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LASIK eye surgery

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Lasik eye surgery - series
Lasik eye surgery - series

Alternative Names    Return to top

Laser-Assisted In Situ Keratomileusis; Laser vision correction

Definition    Return to top

LASIK is eye surgery that permanently changes the shape of the cornea (the clear covering on the front of the eye) in order to improve vision and reduce a person's dependency on glasses or contact lenses.

See also: Corneal surgery

Description    Return to top

For clear vision, the eye's cornea and lens must bend (refract) light rays properly, so that images are focused on the retina. If the light rays aren't clearly focused on the retina, the images you see are blurry.

This blurriness is referred to as a "refractive error." It is caused by an imperfectly shaped eyeball, cornea, or lens. LASIK uses an Excimer Laser (an ultraviolet laser) to precisely remove corneal tissue to correct the shape for better focusing.

A complete eye examination will be done before surgery to make sure your eyes are healthy. Other tests will be done to measure the curve of the cornea, the size and position of the pupils, the shape of the eyes (to make sure LASIK is an option), and the thickness of the cornea (to make sure you will have enough cornea tissue left after surgery).

A signed informed consent form is needed before the procedure, confirming knowledge of the risks, benefits, alternative options, and possible complications.

LASIK is an outpatient surgical procedure and will take 10 to 15 minutes for each eye.

The only anesthetic used is an eye drop that numbs the surface of the eye. The procedure is done with the person awake. LASIK may be done on one or both eyes during the same session.

During LASIK, a special knife (a microkeratome) is used to cut a hinged flap of corneal tissue off the outer layer of the eyeball. The flap is lifted out of the way and a special laser is used to reshape the underlying corneal tissue.

The calculation for how much tissue is removed by the laser is done ahead of time. Once the reshaping is done, the surgeon replaces and secures the flap. No stitches are needed. An eye shield or patch will be placed over the eye to protect the flap and to help prevent rubbing or pressure on the eye until it has had enough time to heal.

Why the Procedure is Performed    Return to top

LASIK is done most often on people who use glasses or contact lenses because of nearsightedness (myopia). It is occasionally used to correct farsightedness. It may also correct astigmatism.

FDA and American Academy of Ophthalmology developed guidelines and recommendations that detail who would be a good candidate for LASIK.

Other recommendations:

For patients with presbyopia, it's important to note that LASIK cannot correct vision so that one eye can see at BOTH distance and near. However, LASIK can be done to allow one eye to see near and the other far. If you can adjust to this correction, it may eliminate or reduce your need for reading glasses. In some instances, surgery on only one eye is required. If your doctor thinks you're a candidate, ask about the pros and cons.

Risks    Return to top

The long-term effects of LASIK past 5 years after the surgery are yet to be determined.

Over- or under-treatment of the condition may occur, requiring additional surgery, contact lens, or glasses.

Risks may include:

Some patients, although they may see much better than before LASIK without glasses, will still need glasses for their best vision.

After the Procedure    Return to top

Immediately following the surgery, there may be a sense of burning, itching, or a feeling that something is in the eye. There may be mild discomfort for which the doctor may prescribe a mild pain reliever medication. It is very important NOT to rub the eye after LASIK, so that the flap does not dislodge or move.

The day of surgery, vision generally is blurry or hazy but by the next day the blurriness improves. The doctor should be called immediately if there is severe pain or any of the symptoms worsen BEFORE your scheduled follow-up appointment (24-48 hours after surgery).

At the first doctor visit after the surgery, the eye shield will be removed and the doctor will examine your eye and test your vision. You may receive eye drops to help prevent infection. Do not drive until your vision has improved enough to safely do so.

Other things to avoid include swimming, hot tubs, whirlpools, contact sports, lotions, cremes, and eye make-up for between 2-4 weeks after surgery. The doctor will give you specific instructions.

Outlook (Prognosis)    Return to top

It may take up to 3-6 months for your vision to stabilize after surgery.

Some people need an additional surgery to get the best possible results. However, a second surgery may improve distant vision, it may not relieve other visual symptoms such as glare, haloes, or difficulty with night driving. These are commonly reported complaints after LASIK surgery. Often, these problems will go away after 6 months, but a small number of people continue to have problems with glare.

If your distance vision has been corrected with LASIK, it is likely that you may still need reading glasses around age 45.

References    Return to top

Yanoff M, Duker JS, Augsburger JJ, et al. eds. Ophthalmology. 2nd ed. St. Louis, Mo: Mosby; 2004:188-195.

Duffey RJ, Leaming D. US trends in refractive surgery: 2003 ISRS/AAO survey. J Refract Surg. 2005 Jan-Feb;21(1):87-91.

Cobp-Soriano R, Calvo MA, Beltran J, Llovet FL, Baviera J. J Cataract Refract Surg. 2005 Jul;31(7):1357-65.IG.Thin flap laser in situ keratomileusis: analysis of contrast sensitivity, visual, and refractive outcomes.

Balazsi G, Mullie M, Lasswell L, Lee PA, Duh YJ. Laser in situ keratomileusis with a scanning excimer laser for the correction of low to moderate myopia with and without astigmatism. J Cataract Refract Surg 2001 Dec;27(12):1942-51.

Miller AE, McCulley JP, Bowman RW, Cavanaugh HD, Wang XH. Patient satisfaction after LASIK for myopia. CLAO J 2001 Apr;27(2):84-8.

McGhee CN, Craig JP, Sachdev N, Weed KH, Brown AD. Functional, psychological and satisfaction outcomes of laser in situ keratomileusis for high myopia. J Cataract Refract Surg 2000 Apr;26(4):497-509.

Update Date: 8/22/2008

Updated by: Paul B. Griggs, MD, Department of Ophthalmology, Virginia Mason Medical Center, Seattle, WA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

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