the individual patient and the specific procedure performed. You will be instructed not to get water in your eye and to avoid eye make-up or lotions for one week following the procedure. You will also be cautioned against eye rubbing in the early post-operative period. Postoperative examinations will be scheduled for the day after your procedure and, (generally) depending on the procedure, 2-7 days later. Additional examinations will be planned for 4 weeks following your procedure and as needed to ensure that all is going well.

 

Risks and Benefits

Benefits:

When considering refractive procedures, the patient and the physician work together to evaluate the relative risks and benefits. The benefits of the procedure are a reduction (and possible elimination) of farsightedness, nearsightedness and astigmatism. A successful outcome decreases an individual's dependency on glasses or contact lenses, and in some cases allows one to function without the need for any glasses or contact lenses. This has permitted many patients undergoing the procedure to participate in a variety of activities not previously possible due to their need for glasses (such as water-skiing or scuba diving). When patients discuss their individual experiences following their refractive procedure, in our experience they frequently describe a general improvement in their overall quality of life as exemplified by such experiences as being able to see the alarm clock in the morning without glasses.

Risks:

As with all surgeries, refractive procedures are not without risks and side effects. One side effect of the successful correction of myopia is that you will need reading glasses at about age forty-five to see near objects. For nearsighted individuals before surgery, "nearer is clearer". However, after the procedure, if you are older than 35-40 years old, you may experience the same difficulty with reading fine print experienced by all "normal" individuals that have never been nearsighted. This may be improved somewhat by intentionally adjusting the treatment to one eye to allow it to remain somewhat nearsighted (monovision). If you are in this age range, we will discuss this option with you.

Because the procedure involves removal of tissue to change corneal shape, other complications are possible, although they are rare. Infection, if it occurs, can cause corneal scarring and reduced vision that may not be correctable even with glasses or contact lenses. Other complications that may occur during or after the procedure include little or no reduction in farsightedness or nearsightedness, the wrong correction resulting from the procedure, scarring of the cornea, healing problems or other unexpected results. Any of these, if they are significant, may require that use of glasses or contact lenses for good vision. In rare instances, as with any surgical procedure on the eye, vision can be permanently reduced as a result of a complication.

Fortunately, the occurrences of significant complications with refractive procedures are very rare. It is important, however, to realize that even though the risks are low, there is no such thing as risk free, guaranteed surgery for any condition.

 

Frequently asked questions

What other options are available for correcting refractive errors?

Answer: By far, the most common method is, of course, eyeglasses. Another popular option is contact lenses; either soft or rigid gas permeable. Common problems with contact lenses include irritation, daily inconvenience, and ongoing cost of lens replacement and contact lens solutions.

Are laser procedures painful?

Answer: The LASIK procedure is associated with a sensation of pressure during certain steps, but the patients rarely describe it as painful. There may be mild or, very rarely, moderate discomfort following LASIK, but most patients find that their eyes are quite comfortable following this procedure.

The PRK procedure itself usually causes little or no discomfort. Discomfort occurs in the first one to three days following the procedure, however. A soft contact lens is placed on the eye at the end of the procedure, and this acts like a Band-Aid(R) to help minimize discomfort. In addition, drops are prescribed to use to treat eye discomfort. The amount of discomfort is quite variable. Some individuals have minimal discomfort, whereas others have moderate pain for several hours or more following the procedure.

How do I decide between undergoing PRK and LASIK?

Answer: The results of both procedures are comparable up to -12.0 diopters, and perhaps higher. The advantages of LASIK are that vision often recovers within just one or two days, and there is usually only minimal or no discomfort after the procedure. LASIK does introduce the small additional risk of the use of the microkeratome, although problems with this fortunately are very rare. We will be happy to discuss these options with you and provide our recommendation, based on your particular condition.

What if I move my eye during the laser treatment?

Answer: While the treatment is performed, you look at a colored light located on the inside of the laser. It is important that you look steadily at the light throughout the procedure, since this keeps the eye centered for the laser. However, if you temporarily look away or lose the ability to look at the fixation light, do not be concerned. The laser will track your eye movements, and can immediately be interrupted and then resume once you and the doctor are comfortable that you are again looking in the correct direction.

When can I resume my normal activities following laser my procedure?

Answer: Following LASIK, one can usually drive within a day or two and return to full activity by two or 3 days. It is best not to go swimming for at least two weeks following LASIK.

Following PRK, most individuals find that they can drive and return to work in 1-2 days and drive in 3-4 days. Full activity can begin within 3-4 days, but patients are asked not to go swimming for two weeks following the procedure.

When does my vision recover following laser refractive procedure?

Answer: Following LASIK, vision is often acceptable by one or two days after the procedure. Vision then improves further over the next week (although in some vision may further increase over the next few months), assuming that no additional correction is needed. Following PRK, vision is typically blurry for the first several days. Some patients experience excellent vision as early as one week, whereas for others, the full recovery may take several weeks or months.

Can laser refractive procedures cause me to lose vision?

Answer: As with any operation, PRK and LASIK are not risk-free. In the U.S. studies of PRK using the VISX excimer laser, serious complications or problems occurred in less than 1 % of the patients. These complications included losing a significant amount of vision even with glasses, too large a correction causing farsightedness, and visually significant corneal haze.

Will I be able to wear contact lenses following LASIK or PRK?

Answer: Yes, although fitting contact lenses following either of these procedures is sometimes a little more difficult. Another possible option, of course, would be to undergo LASIK or PRK again to touch-up or improve the correction achieved by the first procedure.

Will LASIK or PRK eliminate my need for reading glasses?

Answer: Neither procedure changes the gradual loss of focusing range that occurs as we get older. If one's farsightedness or nearsightedness in both eyes is nearly or fully corrected with LASIK or PRK, then reading glasses will be required at around age 43-46.

One option that is extremely successful in some patients is called monovision. In this approach, one eye is deliberately left with a modest amount of nearsightedness, permitting this eye to serve as the reading eye. In many patients, this can reduce or eliminate the need for reading glasses until the mid-50s. The compromise, of course, is that the eye that is left with some nearsightedness does not see as well at distance. This could slightly decrease depth perception and is not recommended for individuals with special needs, such as pilots.

 

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West Texas Eye Associates
Tim Khater, M.D., Ph.D.

Lubbock's Eyecare Center for Excellence

Copyright 1999 Tim Khater, M.D., Ph.D..  For information, please contact drkhater@wtxeye.com

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Last updated January 11, 2009 .
This page designed and created by Tim Khater, M.D., Ph.D..  (yes, the doctor really created the web page, ...without any help from his kids...)

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