LASIK

Overview of Refractive Eye Surgeries

It used to be that when a person had blurred vision because of a refractive error, the only choice was to correct the problem with eyeglasses or contact lenses. However, with new developments in eye surgery, dependence on these options may be reduced. Refractive surgery includes several surgical techniques, with LASIK eye surgery being the most well-known, designed to improve problems in focusing the eyes. While clearly not for everybody, some individuals certainly may benefit from refractive surgeries such as those offered by LASIK procedures.

In order to understand how the eye works, think of your eye as a camera. When you look at an object, light is focused, or refracted, by the cornea and the lens inside your eye. When the cornea and lens combine to focus an image precisely on the retina, then your vision is clear.

However, your vision may be blurred if the cornea, lens and the front-to-back length of the eye place the focal point of an image in front of the retina or behind the retina.

If the focus is in front of the retina, then a patient is nearsighted or myopic.

If the focus is behind the retina, then the patient is hyperopic or farsighted.

In addition, the image may be distorted if the cornea has unequal curvatures. This is called an astigmatism.

Refractive problems are solved by helping the eye focus light using glasses, contact lenses or refractive surgery. The goal of surgical techniques, like LASIK, is to improve the eyes’ focus by changing the shape of the cornea, and there are several ways that this can be done.

It is important for any person considering refractive surgery at our St. Louis or other Missouri locations to realize this is a relatively new area of medicine which is continually evolving as new techniques and instruments become available. Many people want to know if refractive surgery is safe, or if one method is better than another. It is important to understand that all surgery involves some level of risk, and no surgical procedure has a guaranteed outcome. These factors, as well as complications and alternative procedures, should be explained fully by the surgeon as they apply to your particular circumstances. The following refractive surgery techniques are currently performed at our Missouri locations: PTK (photo therapeutic keratectomy), RK (radial keratectomy), CK (conductive keratoplasty), PRK (photo refractive keratectomy), and LASIK (laser assisted in-situ keratomileusis).

LASIK Surgery St. Louis

If you have questions about LASIK laser vision correction or are searching for a Board-Certified LASIK surgeon, we encourage you to contact us here at Ophthalmology Associates- The Cornea and Laser Vision Institute. With three locations in the Central Eastern Missouri region, we are proud to serve the surrounding communities of St. Louis, St. Peters and Sullivan.

Information on LASIK or “Laser Assisted In-Situ Keratomileusis”

Performed since the early 1970’s, refractive surgery procedures improve vision due to nearsightedness (myopia), farsightedness (hyperopia) and astigmatism. With the development of the excimer laser for refractive surgery (photo refractive keratectomy), a new era in eye care is unfolding. It has been found that the excimer laser procedure combined with the creation of a corneal flap (lamellar keratectomy) is an excellent technique for reshaping the surface of the cornea to correct nearsightedness, farsightedness and astigmatism. The combination of both procedures is called Laser Assisted In-Situ Keratomileusis, better known as LASIK eye surgery, and offers the accuracy of the excimer laser with the benefits of automated lamellar keratectomy’s recovery.

The excimer laser, first developed by VISX, creates light in a manner similar to a light bulb. In an excimer laser, an electric current is passed through a tube containing Argon and Fluoride gases creating a reaction that produces ultraviolet light. The direction, focus, and release of the light are precisely controlled by the LASIK surgeon and a computer.

As the ultraviolet light is produced, it passes through a system of lenses which focus the light energy to become more concentrated and the beam gains strength. Laser light reaches its maximum strength at the focal point, the point where all the rays converge. The strength of the beam rapidly diminishes after passing the focal point, and can no longer affect other tissues in the eye.

A special instrument called a microkeratome is applied to the cornea creating a thin flap of corneal tissue.

The flap remains attached to the eye at one end. The excimer laser is then used to reshape the cornea.

Instead of using heat to alter tissues like other lasers, the excimer laser beam breaks the molecular bonds that hold tissue together with only minimal effect on surrounding tissues.

These properties allow the excimer laser to be used in the same LASIK eye surgery procedure to reshape tissue immediately beneath the surface of the corneal flap. A computer controls the laser and the reshaping of the cornea.

The flap is then placed back into position without stitches.

LASIK eye surgery is performed on an outpatient basis at two of our St. Louis LASIK surgical centers here in Missouri. The surgery uses topical anesthetic eye drops to numb the eye. The LASIK eye surgery itself is painless and usually takes less than ten minutes per eye to perform. Plastic eye shields are placed over the eyes for temporary protection and to keep patients from rubbing their eyes when sleeping. Postoperatively, medication drops are used to prevent infection and promote healing. After LASIK surgery is performed, patients usually return to their normal life-style quickly with very few restrictions during the short healing period.

After LASIK surgery, the vast majority of patients, about 98%, are able to pass a Missouri driver’s license vision test without glasses or contacts. Many St. Louis LASIK patients report an immediate improvement within the first day. For others, vision may be blurry and fluctuate for several days or weeks. Since each patient’s situation is unique, not everyone should expect to achieve full visual correction. People with high levels of myopia or astigmatism may require an additional procedure to achieve the desired results.

To be eligible for LASIK surgery, the eye must be in good health and vision must be stable. Some patients are better candidates than others and consultation with an ophthalmologist prior to surgery is important to determine estimated benefits and possible complications.

Faq:

How can I find out if I am a candidate for laser vision correction?

The vast majority of individuals who are nearsighted, farsighted or have astigmatism may be candidates to undergo laser surgery for vision correction. However, only a comprehensive examination by your eye care provider, such as an ophthalmologist or optometrist can make that determination. Our ophthalmologists do all of their own comprehensive eye exams.

What are the risks associated with laser vision correction?

As with any surgery, there are attendant risks that are associated with any procedure. No procedure is 100% foolproof or risk free; however, the risks associated with laser vision correction are usually minimal and may include a scratchy eye sensation, tearing, mild halo vision, as well as, not achieving the intended vision correction (i.e., a patient may still be left slightly under corrected or possibly over corrected). These risks, notwithstanding, approximately 98 to 99% of people will see 20/40 or better after surgery. This will allow these individuals to drive a car without glasses, as well as, perform the vast majority of their daily affairs without the dependency on glasses or contact lenses.

How long does the LASIK procedure take?

The entire procedure takes approximately 25 minutes to complete surgery on both eyes.

Does the LASIK procedure hurt?

Unequivocally, we can state that laser vision correction surgery is not painful. The procedure is done under topical anesthesia using eye drops. The procedure itself is painless. Afterward when patients go home at night, there may be some mild burning, stinging, irritation and tearing which may last four to seven hours. These mild symptoms can be controlled with eye drops or oral aspirin-like products.

How long will I be off work?

Usually, most patients are comfortable and could return to work on the following day. Approximately, 60% of patients will be able to drive their car to work or to the doctor’s office the following day for examination. Although most patients will be comfortable enough to go to work and perform nominal daily activities the next day after surgery or possibly just take the day off to recuperate.

Are there any alternative surgeries that are available for laser vision correction?

Currently, individuals who are nearsighted or have significant astigmatism have alternate surgeries such as radial keratotomy, astigmatic keratotomy, photo refractive keratectomy using the excimer laser, or a newer procedure using plastic implants in the cornea called Intacs. Currently, the state-of-the-art procedure for the correction of nearsightedness, farsightedness and astigmatism is using the excimer laser in a procedure called LASIK. For individuals who are farsighted, the only treatment is using LASIK.

What are the credentials necessary for individuals to perform laser vision correction?

Currently, only eye physicians and surgeons may be credentialed to perform laser vision correction using the excimer laser. Eye physicians are called ophthalmologists. These eye doctors are surgeons who have gone to medical school and then spent four years in an ophthalmology residency program learning medical and surgical treatment of eye diseases. These individuals then, have undergone further instruction in the use of the excimer laser. Personally, Drs. Berdy and Malhotra are ophthalmologists who have taken two to three additional years of training in corneal and refractive surgery training. These physicians have been using the excimer laser since the early and late 1990’s, as Dr. Berdy was a principal investigator for the initial FDA studies to approve the excimer laser for surgery. Dr. Berdy is currently a certified instructor for VISX, the company which developed the excimer laser, and for TLC Vision Centers, the company which markets and provides the excimer laser for surgeons use.

Which lasers are currently available for use in the United States?

Currently, there are at least six lasers that have been approved by the FDA for use in correcting nearsightedness, farsightedness and astigmatism. Not all of these lasers can perform all phases of refractive surgery. The majority of procedures performed in the United States are performed on the VISX laser. The VISX laser is approved for more indications for the correction of eye diseases than any laser in the country. They personally use the VISX laser for all their procedures.

Will I have to wear glasses after surgery?

The answer to this question depends on what the needs of each individual are and the age of the individual. The vast majority of individuals, (i.e., 98% of people) will be able to perform their normal daily activities without the dependency on glasses or contact lenses. However, there may be times when the vision is not quite sharp enough to perform specific duties, for example, driving at nighttime or reading very small print. In these instances, just like most individuals who have “normal” vision, patients may need to wear a very thin eyeglass to fine tune their vision. Also, individuals who have reached their mid-forties may need to wear reading glasses after surgery, just as any other individual would have to wear reading glasses as they age.

What to expect after a laser vision procedure

This information is provided to you as a general guideline only. Please do not use it as a replacement for your surgeon’s instructions.

Immediately Following Treatment Activities

Arrange for a friend or family member to drive you home. Go directly home after your procedure. Wear glasses and keep your eyes closed.
Take a 2-4 hour nap (or keep eyes closed) with the clear plastic shields over your eyes.
When you wake up remove the glasses/goggles and begin using antibiotic, steroid drops and preservative-free artificial tears as directed by your surgeon.
Be very careful not to poke, rub, squeeze or touch your eyes – all could cause discomfort and could dislodge the flaps.
Use the preservative-free artificial tears for irritation and/or dryness.
Avoid staring. Blink frequently.
Avoid soap and water in the eyes.
Take It Easy! Restrict activities to minimal, restful things and keep eyes well lubricated with artificial tears. We advise no reading, no computer work, and no watching TV. We recommend resting for the first 24 hours following surgery.
Your vision may be hazy or blurry. This is typical as your eyes continue to heal.
Your eyes may burn, tear, itch, be slightly red/swollen or feel like there is something (like an eyelash) in them.
You may experience sensitivity to light, glare, starbursts or halos around lights.
Any of these symptoms should improve considerably within the first few days following treatment.
You may want to wear your glasses/goggles while sleeping and at bedtime, so you don’t accidently bump or rub your eyes.
Contact us immediately if you develop any unusual or worsening symptoms at any point following treatment.
If you have concerns before the surgery, please feel free to speak to us beforehand.

Day After Treatment Activities

Continue using antibiotic, steroid, and preservative-free artificial tears, as directed.
When showering, do not let the water hit you directly in the face. It should hit you in the back of the head and then let it run over into your face. No soap or shampoo in the eyes.
Avoid soap and water near the eyes.
Do not rub eyes (below and above cheekbone) for 7 days.
Attend post – operative evaluation. This appointment is relatively brief. Our doctor will test your vision, check the healing of the flap, thoroughly examine your eyes, and answer any questions your may have.
Most people see well enough to drive to their first post-operative appointment. If you do not feel comfortable driving please ask someone to drive you.
Reading, watching TV and computer work is acceptable, but remember to keep eyes well lubricated blink frequently.
Restrict activities to light activities. Strenuous and contact sports must be avoided. With light exercise, keep sweat out of your eyes; a sweatband should be worn for the next 7 days.
Avoid gardening, yard work, grass cutting, and dirty/dusty environments for at least 7 days.
No lotions, creams or eye makeup (shadows, mascara, or eye pencil) for 7 days.
Most people can return to work the following day.

Day 7 Activities

Exercise can be resumed with eye protection, but minimize sweat in your eyes and avoid touching eyes. Continue to avoid strenuous and contact sports, swimming, whirlpools and hot tubs.
Be unusually careful playing with children so eyes do not get bumped or hit.
Discontinue wearing eye shields at night.
Continue to keep eyes well lubricated. After 7 days, it is acceptable to use tears with preservatives.
Carefully begin using lotions, creams and eye makeup, unless the doctor advises differently.
Discuss any other questions regarding resuming regular activities with our doctors.

Week 3 Activities

Scuba diving is restricted for 3 weeks, due to the extreme change in pressure.
Strenuous activities and contact sports may be resumed, including swimming.
Lawn mowing and other outdoor activities can be resumed. Continue to take great care with your eyes to protect them from anything that might get into them.

3-6 Months Activities

May take 3-6 months for vision to stabilize. Vision may fluctuate day to day.
This is typical as eyes continue to heal.
It is vital that you return for all post-operative evaluations, as scheduled by the office.
Contact us immediately if you develop any unusual symptoms, if you experience severe pain or the unlikely event of your vision begins to get worse instead of better.

PTK – Photo Therapeutic Keratectomy

PTK is an excimer laser surgical procedure that removes roughness or cloudiness from the cornea. The cornea is the smooth clear window of the eye in front of the colored iris that helps bend light rays so they focus directly on the retina, the light-sensing layer of cells at the back of the eye. If the corneal surface is rough or cloudy, the rays of light do not focus properly on the retina and the images are blurry.

Until recently, the rough cornea was scraped smooth with a surgical blade, while the cloudy cornea required partial or full corneal transplant. More recently, photo therapeutic keratectomy, or PTK, is an option.

The excimer laser allows some abnormal corneas to be treated with a cool beam of light that evaporates tissue. The principal advantage of laser surgery over conventional surgery is the laser is able to create a smoother corneal surface than a blade and smaller amounts of tissue can be removed.

Potential complications after PTK include poor wound healing, excessive corneal flattening resulting in farsightedness, and irregular astigmatism or poor vision that cannot be corrected completely with glasses.

CK – Conductive Keratoplasty

NearVision CK is intended for people over 40 who want to improve their near vision and reduce their independence on reading glasses. CK is not intended for people with nearsightedness. All patients considering vision correction should undergo a complete consultation with Drs. Berdy and Malhotra.

How does CK work?

NearVison (CK) is a quick procedure with no cutting involved. The surgery is performed on an out patient basis. A good candidate for CK is someone over forty, has great vision their whole life and only requires glasses for reading.

The Procedure:

Using radio frequency energy, (refered to as RF), CK can change how the eye focuses light by reshaping the cornea to make it steeper. After the surgeon has applied a topical anesthetic eye drop, controlled RF energy is applied in a circular pattern to shrink the corneal tissue. This pattern is applied in the periphery of your cornea and therefore minimizes the interference with your line of sight. We use a speculum to hold your eye open. Some surgeons will offer patients a mild sedative prior to the CK procedure.

Once the procedure is over, patients may leave without any patches on their eye and can usually return to work the very next day. Vision will begin to improve in about a weeks time.

REMEMBER-while CK can turn back the clock on your vision, it cannot stop it entirely.

Risks and Complications:

NearVision is associated with a normal amount of related surgery complications. Some side effects are impaired vision for a few days, glare, discomfort, halos and tearing. Although these are risks that are rare, please take into consideration that everyone who has CK may react differently.

PRK – Photo Refractive Keratectomy

Until recently, if you were one of the millions of people with a refractive error (eg. light rays not focusing precisely on the retina), eyeglasses and contact lenses were the only options for correcting vision. But with the arrival of refractive surgery, some people may have their vision corrected through surgery. Photo refractive keratectomy (PRK) is one of several refractive surgery procedures used by ophthalmologists to permanently change the shape of the cornea to improve the way it focuses light on the retina.

PRK is an outpatient procedure, done under topical anesthetic eye drops. It takes about fifteen minutes. The epithelium, the outer layer of the cornea, is removed with a blade, alcohol or laser.

An excimer laser, which produces ultraviolet light and emits high-energy pulses, is used to remove a thin layer of the corneal tissue.

Your ophthalmologist enters your vision correction information in a computer and the laser beam vaporizes the surface of the cornea up to that precise depth. By breaking the bonds that hold the tissue molecules together, your cornea is reshaped, correcting the refractive error. Because no incisions are made, the procedure does not weaken the structure of the cornea.

Immediately following surgery the eye is patched or a bandage contact lens is placed on the eye. After PRK, vision is blurry for three days to one week. It may take a month or longer to achieve one’s best vision. Patients may be on eye drops for up to three months.

Possible complications of PRK surgery include under correction, over correction, poor night vision and corneal scarring. Permanent vision loss is very rare. In recent studies monitored by the FDA, 95% of eyes were corrected to 20/40, the legal limit for driving without corrective lenses in most states.

To be a candidate for the procedure you must have a stable and appropriate refractive error, be free of eye disease, be at least eighteen years old and be willing to accept the potential risks, complications and side effects of PRK.

Radial Keratotomy DiagramRadial keratotomy (RK) is a surgical procedure that has been used since the late 1970’s to reduce myopia by changing the curvature of the cornea.

Using a microscope, microsurgical instruments, and a diamond blade, the surgeon makes several deep incisions (keratotomies) in the cornea in a radial or spoke-like pattern. People with myopia have difficulty with distance vision because the cornea has too much power and focuses light rays in front of the retina. RK weakens the support of the cornea, flattening it and reducing its power. This allows the light rays to focus directly on the retina.

RK takes fifteen minutes and may be performed with the patient awake. Eye drops anesthetize the cornea, eliminating pain during the procedure. Following surgery, people are moderately uncomfortable and often require oral pain medication. Antibiotic eye drops need to be taken for approximately one week. Clear vision can be present the day following surgery.

Postoperative complications include glare, halos, under correction, over correction and astigmatism that may not be able to be corrected with glasses. The major disadvantage of RK compared to laser procedures is it permanently weakens the cornea. Radial keratotomy is currently being used to correct low levels of myopia.