Laser Eye Surgery

Is the world a complete blur for you without your glasses or contact lenses? And when you do get your glasses on, do you resent the lack of freedom in all your movements? Perhaps it's time you went in for corrective eye surgery.

Most corrective eye surgery is technically known as refractive eye surgery, an elective procedure intended to correct common eye disorders, or refractive errors, such as myopia (near-sightedness), hyperopia (far-sightedness) and astigmatism (distorted vision).

Where does laser eye surgery come in?

Laser refractive surgery is rapidly becoming the most technologically advanced and popular method available today to correct refractive errors, primarily because it provides near-total precision and predictability. However, there are still a relatively small number of ophthalmologists in the US who are trained in laser refractive surgery and in the calibration and operation of the laser.

The excimer laser, which is used in this type of surgery, received FDA approval in 1995 for correcting mild to moderate nearsightedness. At present, the excimer laser is approved for use in procedures called photorefractive keratectomy (PRK) and laser in situ Keratomileusis (LASIK).

Photorefractive Keratectomy

Performed with local anesthetic eye drops, PRK is a refractive surgery that reshapes the cornea by removing tiny amounts of tissue from the outer surface with a computer-controlled ultraviolet beam of light. The beam is so precise that it can notch a strand of human hair without breaking it. The procedure is the commonest form of laser eye surgery, takes only a few minutes, and you can get back to normal life in a couple of days.

Is Laser Surgery for You?

Millions of patients have experienced total freedom from any kind of eyewear after laser surgery, but there are cons too, as with every surgical procedure. It is best to find out whether you are eligible for laser eye surgery. Here's a checklist so you don't end up with worse eyesight than you had before you went in:

- People who are slow healers or have ongoing medical conditions like glaucoma or diabetes are not good candidates for laser surgery

- Those with uncontrolled vascular disease, autoimmune disease, or people with certain eye diseases involving the cornea or retina are also poor candidates, so make sure you have a long chat with your doctor before you opt for surgery

- Pregnant women should avoid refractive surgery of any kind because the refraction of the eye may change during pregnancy


Facts you should know

- You needn't worry if your pain threshold is low, since there is hardly any discomfort during surgery. Once the anesthetic wears off, the degree of pain varies from individual to individual, but any irritation is minor and usually vanishes within hours

- Worried about when you can return to work? Usually in one to three days post-surgery, but a better idea is to wait until you feel up to it

- Convalescence is minimal, and usually you can be driven home about 30 minutes after surgery. Typically, your eyesight improves within 3 to 5 days

- According to numerous surveys in the U.S. and worldwide, the effects of surgery appear permanent. As people age, however, their vision deteriorates naturally, so re-treatment may be necessary

- Laser surgery does not really restrict your activities, except you should not rub your eyes after surgery. Other than that, you can do whatever work you feel up to provided you follow doctor's orders

The risk factor

In one word, minimal, but there have been a handful of cases where complications resulting from laser eye surgery have resulted in corneal transplants. So here goes:

- There is about a 0.1 percent chance of the cornea becoming infected after PRK, which usually means added discomfort and a delay in healing, but no long-term effects within a period of four years

- It is as yet not possible to definitely predict how your eye will respond to laser surgery. As a result, you may still need lenses after surgery for good vision. In some cases, a second procedure can improve the initial result

- Some patients find that their best vision with corrective lenses is worse than it was before the surgery. This is a result of either irregular tissue removal or development of corneal haze

- However, corneal haze is part of the normal healing process after PRK. In most cases, it has little or no effect on the final vision. However, some cases of excessive haze interfere with vision. As with under-correction, this can often be corrected by additional laser treatment.

- In some patients the effect of surgery gradually fades over several months. In such cases, a re-treatment is once again usually sufficient

- Some patients experience the halo effect, an optical effect noticed in dim light. As the pupil enlarges, a second faded image is produced by the untreated peripheral cornea. This can interfere with night driving. However, recorded cases are extremely rare.

As of now, a number of other lasers for eye surgery are being tested to determine their safety and efficacy. Such tests may allow for clinical studies involving the excimer laser and the correction of farsightedness, provided the FDA grants approval, which is something a potential patient should always check.