Common laser vision correction procedures include LASIK, PRK and LASEK.
LASIK stands for laser-assisted in-situ keratomileusis. During the procedure, a thin flap is created on the cornea using a microkeratome or a femtosecond laser. This flap is then lifted, and an excimer laser reshapes corneal tissue to alter the way light enters the eye. The flap is then replaced. The entire procedure takes only 15-20 minutes for both eyes. Recovery time is also short, and improvement in vision can be seen within a day. Vision often continues to improve and stabilize for a few weeks.
LASIK – WF OPTIMIZED
FREQUENTLY ASKED QUESTIONS FOR LASIK SURGERY
We have proudly offered LASIK and PRK in our Flagstaff center for over ten years, and since 2006 have operated with the Technolas 217z, which now has the most advanced eye tracking device available. The Technolas 217z 100 with ACE tracking, is the only laser system with a tracker that will actively follow a patient’s eye movements side to side, up and down, and twisting. This superior tracking device leads to the most accurate placement of the laser treatment, improving results.
We use a mechanical microkeratome for cutting the flap during LASIK. We have had tremendous success with a very low complication rate with our equipment. We see no advantage to purchasing the very expensive “no blade” systems. According to studies, the “no blade” or laser flaps “did not have an advantage in efficacy, accuracy, and safety measures over mechanical microkeratome LASIK”.* Ref: J Cataract Refract Surge 2011; 37:2151-2159 2011 ASCRS and ESCRS.
If you are wearing soft contacts they need to be out for at least one week before your evaluation exam and two days before your surgery. If you are wearing hard or gas permeable contact lenses they need to be out for at least three weeks prior to your exam and surgery. If you have little or no astigmatism we can try to get you into soft lenses to transition you during this period.
Hard and gas permeable lenses reshape the cornea, and even a soft lens can alter the shape by causing swelling. Leaving them out helps your cornea return to its most natural shape. By waiting this period of time, or even longer, we assure that we will get the most accurate results from your exam, which has a direct effect on the accuracy of your surgery. The goal is to get the best measurements for your vision correction.
Dr. Mahanti routinely performs laser surgery on both eyes on the same day. On the occasion that one eye is done at a time, this is often personal patient preference. It may depend, however, on the procedure you’re having. It is possible that at the time of surgery Dr. Mahanti will choose to not proceed with the second eye.
You will be at our laser center for an about an hour on the day of surgery. The surgery itself takes about 5-10 minutes for each eye. Prior to surgery, you may have a small dose of Valium to relax you if you wish. Upon your arrival your paperwork & instructions are reviewed. And after your procedure you will go home to rest.
There is little pain associated with the modern refractive procedures. Your eyes are numbed before the surgery with anesthetic eye drops. During the surgery, you may feel a small lid support holding the eye open and pressure from the suction ring during the creation of the flap (if you are having LASIK). Most patients do not report this as being painful. The laser portion of the surgery is painless. The anesthetic drops continue to numb the eyes for about 20-30 minutes after surgery. Once the anesthetic drops wear off, your eyes may burn and water for about 6 hours. Usually Tylenol and going to sleep will allow the eyes to heal well. Prescription pain pills will be given if you are having PRK, as this procedure causes more irritation.
Refractive surgery involves delivering a laser treatment from an FDA approved Excimer laser into the stromal layer of the cornea. With LASIK, a thin flap of the top two layers of the cornea is created to reach the stroma. The success rate in the creation of the flap in our practice is over 99%. If there is anything abnormal about the flap, the surgery is stopped and can be attempted again in three months. With PRK, just the very top layer of the cornea is removed to reach the stroma. The other critical part of the procedure is the laser application. The laser must be properly programmed, aligned and the patient must hold his attention on a blinking target light during the application. Do not be too concerned about your ability to hold your eye absolutely still, as our laser has a superior tracking device that will allows the laser beam to follow the small movements you cannot control. The consent form for surgery provides a more complete discussion of complications. Fortunately, in Dr. Mahanti’s experienced hands complications are truly rare, and he will discuss these with you at your eye evaluation.
Most refractive patients experience intermittent mild irritation for several days after the surgery. The vision can fluctuate from day to day, and it also may be different in each eye. This imbalance can be annoying in the early post-operative period. There are some patients whose vision takes several weeks to several months to improve to its maximal level. Dryness in the eye can be exacerbated by the surgery, requiring the frequent use of eye drops for a while. There are also some patients that will need to use lubricating eye drops for a prolonged period of time. Glare and light sensitivity can also occur, and night driving can be more difficult after surgery. Rarely the use of night driving glasses is required. These side effects usually resolve within several months.
Insurance companies, for the most part, still look at Laser Refractive Surgery as cosmetic in nature and so do not cover it. A few insurance companies are trying to be more progressive, so we always encourage you to call them and ask. Some vision plans may be contracted with one or two surgeons in the state to perform surgery at a discounted rate, and these surgeons are usually in Phoenix, so you need to calculate in your travel expenses, and take into account that you will not be developing any relationship with your surgeon. Many people have a flex-plan or health savings plan available with their workplace, which provides pretax dollars you can use for your surgery. We also have financing available if desired. The IRS considers Laser Refractive Surgery as reconstructive and eligible as a medical expense deduction.
You should not have any problems seeing up close after surgery until you reach your 40’s. Most people in their mid- to late 40’s naturally have trouble seeing up close, whether they’ve had surgery or not, and need to use store-bought readers or bifocals to read small print. The need for reading correction will occur for most patients regardless if they have Laser Refractive Surgery or not. Patients over the age of 50 may also have more difficulty with arms length or intermediate range vision.
INTRODUCING THE 217Z 100 LASER
We have the only Excimer laser in Northern Arizona, the Technolas 217z 100, which has the most advanced eye tracking device available. The Technolas ACE tracking device is the only tracker that will actively follow a patient’s eye movements side to side, up and down, rotational and twisting. This leads to the patient having the most accurate treatment, which improves results.
PRK is the original refractive procedure performed with the Excimer laser. The surgeon removes the top layer of corneal cells (epithelial cells). The laser treatment is then done on the lower layer of the cornea, as with LASIK. The epithelial cells will grow back right where they belong within three to seven days. The risk of PRK is lower than LASIK because no flap is created. The healing process with PRK comes with some discomfort, even with medication, and your vision takes about 5-7 days to improve and a month or more to reach its full improvement. Studies show the visual outcomes are the same with PRK and LASIK.
PRK – WF Optimized
LASEK is a modification of the LASIK procedure. The eye is bathed in a special solution. Then a thin flap of corneal tissue is lifted so the central cornea may be treated with an excimer laser. More cornea is available for treatment than with LASIK, making LASEK a better choice for some patients with anatomically thin corneas. After treatment the flap is replaced and allowed to heal. A contact lens may be worn for a few days until recovery is complete.