Dr Anupam Chatterjee Eye Surgery Blog

Author: Lisa Scott

LASIK, an acronym for Laser-assisted In Situ Keratomileusis, is a form of refractive laser eye surgery procedure performed by ophthalmologists intended for correcting vision. The procedure is usually a preferred alternative to photorefractive keratectomy, PRK, as it requires less time for full recovery, and the patient experiences less pain overall.

The LASIK technique was made possible by Dr Jose Barraquer (Colombia), who around 1960 developed the first microkeratome, used to cut thin flaps in the cornea and alter its shape, in a procedure called keratomileusis. This procedure was developed and pioneered by the world leading Barraquer Clinic, based in Bogota, Colombia.

LASIK surgery was developed in 1990 by Dr. Lucio Buratto (Italy) and Dr. Ioannis Pallikaris (Greece) as a melding of two prior techniques, keratomileusis and photorefractive keratectomy. It quickly became popular because of its greater precision and lower frequency of complications in comparison with these former two techniques.

In 1991, LASIK was performed for the first time in the United States by Drs. Stephen Brint and Stephen Slade. The same year, Drs. Thomas and Tobias Neuhann successfully treated the first German LASIK patients with an automated microkeratome.

Patients wearing soft contact lenses typically are instructed to stop wearing them approximately 7 to 10 days before surgery. One industry body recommends that patients wearing hard contact lenses should stop wearing them for a minimum of six weeks plus another six weeks for every three years the hard contacts had been worn.

Before the surgery, the surfaces of the patient’s corneas are examined with a computer-controlled scanning device to determine their exact shape. Using low-power lasers, it creates a topographic map of the cornea.

This process also detects astigmatism and other irregularities in the shape of the cornea. Using this information, the surgeon calculates the amount and locations of corneal tissue to be removed during the operation. The patient typically is prescribed an antibiotic to start taking beforehand, to minimize the risk of infection after the procedure.

The operation is performed with the patient awake and mobile; however, the patient typically is given a mild sedative (such as Valium or diazepam) and anesthetic eye drops.

Lasik is performed in two steps. The initial step is to create a flap of corneal tissue. This process is achieved with a mechanical microkeratome using a metal blade, or a femtosecond laser microkeratome that creates a series of tiny closely arranged bubbles within the cornea. A hinge is left at one end of this flap. The flap is folded back, revealing the stroma, the middle section of the cornea. The process of lifting and folding back the flap can be uncomfortable.

The second step of the procedure is to use an excimer laser (193 nm) to remodel the corneal stroma. The laser vaporizes tissue in a finely controlled manner without damaging adjacent stroma by releasing the molecular bonds that hold the cells together. No burning with heat or actual cutting is required to ablate the tissue. The layers of tissue removed are tens of micrometers thick.

During the second step, the patient’s vision will become very blurry once the flap is lifted. He or she will be able to see only white light surrounding the orange light of the laser. This can be disorienting.

Currently manufactured excimer lasers use a computer system that tracks the patient’s eye position up to 4,000 times per second, redirecting laser pulses for precise placement. After the laser has reshaped the cornea, the Lasik flap is repositioned over the treatment area by the surgeon. The flap remains in position by natural adhesion until healing is completed.

Author: Nicky Pilkington

Just as each person is different in many ways, the symptoms after laser eye surgery can be different for each person. Many people are now opting for this procedure as a way to see clearly without the aid of glasses or contact lenses, but some expect to walk out of the office with perfect vision and no complications or symptoms. The one thing that you must remember is this is a surgery procedure and all surgeries have risks.

The most common symptoms following laser eye surgery include the fluctuation of vision. During the first few hours after surgery, your vision will not be clear. It can fluctuate from clear to blurry for at least the first couple of hours and in some cases a bit longer.

Dry eyes are another complaint of some patients. The eyes will not have the natural tear producing characteristics for a few hours. This is the most common problem and can last for several days.

Many individuals see an indifference to light as well. When exposed to bright lights indoors or outdoors the eyes can feel aggravated. Your eye doctor will normally recommend that you wear an eye shield the first few hours after surgery to aid in helping the cornea to heal and to shield the eye from bright lighting.

Some individuals notice a glare or halo effect after surgery. In some cases, a second procedure must be done to correct this problem. However, in most cases, this symptom will also disappear over time.

If the eyes are not protected after surgery with an eye shield, dust and other objects can cause an eye infection, which will cause the eye to burn and itch.

Right after laser eye surgery, most individuals with farsightedness see a major improvement within 24 hours. Objects that are far away may still seem a bit blurry but over the next few days, this will improve. Persons with nearsightedness have noted improvement in their vision within one hour after surgery. However, some have had a few problems in reading shortly after surgery until their eyes have had time to heal. In some cases, reading glasses are prescribed until the eyes have had sufficient time to heal.

Bring someone along with you the day of your laser eye surgery. You will not be able to drive for a few hours after surgery. A flap is created in your cornea so surgery can be accomplished and this flap needs time to heal properly before you can take off the protective eye shield.