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Everything you need to know about Lasik Surgery

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Author : Dr Deepak Garg

What is LASIK eye surgery? 

Lasik stands for "Laser in-situ keratomileusis". This is a procedure done to improve your vision or in other words, get rid of the need to wear glasses. It is a popular procedure that can help those who have different types of eye powers. Sometimes it also helps people with other eye conditions mainly corneal issues like scarred or irregular corneas.

Type of Laser eye surgery - SMILE

Watch a video by Ziess showing how a SMILE procedure is performed

What conditions warrant a laser treatment for eyes?

Lasik eye surgery is done for the following conditions

  1. Myopia 
  2. Hypermetropia
  3. Astigmatism
  4. Recurrent epithelial defect
  5. Irregular corneal surface
  6. Superficial corneal scarring

What are the types of Lasik Procedures?

There are a few types of procedures available to get rid of your glasses. The first 3 are the most commonly performed laser procedures.

1. Lasik - Laser-assisted in-situ keratomileusis

This is the most common vision correction surgery performed mainly because the recovery is the fastest and the patient is the most comfortable post the laser. Here the corneal tissue, which is the front most transparent layer of the eye is cut. This cut leads to the creation of a flap. It is during the creation of this flap that patients may feel high eye pressure. This corneal flap is pushed to the side and the bed of the cornea is treated with a laser. Once done the flap is repositioned. Your doctor will make sure that the flap is in position and is not moving and after a minute of waiting the procedure is done. This is a quick surgical procedure and takes about 10 minutes per eye.

Lasik Flap
Notice the flap which has been pushed aside to perform the laser

This flap creation can be done in two ways

  1. With a blade - This blade is also known as the microkeratome
  2. With a laser - This laser is also known as the femtosecond laser
Steps of Lasik

2. PRK - Photorefractive keratectomy

In PRK, no corneal flap is created. Instead, the outermost layer of the cornea called the epithelium is removed. Usually, some alcohol is applied to the cornea surface to remove the epithelium. This alcohol separates the epithelium from the underlying stroma. Once the epithelium is removed the stroma is reshaped with a laser.

The results of PRK and LASIK are similar. However, the patient experiences more discomfort in PRK as compared to LASIK. This discomfort lasts for a week to 10 days. Patient feel significant

Useful in patients who have thin corneas and cannot undergo flap LASIK

3. Smile - LASIK

Smile Laser

SMILE is a procedure performed by a machine manufactured by Zeiss. Here the laser will cut out a spindle-shaped structure is cut out within the thickness of the cornea. This spindle-shaped structure is then carefully removed by making a small opening within the cornea. After this, the pocket that has been created is washed and the eye is covered with a protective cup.

Here the symptoms are like LASIK and overall the patient is comfortable. 

While the patient can see the last line on the visual chart the very next day, the clarity takes a few days to return.

Useful in patients who have

  • Thin corneas
  • High myopia
Smile Vs Lasik

4. ASA - Advanced Surface Ablation

This technique is the same as PRK but uses the Zeiss excimer laser Advanced Surface Ablation program to reshape the cornea. This is a form of PRK and was FDA approved in 1995.

5. LBV - Laser blended vision

LBV  is a laser technique to give over 45-year-olds distance and reading vision. It uses mono-vision with the dominant eye treated for distance and the non-dominant eye treated for near. It commonly uses LASIK but the PRK techniques can also be used in myopic patients. 

6. PTK - Photo Therapeutic Keratectomy

This procedure is used to remove superficial corneal scars or to treat recurrent epithelial defects. In other words, the laser is used to remove a small amount of corneal tissue which is causing an issue for the patient.

What happens before and after LASIK eye surgery

Things to remember before coming for the refractive laser surgery?

  1. You need to have a detailed eye examination
  2. Ideally, two eye exams a few months apart to confirm the power is stable
  3. Stop wearing contact lenses for 2 weeks before the procedure
  4. Take a head bath before coming for surgery
  5. No perfume on the day of surgery
  6. Wear a buttoned shirt and not a T-shirt on the day of surgery so that when back at home there is no risk of the shirt touching the eyes while removing

What happens on the day of Laser vision correction?

On the day of your surgery, we will do the following in order

  1. Repeat eye power check-up
  2. Repeat pachymetry
  3. Repeat topography
  4. You will be guided to your room 
  5. When it's your turn you will be taken to the laser room and lie on your back
  6. You will lie down and numbing eye drops will be placed in your eyes
  7. The area is cleaned with an antiseptic solution like betadine and a sterile eye drape is applied to the eye to be operated on first.
  8. The lid speculum is placed in the eye and this instrument holds the eyelids apart and prevents the eyes from closing
  9. In LASIK (where a flap is created ) an instrument called a microkeratome is applied to the eye and a flap is created. If a PRK (no flap created but epithelium removed) some alcohol is placed on the surface of the cornea and the epithelium is removed.
  10. The laser is then used to reshape the cornea
  11. The flap is placed back in position in the case of LASIK. In PRK a large bandage contact lens is placed on the eye. Sometimes even in LASIK, a bandage contact lens is placed on the eye.
  12. A protective eye cup is placed on the eye till you reach your room.
  13. Your doctor would examine you once on a microscope and the protective cups can be removed and replaced with your glares (those that you have always wanted to wear)
  14. The doctor will explain how to use all the eye drops and see you the next day.

What is Post Laser eye surgery care?

Like any other surgery, post-laser care is important for LASIK too. The complete recovery time after LASIK is about 3 weeks. You may experience blurred vision on the first day but would have clearer vision from the second day itself. Usually, you should get perfect vision in a week after the surgery.

  1. Steroid antibiotic eye drops for a week - Using these drops reduces the risk of infection
  2. Steroid eye drops for a month
  3. Lubricant eye drops for 3-4 months
  4. Lubricating eye ointments for 2-3 weeks
  5. No head bath for a week
  6. No swimming for a month
  7. No restriction on food intake
  8. No restriction on using gadgets and watching TV

What are the risks & side effects of LASIK eye surgery?

Following are the side effects of LASIK eye surgery

  1. Dry eyes
    • LASIK surgery causes a temporary decrease in tear production. For the first six months or so after your surgery, your eyes may feel unusually dry as they heal. Dryness may also lead to blurry vision. Even after 6 months, you may experience an increase in dry eye symptoms. Your eye doctor might recommend that you use eye drops during this time.
    • This is why if you already have symptoms of dryness before LASIK surgery you may not be a good candidate for the procedure.
  2. Glare, haloes around lights and double vision. After surgery, you may have difficulty seeing at night. You might notice glare, halos around bright lights, double vision or just have sensitivity to light. This generally lasts a few days to a few weeks, but it can also become a long-standing problem.
  3. Undercorrections. If the laser removes too little tissue from your eye, you won't get the clear vision results you were hoping for. You may need another refractive surgery (called an enhancement) within a year to remove more tissue.
  4. Overcorrections. It's also possible that the laser will remove too much tissue from your eye. Overcorrections may be more difficult to fix than under corrections. That being said overcorrections are very rare. Doctors are aware that this is not a problem they want to give their patients and thus err towards under corrections than overcorrections.

Difference between Lasik and Cataract Surgery

LASIK is a procedure that gets rid of eyeglasses. Cataract surgery on the other hand replaces the natural lens of the eye. This lens is replaced because it has become white or cataractous. Cataract surgery also leads to glass-free vision for near and far depending on the lens that is implanted in the eye.

Thus, if someone near the age of 50 years wants to get rid of glasses, it may make more sense to undergo a clear lens extraction than to undergo a LASIK eye surgery. 

Lasik (Laser) eye surgery Cost in India

There are various types of LASIK procedures as mentioned above. The cost of LASIK for both eyes ranges from Rs 65000 to Rs 125000 for both eyes. The difference exists because charges would depend on the machine used and the type of LASIK done.

How to find the Best Lasik Eye Surgery in India

Eye Solutions offers all types of the above-mentioned LASIK procedures mentioned above. By adopting the latest technology we have been able to offer the latest innovations in LASIK surgery. There are situations when we cannot perform a LASIK because the patient is not the right candidate. We have even been able to help those patients with procedures like clear lens extraction or ICL.

Frequently asked questions

  1. Can people who are under the age of 18 undergo LASIK eye surgery?
    • People under the age of 18 years should not undergo LASIK because their power may not be stable. Even after 18 years, you should have two visits with your eye doctor 6 months apart to confirm that the eye power is stable.
  2. Do insurance companies cover LASIK eye surgery in India?
    • Insurance companies generally do not cover LASIK in India. We have had a few patients who have got reimbursed for their LASIK procedures but in most cases, insurance companies do not cover LASIK in India.
  3. Is eye operation covered in mediclaim?
    • All eye operations except squint surgery and LASIK surgery are covered under mediclaim. Sometimes patients are reimbursed for their squint and LASIK surgeries but more often than not they are not.
  4. Can you go blind from LASIK?
    • While the loss of vision from LASIK is extremely rare, it is not impossible. Nothing is 100% in medicine and so too with LASIK.  Blindness because of LASIK is because of eye infections which again are very rare. More importantly, these eye infections can be treated effectively and 99.99% of patients never have an issue. That being said LASIK has a very high success rate.

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