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LASIK

Dr. Grandon performing LASIK

Laser In-situ Keratomileusis, or LASIK, has evolved as the most successful laser procedure for the correction of low, medium, and high myopia, with or without astigmatism. Especially those individuals with high myopia (-5 or more diopters) who were difficult candidates for radial keratotomy have a new window of opportunity. Now, LASIK is being performed successfully to correct hyperopia and astigmatism, as well.

Patients must have stable vision and no other significant eye problems in order to qualify for LASIK surgery. Of course, final determination of eligibility rests with the ophthalmologist's evaluation of the patient's complete eye examination.

Patients wearing hard contact lenses must not wear them for about one week prior to their eye examination; patients with soft contacts must remove them two to four days before the examination. Prior to LASIK surgery, hard and soft contact lenses must not be worn for one to three days.

Technique

The flap maker separates surface layers of the cornea.

During the LASIK procedure, the patient is awake, but the eye is numbed with a topical anesthetic (eye drops). A tiny instrument (speculum) is affixed to hold the eyelids open. The eye is held steady by a suction device while the keratome (flap maker) separates surface layers of the cornea, lifting but not removing them.

The surgeon then removes microscopic layers of the cornea with pre-programmed laser pulses. The corneal flap is then laid back into place. No stitches are needed to secure this flap, as hydrostatic pressure bonds it in place during the healing process.

The procedure takes approximately 10 minutes for both eyes. We like to refer to LASIK as the 10-minute miracle.

Treating nearsightedness, farsightedness, and astigmatism

LASIK/Nearsightedness	To treat nearsightedness, the cornea must be made flatter. This is accomplished by removing tissue from the center of the cornea.
LASIK/Farsightedness	To treat farsightedness, the central cornea must be made steeper. This is accomplished by directing the laser beam to remove tissue from around this area.
LASIK/Astigmatism	To treat astigmatism, the cornea must be made more spherical. By changing the pattern of the beam, more tissue is removed in one direction than the other.

Postoperative care and expectations

Until the next day following LASIK surgery, the patient wears clear plastic eye shields. He or she should be especially careful not to rub the eyes, as rubbing could displace the corneal flaps. After that first day, the shield should be worn to bed for seven nights so the patient cannot rub his eyes during sleep.

Antibiotic eye drops are used for one week following surgery, and anti-inflammatory medication (steroids) is usually taken for one to four weeks.

There are few restrictions following LASIK surgery. Eye makeup should not be worn for 10 days postop, for instance, nor should the patient swim for 14 days. If the patient plays contact sports, he should wear eye guards for the first three months postop. As we have already indicated, the eyes should not be rubbed.

Results

With LASIK, patients usually are greatly improved within the first hour of surgery. By the next day, they often see 20/20 or 20/25. The final result takes three to four months. Even though the patient usually sees well the first day, there is continued improvement over the next three to four months. The results are very stable with very little fluctuating or changing vision over the years.

Patients are usually very pleased with the LASIK procedure, because there is virtually no pain, and recovery is very swift. Since the results of LASIK are usually very predictable, both eyes can be corrected the same day or just a few days apart. Occasionally, a touch-up might be necessary. That procedure involves lifting the flap, re-lasering the corneal bed, and replacing the flap. A bandage contact lens is inserted for 1 to 4 days after a touch up procedure is done. If the procedure is necessary, with the special equipment and instruments Dr. Grandon uses, it can be done as late as 4 years after the first procedure is performed.

Latest development

The Hansatome Keratome

Dr. Grandon uses the highest technology available for LASIK surgery. Included is the VISX-S-4 laser (third generation) with Active Trak, allowing for an 8mm optical zone (the largest in the industry). The results have greatly improved, and the chance of night time glare has greatly diminished.

With this instrument, the surgeon has a great deal of confidence that a perfect corneal flap can be created for the great majority of patients. Most importantly, the patient's surgical experience and recovery are excellent.

Possible complications

Most patients who undergo LASIK surgery will encounter no difficulties with the procedure at all. However, no surgical procedure is without any risk.

Prior to the Hansatome Keratome, such complications as loss of pressure, creation of a ring flap or a button-holed flap, epithelial ingrowth with central scarring, and loss of best corrected visual acuity occurred. Because of greater risk of these complications, Dr. Grandon chose to wait for newer and safer instruments before he would perform LASIK on his patients.

With the Hansatome Keratome, the surgeon has a safety net. The risk of surgical complications is minimized. Postoperative complications rarely arise in the form of temporary corneal haze, a little glare, and very little fluctuation of vision.

Long-term stability

LASIK has been performed worldwide since the early 1990s and with the Hansatome Keratome only since early 1998. The prospects for long-term stability are very high, based on historical evidence of postoperative corneal healing.

HYPEROPIC LASIK

LASIK has been determined to be appropriate for farsighted patients with +1 to +6 diopters of hyperopia or more, providing their farsightedness is not a result of aging (that condition is known as presbyopia).

During the procedure, the surgeon makes the corneal flap, and then the laser removes peripheral tissue, making gutters around the cornea, resulting in a doughnut effect. In so doing, the center becomes steeper, allowing for light rays to focus more directly on the retina. It is the reverse of what the surgeon accomplishes in the correction of myopia.

LASIK FOR ASTIGMATISM

In the astigmatic patient, one visual axis is steeper than the other, giving the eye a football shape. During LASIK surgery for the correction of astigmatism, the keratome creates the corneal flap, then the laser progressively removes more tissue off the steeper axis, thereby flattening that axis and making the cornea spherical.