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LASIK

Introduction

LASIK is a procedure that we have all heard of. It is a laser refractive surgery and what this procedure does is that it gets rid of glasses or contact lenses that a person is wearing.  People refer to lasik as laser eye surgery.  The laser used for this procedure is known as the excimer laser.  There are a few other lasers used in ophthalmology too.

LASIK does not really change the condition of the eye except getting rid of the glasses or contact lenses.  So let's say someone wears  -5 numbered glasses but cannot see very clearly because of some retinal problem, after LASIK the -5 will not have to be worn anymore however his vision will be the same as it was with the -5 glasses mainly because LASIK has not corrected the retinal problem.

What happens in all types of Lasik Procedures ?

When someone has an eye power it means they have to wear glasses or contact lenses so that they see things clearly.  What these visual aids do is they focus the rays of light onto the retina because the shape of the eye does not do it properly for that particular individual.  

In lasik surgical procedure your eye doctor or refractive surgeon basically reshapes the cornea so that after the laser the eye can now focus the rays of light on the retina and the person can see clearly.  While reshaping the cornea some micro thin layers of the cornea are removed.   Lets say around 10-12 microns of the cornea are removed for every 1 diopter ( Unit of measurement of eye power) of power.   So if you have a -5.00 eyesight power then 5 X 10 microns = 50 microns of the cornea are removed.   1000 Microns make a mm. 

This laser is wavefront-guided lasik.  What this means in simple terms is that every lasik is customized to the individual.  Thus even the natural and normal aberrations that every eye may have can be corrected with this procedure.  In theory, even someone with normal vision can undergo lasik because it would make the visusal outcomes better than what vision was before.

You may wonder if removing a part of the cornea is safe.  Well, to an extent it is safe.  However, if the cornea is already thin then it would not be safe to remove more of the cornea while doing lasik.  Which is why measuring the corneal thickness before this refractive surgery is important.  Pachymetry is the test used to measure corneal thickness.

The cornea is front most layer of the eye.  It is transparent and is the first layer that light entering the eye hits.  Corneal tissues are avascular which means they dont have a blood supply.  This may sound crazy but thank god for that because it is because of this that the cornea is transparent and we can actually see.

There are a few types of lasik but all of them basically do the same thing which is to change the shape of the cornea.

What are the types of Lasik Procedures?

Eye Solutions offers 4 types of Lasik refractive procedures.  These variations occur because of changing technology.  These are the types for understanding

  1. Type 1 A
  2. Type 1 B
  3. Type 2
  4. Type 3

Let us try and break it down for you as simply as we can.

Type 1 laser

The first type is one in which a corneal flap is created.  This hindged flap is then lifted of the cornea and the bed of the cornea is treated with the excimer laser.  Now this hinged flap creation can be done in 2 ways. 

By using a blade - Type A

By using laser - This laser is called a femtosecond laser and is the latest technology laser being used in ophthalmology. - Type B

Once this laser treatment is over ( which takes a few seconds per eye ) the flap of the cornea is placed back in its position.  After your eye doctor makes sure that the flap is correctly placed a contact lens is then placed on the eye.  You can then go home.

Type 2 laser 
In the second type, no flap is created in the cornea,  The epithelial layer of the cornea is scraped off.  Epithelium is the front most layer of the cornea.  Once this is scraped off the remaining cornea is then treated with Laser.  After the treatment a contact lens is placed on the eye. 

The difference between the first and second types of lasik

  1. No flap created in the second type
  2. Patients who undergo the second type have a lot of symptoms like watering, redness, pricking, and irritation.  These symptoms last for a week to 10 days.

Type 3 laser

The third type of Lasik is called the ” SMILE ” procedure.  This laser technology is made by Zeiss.  This is the video of how a smile procedure is done.   As you will see here too there is no flap created.  The laser used for this is also a femtosecond laser.  This laser cuts out a spindle-shaped structure within the thickness of cornea.  Now that this spindle shaped structure is cut it needs to be removed.  So a small 2mm opening is made on the cornea to reach that spindle shape and it is pulled out.  Here it will be easier to appreciate how a part of the cornea is removed the cornea thus becomes thinner than before the laser surgical procedure.

When is the best time to do undergo Lasik Procedure?

Usually, this laser for number removal is done after the age of 19 or 20 years.  The idea is that we want the number to stabilize and only then perform the laser.  But you must remember that this refractive procedure is an elective procudure

When can one not undergo the laser vision correction ?

There are a few reasons when someone cannot undergo lasik

  1. Thin cornea - As mentioned earlier some of the cornea is shaved off when we perform lasik.  If there is not enough to shave off then we cannot do the procedure.  The corneal thickness requirement depends on the amount we want to shave off.  Corneal thickness is measured by a test called pachymetry.
  2. Dry eyes - If a person has dry eyes before getting lasik done then lasik may not be a good option.  The reason is that excimer laser ablation is known to cause some amount of dryness.  If you already have dryness then it may get worse.  Conditions like sjogrens syndrome or rheumatoid arthritis are associated with dry eyes and thus one must avoid lasik in patients with these conditions.  Dry eyes ofcourse can be treated in many ways including lubricants and punctal occlusion.
  3. Other eye diseases - If there are other corneal diseases like advanced keratoconus then one cannot undergo lasik.  It is also imortant to remember that a lasik only gets rid of the eye number.  If the patient has lets say a retinal disease which is causing loss of vision then after the procedure the glasses will go but the retinal problem will remain.  Thus the vision loss because of that retinal problem will remain.

What should I remember before coming for the refractive laser surgery ?

On the day of your surgical procedure you should arrive at the clinic 30 minutes before the alloted time.  At Eye Solutions we reexamine the patient and repeat all the measurements.  You must remember to take a head bath on that day and not use any eye makeup or any perfume.

What happens on the day of Laser vision correction ?

When you come to the hosptial on the day of surgery and the registration formalities are completed you are directed to your room.  Here you change into the hosptial clothes and await your turn

Once you enter the laser room you will be made to lie down on the laser machine bed.  The eye is cleaned with betadine and a plastic drape or sheet is placed over your eye.  A clip called a speculum is inserted in your eye to keep your eye open.  

Depending on the type of laser ablation you are undergoing either a flap is created with a blade or with the laser.

If you had chosen the femotosecond laser then you are moved to another laser machine whereas if you had chosen the blade you remain on the same laser machine.

Patients ask us "what would happen if I move my eyes ?".  This is a valid question but you must remember that the procedure is very short and the machines are able to detect the slightest eye movements.  If a significant eye movement is detected the laser immediately stops firing and waits for the eye to return to the normal position.

What is the Post Lasik care for the eyes?

After the LASIK procedure, patients experience irritation and watering.  Some even feel glare when they step out in bright lights and blurry vision..  This is because there is a fresh wound on the cornea and till it heals these symptoms will persist.  However, these symptoms dont last for more than a few days after surgery.

Your eye surgeon would prescribe a few eye drops.  These eye drops have to be used for periods ranging from 2 weeks to 6 months.  These drops help in healing and also help in preventing infections.  Following are the prescription drugs

Flurometholone eye drop - Mild steroid - reduce corneal inflammation and help in healing

Antibiotic steroid combination eye drop - these drops reduce the corneal inflammation and help in healing and also reduce the risk of infection.

Lubricants or artificial tears - These drops reduce the symptoms of irriatation that occur after lasik.  They also help in healing and reduce dry eye symptoms.  In the intial days patients may experience clearer vision every time they put these artifical tears.

Usually in a few days patients become comfortable and can carry on their routine activities.  Of course because the myopic or minus eye power has now become zero, the patient immediately notices that the distance vision has become much clearer without glasses. We advise patients not do take a head bath for a few days and not to swim for a month after the lasik procedure.  The healing process of the cornea can take a few weeks.  For the vast majority visual recovery happens much earlier. 

Will the eye number ever come back?

There is always a small chance that a small eye number comes back after performing LASIK.  The entire number that was treated does not come back but a small number may.  This is one of the potential risks of undergoing lasik.  We would not really call it a surgical complication.

Also one must remember that at the age of 42 we will get reading glasses.  Of course one may get these reading glasses a few years earlier or later.  Lasik does not prevent that from happening.  Once someone undergoes LASIK, at 42 years of age they will have a challenge reading small print and would start having to wear glasses for the same.

Dryness after undergoing Lasik

This is a known side effect of undergoing lasik.  This occurs because the laser damages some of the corneal nerves and this leads to dryness.  All our patients who undergo lasik in Mumbai are put on lubricants for 4-6 months after the procedure for this reason.  

What are the other conditions for which this refractive surgery is done ? 

Lasik is mainly used as a refrative surgery.  Getting rid of glasses.  However, as mentioned earlier this laser basically shaves off some part of the cornea and thus is used for some other condition as well.

  1. Mild corneal opacities - If a corneal opacity is causing some vision loss then this laser eye surgery can be done to remove the opacities
  2. Corneal dystrophies - Again if these dystrophies are causing a visual disturbance then these opacities can be removed with laser
  3. Recurrent epithelial defect - Epithelium is the front most layer of the cornea.  If there is a recurrent epithelial defect then lasik is done to create a new bed to enable the new epithelium to stick to the rest of the cornea.

What are the common complications ?

Lasik is a very safe procedure and we dont really see many complications

However, nothing is 100% in medicine.  The complication that we are most worried about is an eye infection.  These eye infections can be treated with eye drops.  Very very rarely these result in significant loss of vision

How do I choose a Lasik Center?

We have to remember to go to a center which has a clean environment. The LASIK machine is located in a cleanroom. This is because one of the complications of the LASIK procedure is a corneal infection, which we want to avoid.

How much time does a Lasik take?

Usually, LASIK surgery takes about 10 minutes in total. The procedure itself will take around 2 minutes for both eyes.

When can I resume normal activities after Lasik?

Most likely you will be able to see clearly by the same evening of the procedure.  By the next day, you would be able to resume normal activity but will have to use drops and follow the protocols that your doctor has advised.

Is lasik covered by Insurance ?

Insurance companies consider lasik as a cosmetic procedure and thus dont cover this procedure.  This happens in majory of our patients.  Very rarely however, we do hear that some of our patients have been able to get their reimbursements.

Frequently Asked Questions ?

What is the cost of Lasik in Mumbai ?
The cost of the procedure depends upon the procedure that is chosen.

There are bascially 4 packages.

Please refer above for the types of lasik.

Types 1A  and 2 we charge Rs 60000 for both eyes.

For type 1B we charge Rs 85000 for both eyes

For type 3 we charge Rs 125000 for both eyes.
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