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1. What is nearsightedness?
2.
What is hyperopia?
3.
What is astigmatism?
4. What is presbyopia?
5. What is a diopter?
6. How can these visual problems be corrected?
7. What are the risks or limitations to glasses and
contact lenses?
8. Are there other non-surgical means of improving
your vision?
9. What is refractive surgery?
10. What is laser vision correction (LVC)?
11. How much tissue is removed?
12. What is the history of the excimer laser?
13. What procedures are performed with the excimer
laser?
14. How do LASIK and PRK work?
15. Which refractive procedure is for me?
16. Will I be in any pain?
17. How long do the procedures actually take?
18. What are the results? Will my vision be 20/20
after LVC?
19. Can you guarantee my results?
20. How well will I be able to see following refractive
surgery?
21. Why is LASIK becoming the procedure of choice
for most patients and surgeons?
22. What are the drawbacks of LASIK?
23. How is astigmatism corrected?
24. How do I know if I'm a good candidate for laser
vision correction?
25. Is there a limit to how much nearsightedness LVC
can correct?
26. Are these procedures FDA approved?
27. Can I have both eyes done at the same time?
28. Will I be awake as the operation is being performed?
29. Will I be hospitalized for refractive surgery?
30. How long does refractive surgery take?
31. When can I go back to work?
32. Will I need glasses or contacts after surgery?
33. Will I need reading glasses after surgery?
34. Can I wear contact lenses after laser surgery?
35. Will I require eye drops after surgery?
36. Will I need an enhancement procedure?
37. How many times will I be seen following surgery?
38. What are the side effects of this surgery?
39. Is it possible to become blind with the surgery?
40. How long do I have to wait before I can take a
bath or shower after surgery?
41. When can I wear eye makeup after surgery?
42. How soon after surgery can I drive?
43. If I have PRK, what kind of vision can be expected
the following day?
44. If I have LASIK, what kind of vision can be expected
the following day?
45. When can I exercise after surgery?
46. What are the long-term effects of LVC?
47. What other surgical alternatives are there to
PRK and LASIK?
48. If I have had a previous corneal injury, can I
have refractive surgery done?
49. Are there other alternatives for astigmatic correction?
50. What about farsightedness?
51. How does LVC for hyperopia work?
52. How do I know LVC is safe?
53. Will the effects of the treatment be permanent?
54. Can I afford LVC?
55. What is the process for patients who reside outside
of Southern California?
56. I'd like to have LVC. How do I proceed?
1.
What is nearsightedness?
Over
60 million Americans suffer from nearsightedness, or myopia. A
person is considered nearsighted when the eye has too much focusing
power. This occurs when the eye is either too long or the cornea
is too steep to allow light to focus directly on the retina (the
film of the eye). Instead, light focuses in front of the retina
causing distant images to appear blurry. A minus power lens in
the form of eyeglasses or contact lens is needed to subtract focusing
power from the eye. 
2.
What is hyperopia?
Hyperopia is a condition where light rays entering the eye are
focused behind the retina instead of directly on it, as in the
normal eye. It may be present in childhood but does not usually
become apparent until people are in their late 20s or 30s when
they can no longer see up close. When these patients get into
their 40s or 50s, they begin having difficulty seeing distant
objects as well. If someone has laser vision correction for nearsightedness
and is already presbyopic (40+ years of age), they will then need
correction for reading. These are typically just the store bought
magnifying glasses. Patients with no vision problems will normally
require reading glasses soon after their 40th birthday due to
a crystallization of the lens in their eye and a decay in the
ability to focus (presbyopia).
Since hyperopias must use their near focusing reserve up to see
clearly in the distance, they need help with reading at an earlier
age and require bifocals when they lack enough reading capacity
to bring distant objects into focus.
3.
What is astigmatism?
Astigmatism
is a condition that occurs when the cornea or lens is steeper
in one axis than another, similar to a football or the back of
a spoon. Light entering the cornea focuses on more than one point
within the eye resulting in blurring vision. Astigmatism is either
regular when steep and flat axes are 90 degrees apart or irregular
when they are not separated by 90 degrees.
4.
What is presbyopia?
This
occurs in people as they age, and is also the reason that people
need bifocals once they reach their 40s. Vision gets split into
two distinct zones: distance and near. If you see clearly at distance,
it is likely you will then need correction for near.
5.
What is a diopter?
A
diopter is a unit of measurement that determines your prescription.
A minus sign means nearsighted, a plus sign means farsighted.
6.
How can these visual problems be corrected?
They
can be corrected with glasses, contact lenses, or surgery.
7.
What are the risks or limitations to glasses and contact lenses?
Glasses
limit peripheral vision, interfere with athletic activities and
water-related recreation, and may cause discomfort to the bridge
of the nose or ears in some. Nearsighted prescriptions also tend
to reduce the size of the viewed image as well as the appearance
of the eyes behind glasses. This tends to become more and more
cosmetically unappealing with higher prescriptions. Farsighted
people get a magnification effect from their glasses and eyes
appear larger behind them.
Contact
lenses may cause irritation, chronic inflammations, and in rare
cases, sight-threatening infections (ulcers). While they do offer
cosmetic and activity-related advantages over spectacle correction,
some patients are unable to wear contacts or are poor candidates
because time constraints prevent them from caring for the lenses
properly. Contacts are also not usually ideal for water-related
activities. However, both glasses and contacts offer the advantage
of being able to fine tune correction in most cases to ones best
possible correction.
8.
Are there other non-surgical means of improving vision?
A
procedure called orthokeratology has been available for many years.
In it, a series of progressively flatter gas permeable hard contact
lenses are used to flatten the cornea. When the cornea has reached
its desired correction, a retainer contact must be worn for several
hours per day to prevent the cornea from returning to its original
shape. Therefore, it does not cause a permanent correction.
9.
What is refractive surgery?
These
are a group of surgical procedures that have been designed to
permanently reduce or eliminate the need for corrective eyewear
to see distant objects. They include laser assisted in-situ keratomileusis
(LASIK), photorefractive keratectomy (PRK), radial keratotomy
and astigmatic keratotomy (RK/AK, to name a few. These procedures
offer an alternative to glasses or contact lenses. These procedures
can only improve vision if it can be improved w glasses or contact
lenses.
10.
What is laser vision correction (LVC)?
These
are refractive procedures performed with an excimer laser. The
excimer generates ultraviolet light of a specific wavelength (193
nanometers) by sending high-voltage electrical energy through
a cavity containing Argon Fluoride gas. The beam that is emitted
has enough energy to break the bonds between the molecules that
make up the tissue on your eye's surface (the cornea). Because
it is a photochemical and not a heating process, it allows the
surgeon to sculpt very precise amounts of corneal tissue from
above without any damaging to neighboring/adjacent) tissue.
11.
How much tissue is removed?
Each
pulse of laser removes 1/4000 of a millimeter (0.25 microns) of
tissue. The laser is delivered though a progressively opening
shutter above the eye to create a concave shape treatment area,
which flattens the cornea.
12.
What is the history of the excimer laser?
The
excimer laser was developed at IBM in 1976, and was used to etch
computer microchips. Its extreme precision with negligible damage
to adjacent tissue made it a very attractive tool for other applications,
and in 1983, Stephen L. Trokel, M.D., in cooperation with R. Srinivasan,
a physicist, applied it to corneal tissue in a New York laboratory.
The first sighted eye was treated with the excimer laser at LSU
on January 14, 1987. Between 1987 and 1995 numerous laser manufacturers,
including VISX and Summit Technology, worked toward U.S. approval
to use the Argon Fluoride excimer laser.
13.
What procedures are performed with the excimer laser?
LASIK,
or laser in-situ keratomileusis, and PRK, or Photorefractive Keratectomy.
14.
How do LASIK and PRK work?
In
both procedures, a specially trained ophthalmologist uses the
computer-guided excimer to gently remove a thin layer of tissue
from the cornea to achieve a desired correction. Prior to the
procedures, drops are placed in the eye to numb it (like the ones
your eye doctor uses to check your eye pressure for a glaucoma
test) and an instrument called a speculum is placed in the eye
to prevent you from blinking. There are no needles and no pain.
In
PRK, the surgeon first removes the surface cells of the cornea
using the laser and then sculpts the underlying tissue. The surface
cells regenerate over the course of 48 to 72 hours under a bandage
contact lens. PRK is usually done one eye at a time with a waiting
period of usually two to threee weeks between eyes. In LASIK,
an instrument called a microkeratome, (similar to a carpenter's
plane) is used to lift a thin layer of the corneal tissue. This
is left attached on a hinge. The laser is then used to sculpt
tissue from the corneal bed and the flap is floated back into
place, reattaching without the need for sutures.
During
the LASIK procedure there is no pain, however there is about 15
seconds of firm pressure while the corneal flap is being created.
Following the procedure, patients are usually more comfortable
than patients undergoing PRK, experiencing only four to six hours
of scratchiness in the eye.
15.
Which refractive procedure is for me?
Determining
the right procedure based upon your profession and overall lifestyle
is very important. There are many considerations to make before
recommending a procedure that would best suit you as an individual.
During your free, complete evaluation, we will talk with you in
detail not only about the procedures we offer, but also about
your visual needs and expectations. The goal of the evaluation
is not only to inform you, but to also make sure that refractive
surgery is the appropriate choice for you. Individual evaluations
are available daily at our various locations. Telephone consultations
are available for those outside of Southern California.
16.
Will I be in any pain?
There
is no discomfort at all during the PRK procedure. Following the
procedure, expect a gritty sensation with some mild to moderate
discomfort in the first few days, which will improve with time.
Not all patients experience significant discomfort since topical
analgesics (advil-like drops), and a contact lens are used as
a bandage for the first few days as the surface layer fills in
to cover over the exposed corneal nerve endings. Anesthesia is
provided during the first 24 hours in the event of severe discomfort.
All discomfort should be completely resolved within 2-3 days except
in the rarest of cases. During the LASIK procedure there is no
pain, however there is about 30 seconds of firm pressure while
the corneal flap is being created. Following the procedure, patients
are slightly more comfortable than patients undergoing PRK, experiencing
only a 4-6 hours of scratchiness in the eye.
17.
How long do these procedures actually take?
Most
patients are in the laser suite for no longer than 20 minutes.
The actual laser treatment time takes just 15-90 seconds, depending
on the degree of correction required. Total time at the center
on the day of the procedure will be about an hour.
18.
What are the results? Will my vision be 20/20 after LVC?
The
results are quite remarkable. In the U.S. clinical trials that
were reviewed during the approval process for laser correction
of nearsightedness, 100% of the patients studied experienced improved
or uncorrected vision. Over 90% were returned to 20/40 sight or
better -- the "driving standard" in most states -- and
were able to enjoy life and perform most activities without glasses
or contacts. With refinement in techniques since the studies,
95-98% of eyes with mild to moderate myopia who undergo PRK vision
correction achieve 20/40 vision or better - enough to pass a driver's
exam without glasses with a single procedure. Two-thirds achieved
20/20 vision.
19.
Can you guarantee my results?
The
results of surgery, in any case or of any kind, cannot be guaranteed.
We will however, provide you with historical data on refractive
surgery results at Advanced Ophthalmology Institute so that you may know
the probability of achieving 20/20 vision and can make an informed
decision.
20.
How well will I be able to see following refractive surgery?
There
are multiple issues that are common to all or nearly all refractive
surgical procedures. Among these are factors involved in assessing
the outcome of a refractive procedure. The ideal outcome of a
refractive procedure would be one in which the patient can see
very soon afterwards at least as well without glasses or contacts
as he/she had previously been able to see with the best possible
glasses or contacts and do so with no side effects. In reality,
however, the outcome is usually something less than this in one
or more respects and is sometimes considerably less. It is very
important that your expectations are reasonable and that you understand
the possible ways in which your expectations might not be met.
It is helpful to know that, although there are exceptions, as
a generality the higher the myopia (nearsightedness) you begin
with, the less likely you are to have an ideal outcome. However,
some of our happiest patients are those who begin with high or
extreme myopia as their enormous dependence on glasses or contact
lenses can make them feel very frightened of situations in which
they might lose their glasses or contact lenses. Our distinction
between the variation of myopia is as follows:
- Low
0 to 5.99 diopters
- Moderate
6.0 to 9.99 diopters
- High
10.0 to 14.99 diopters
- Extreme
15.0 and over diopters
These
categories are fairly arbitrary but are of some value in predicting
outcomes and in selecting parameters of treatment.
There
are other objective and subjective aspects of vision that affect
a person Oł perception of the quality of their overall sight.
Some objective factors would be peripheral vision, color vision,
glare, and contrast sensitivity. Some examples of subjective factors
would be: shadows, halos, starbursts, multiple images, distortion,
and haze.
21.
Why has LASIK become the procedure of choice for most patients and
surgeons?
Because
the healing occurs in the interior of the cornea, and no regrowth
of surface cells are required. The corneal flap protects the treated
area and there is usually little, if any, post-op discomfort.
Visual rehabilitation is much quicker and regulation of the healing
process with long term post-op drops is unnecessary since the
center of the cornea tends to have much less of a healing reaction
than the surface.
22.
What are the drawbacks of LASIK?
While
more comfortable and yielding quicker rehabilitation of vision,
LASIK is technically more difficult to perform than PRK and carries
with it a slightly higher complication rate. This is because there
is an extra step involved - the creation of the corneal flap.
This is rarely associated with any considerable or permanent vision
loss, however, there are occasional circumstances which could
cause flap wrinkling, or incomplete flaps which could lead to
vision difficulty, requiring further procedures.
23.
How is astigmatism corrected?
One
method employed by the VISX Star excimer laser introduces an additional
set of shutters into the path of the laser beam to block treatment
in the axis where the cornea is flatter, thus allowing more treatment
in the regions where the cornea is steep. The autonomous LADAR
vision laser applies additional pulses along the steeper axis,
thereby reducing the astigmatism. The difference between the Visx
Star Excimer Laser and the Autonomous LADAR Vision Laser is as
follows: The Visx Star S2 employs a broad beam laser which measures
a 6 to 6.5 millimeter in diameter. The Autonomous LADAR Vision
Laser has a small (.8mm) laser spot, which rotates quickly to
cover the optical zone treatment area. LADAR vision also has an
active eye tracker which follows the eye movements during laser
treatment at the speed of 4,000 times per second. The optical
zone can be expanded with the LADAR vision unit up to 8 millimeters
in size. If astigmatism exists, the optical zone in the autonomous
LADAR vision is expanded with a blend zone of 2 millimeters so
zones of up to 10 millimeters are possible. Both lasers can provide
excellent visual results. Patients can choose between the two
lasers based on the following: The Visx Star S2 is the most popular
laser used in the U.S. today, and the Autonomous LADAR Vision
Laser is a newer laser with some technological advancement. If
you have concerns about large pupils in dim lighting, which can
lead to an increased incidence of glare/halos, then larger zones
employed by the LADAR vision unit are beneficial. If pupil size
is not an issue (smaller than 7 mm in dim lighting), then typically
you will not have any additional glare/halo risks if you choose
the Visx laser. Also, if you believe you will have trouble fixating
on the laser during treatment, the eye tracker on the Autonomous
Laser will provide an added safety feature.
24.
How do I know if I'm a good candidate for laser vision correction?
The
great majority of all nearsighted Americans are potential candidates
for the laser treatment. Patients must be at least 18 years of
age, have mild to moderate near sightedness with a stable prescription
and has no ocular or health issues. The best candidates tend to
be people who are dissatisfied with their glasses or contact lenses
and are motivated to make a change, whether it's due to occupational
or lifestyle reasons.
Although
a patient's prescription may make him or her a suitable candidate
for laser vision correction procedure, it is very important that
the patient have the appropriate level of expectations regarding
the outcome of the procedure. Although uncorrected post-op vision
(after healing) is usually excellent, no one can promise you 20/20
vision.
A
person is a good candidate for Laser vision correction if he or
she expresses the following sentiments in discussing whether or
not to undergo the procedure:
- I
dislike being dependent on glasses for clear vision.
- I
was never a good contact lens candidate/wearer.
- Wearing
corrective lenses restricts my participation in sports and other
activities.
- My
overall appearance is improved without glasses.
-
I worry about losing my corrective lenses (or breaking my glasses).
Without them I fear that I would be totally disabled.
- Having
good vision without corrective lenses is more important than
having great vision with corrective lenses.
-
I would be happy if my vision was greatly improved, even if
I still had to wear corrective lenses some of the time.
- I
usually adjust well to change.
- I
am a fairly easy-going person.
- Not
wearing corrective lenses would open new career opportunities
for me.
- I
have often wished I did not have to wear corrective lenses.
A
person is probably not a good candidate for Laser vision correction
if he or she expresses the following sentiments in discussing
whether or not to undergo the procedure:
- I
like wearing glasses and would feel uncomfortable without them.
- I
don't mind wearing contact lenses.
- They
give me excellent vision for all activities.
- I
don't accept changes easily.
- I
get upset or stressed out easily when things don't seem to happen
in just the way I had planned or expected.
- I
am a perfectionist and little irregularities bother me.
- I
would be very upset if I did not end up with perfect vision
after my procedure and would probably consider the entire experience
a failure.
- If
I needed more correction after my procedure, I would be devastated.
A
patient is also not a good candidate for Laser vision correction,
if any of the following conditions are present:
- Less
than 18 years of age
- Progressive
myopia/unstable refractive error (>0.25-0.50/yr)
- History
of keloid formation (there may be a relationship with significant
post-operative haze in the cornea although no association has
been proven)
- Keratoconus
- an abnormal progressive weakening of the cornea that your
doctor can detect with a sophisticated computerized machine
called a corneal topographer as well as other tests
- Pupil
size greater than 7 mm in diameter (in dim illumination) are
only candidates for LADAR
- Cataracts
- removal of the cataract with insertion of the appropriate
implant lens will greatly reduce one's dependence on glasses
- Unwilling
to commit to post-procedure and follow-up care instructions
- Pregnancy
-
Ocular herpes
- Uncontrolled
diabetes
- Uncontrolled
inflammatory diseases
Larger
pupil size will put you at a greater risk for glare at night.
Autonomous LADAR vision allows larger optical zones, thereby allowing
safer treatments of patients with larger pupil sizes.
25.
Is there a limit to how much nearsightedness LVC can correct?
Most
refractive surgeons now believe that -12D is the upper limit for
good patient satisfaction, although LASIK can be used effectively
under certain circumstances for prescriptions as high as -15D.
Above these levels, other procedures involving the implanting
of lenses inside the eye will probably become the procedures of
choice. PRK is approved by the FDA for treatments of up to -12D.
However, most surgeons prefer LASIK to PRK when treating more
than 4D of myopia. Corneal thickness measurements are very important
and this also limits the amount of correction that is performed.
26.
Are these procedures FDA approved?
Yes,
both the PRK and LASIK procedure have been FDA approved. Specific
amounts of correction approved for treatment vary according to
specific laser manufacturers.
27.
Can I have both eyes done at the same time?
Most
patients undergoing LASIK prefer to have both eyes treated on
the same day, however this is entirely up to the patient. PRK
is not performed on both eyes the same day, and a waiting period
of approximately two to three weeks is recommended.
28.
Will I be awake as the operation is being performed?
Yes.
Your doctor will need you to fixate on a red blinking light in
the microscope during the procedure. This will ensure that the
tissue removed will be centered over your pupil (the shutter of
your eye).
29.
Will I be hospitalized for refractive surgery?
Refractive
surgery at Advanced Ophthalmology Institute is done on an out-patient basis
in our own Surgical Center located at our facilities in San Diego,
California.
30.
How long does refractive surgery take?
Depending
on the refractive surgical procedure chosen, the surgery itself
can take between 5-20 minutes; however, please plan to be at the
facility approximately 4 hours on the day of surgery. Pre-operative
paperwork, discussions, and allowing medication and eye drops
to work, takes a minimum of 1 1/2 to 2 hours and we wait a minimum
of 1/2 an hour after your procedure to recheck your eyes prior
to discharge.
There
are many factors that affect our ability to stay "on schedule"
during a surgery day, but they ultimately come down to taking
whatever time is required to provide the best care we are capable
of to every patient. We realize that no one likes to wait and
if we do get behind it is not pleasant for our staff knowing that
each patient and those with them are irritated by the delay. Please
realize that we spend considerable time and effort trying to coordinate
all aspects of each patient's individual situation into a schedule
that can flow smoothly. We want you to know that we will never
compromise your care to be on time for someone else.
Many of our patients describe their results as "miraculous."
We hope you will find the time you spend with us a small price
to pay for the opportunity to see well without glasses.
Please
note, you will need to be seen pre-operatively for a consultation
and examination prior to surgery and a number of times post-operatively.
If necessary, some of this pre and post-operative care can be
completed by your own family eye doctor.
31.
When can I go back to work?
Most
patients will be able to return to their normal activities within
a few days as long as they work in a clean environment. Procedures
are performed on a variety of days to accommodate your work schedule.
32.
Will I need glasses or contacts after surgery?
If
the patient opts to have only one eye treated at a time, your
doctor will need to fit your untreated eye with a contact lens
for use during your wait before the second eye is done. This can
be done in almost all cases, even if you have not been able to
tolerate contacts in the past. The optics of removing the glass
in front of your treated eye in your spectacles, while giving
clearer vision to each eye individually, will often cause disorientation
and headaches due to image size discrepancy, unless your original
prescription was less than -3.00.
33.
Will I need reading glasses after surgery?
As
people enter their 40s, they start to develop presbyopia (see
#4). Regardless of whether or not you've had Laser vision correction,
this process will happen to you. Your surgeon can create an effect
known as monovision. This means that one eye will be left slightly
nearsighted, thus allowing you to focus on print such as labels
and menus without reading glasses, and perhaps allowing you to
read into your 50s. As one gets older, it will be necessary to
wear reading glasses. Furthermore, if you are over the age of
40 and are used to removing your glasses to read, you must realize
that this will no longer be an option following a full correction
of your nearsightedness with the surgery.
Shortly
after you have had the procedure, it is possible that you may
require a temporary pair of reading glasses if you are approaching
your 40th birthday since the laser, by design, causes an early
overcorrection that normally goes away with time.
34.
Can I wear contact lenses after laser surgery?
If
you were able to wear contacts prior to surgery, you should be
able to wear contacts afterwards. There may be some increase in
difficulty due to the new shape of the front of the eye, however,
it is very unusual for patients to require significant corrections
after surgery.
35.
Will I require eye drops after surgery?
In
PRK, because the laser removes tissue from the surface of the
eye, the body will attempt to fill in the defect much like if
you had a cut on your hand. Since corneal tissue has different
healing properties, the process can normally be regulated with
the use of topical steroid drops which patients may be required
to use over a one-month period. In LASIK, these drops are only
used for a week. These drops will rarely cause any problems. However,
eyes must be monitored on a monthly basis to fine tune the drop
dosage and check for any unwanted side effects such as delayed
or too rapid healing and elevation in eye pressure (glaucoma).
Antibiotic drops are also used for about a week with both procedures.
Please see - Post Operative Instructions.
36.
Will I need an enhancement procedure?
As
we strive to correct every eye to a specific goal, we actually
only accomplish this "perfect" correction in a minority
of cases. A vast majority of people, however, are corrected closely
enough to the goal to feel very pleased with their outcome and
to see well for most purposes without glasses. Some people (about
45% with conventional or mechanical ALK, about 30% with Radial
Keratotomy, and about 10-15% with LASIK) will require an enhancement
or other surgical correction to attain this satisfactory result.
A few people may elect to accept the initial result and not have
additional surgery, and a few will remain less well corrected
than they wish, even after appropriate additional procedures.
We expect these latter two groups to total less than 5% of persons
having refractive surgery varying from almost zero in the people
beginning with low myopia and reaching near 5% in the higher ranges.
If your correction is close to what was aimed for, you will probably
see well enough without glasses for most activities, but a fair
number of patients will still need or want glasses for at least
occasional use. Remember, if you aimed for good distance vision
and are over 40 you can expect to need reading glasses; and if
you aimed for "reading" vision, you can expect to need
distance glasses.
Patients who do not completely achieve the desired goal will find
they need or want to use glasses all or most of the time, especially
if they should be significantly overcorrected. It is important
that you understand this possible outcome and accept it as one
of the risks of surgery. If this should occur, you will most likely
be disappointed with your result. Under or overcorrections are
actually the most common undesirable result or complication of
surgery.
37.
How many times will I be seen following surgery?
Plan
on about 5 short visits in the year following surgery in addition
to your initial consultation and the laser procedures.
38.
What are the side effects of this surgery?
The
most common side effects of laser vision correction are "halo"
effect and some glare at night around lights. These are related
to the area of treatment on the surface of the eye and the size
of your pupil in dim lighting. However, these problems are no
worse than what most contact lens and eyeglass wearers often experience.
Using the autonomous LADAR vision we can expand the treatment
areas thereby reducing the risk of the side effects in patients
with larger pupils.
With PRK, a small percentage of patients may develop haze that,
in rare cases, may effect visual acuity. This is exceedingly rare
in patients whose initial prescription is < -4D. The effect
may last for several months, but is rarely permanent.
39.
Is it possible to become blind with the surgery?
All
eye surgeries carry with them the possibility of infection. The
worst case scenario of infection is that it could damage the cornea
or retina and result in loss of sight. It is important to put
this possibility into perspective when considering Laser vision
correction. However, the risk of a catastrophic complication from
LVC is probably less than the risk of loss of sight through the
use of extended wear contact lenses. In addition, there are other
corneal irregularities which can rarely occur. The worst case
scenario could be corneal scarring which could require corneal
replacement.
40.
How long do I have to wait before I can take a bath or shower after
surgery?
You
can shower or bathe the day after surgery. Avoid getting soap
or water in the eyes.
41.
When can I wear eye makeup after surgery?
It
is a good idea to buy new mascara after surgery to avoid infection
and it is best to wait 2 weeks before using eye makeup.
42.
How soon after surgery can I drive?
You
can resume driving as you feel comfortable with your vision. About
90% of patients are able to drive on their own on the day following
LASIK. With PRK, it usually takes about 4-5 days to feel comfortable.
You should avoid driving while under the influence of any medications
taken following surgery.
43.
If I have PRK, what kind of vision can be expected the following
day?
Vision
is greatly improved but typically blurry immediately after the
procedure (20/80-20/200). It generally starts to improve once
the surface layer of the cornea (epithelium) has grown back, which
in most cases takes 3 to 4 days (approximately 20/40). Vision
typically starts to get good within 7-10, days but can continue
to be blurry for a number of weeks. For most patients, vision
stabilizes within 3 months (some may take 6 months or longer).
The healing process varies for each patient, and it is difficult
to predict precisely when you will achieve your best visual acuity.
However, most patients who have both eyes treated at the same
time report that they are able to drive a car safely and resume
their normal activities between 3-5 days following PRK.
44.
If I have LASIK, what kind of vision can be expected the following
day?
The
first day after LASIK, most patients have experienced a large
improvement in their vision, to approximately 20/40 or even better.
This greatly depends on your preoperative prescription. You can
expect to regain approximately 75% to 80 percent of your vision
in the first two to three days after LASIK. The remainder of your
vision will improve gradually over several weeks. If you have
significant astigmatism, or are very near sighted/far sighed sight
recovery and stabilization are slower.
45.
When can I exercise after surgery?
You
may resume exercises as you wish. Don't get sweat in your eyes.
Try to keep your hands clean and away from your eyes. Swimming,
however, should also be avoided for at least two weeks.
46.
What are the long-term effects of LVC?
Although
LASIK and PRK is a relatively new procedures, results from U.S.
studies to date show that 95-98% of patients with mild to moderate
myopia who have undergone PRK have achieved stable 20/40 distance
vision or better with one treatment. Although a 1-2% of eyes will
lose a line of best correctable vision, no significant long-term
sight threatening consequences have been reported in ten year
follow-up from international centers.
47.
What other surgical alternatives are there to PRK and LASIK?
Radial
Keratotomy (RK) is a surgical procedure that can also correct
nearsightedness by changing the shape of the cornea. Microscopic
incisions of 90% depth, placed in a radial pattern, like the spokes
of a wagon wheel, reshape and flatten the central cornea, allowing
light to focus more precisely on the retina. The length and number
of incisions determine the effect of the surgery. Patients with
less than 3 diopters of nearsightedness and stable prescriptions
are the best candidates.
48.
If I have had a previous corneal injury, can I have refractive surgery
done?
A
full eye exam is needed in order to determine if you are a good
candidate. If you have had a corneal injury, it will depend upon
the size and type of injury.
49.
Are there other alternatives for astigmatic correction?
A
variation of RK, called astigmatic keratotomy or AK, is a very
effective means of reducing astigmatism. By making incisions in
an arc-like or segmental fashion parallel to the white of the
eye where the cornea is steep, it is caused to relax and become
more spherical.
50.
What about farsightedness?
In
the past ALK was used. In this procedure a thicker layer of the
cornea was folded back with the microkeratome. Pressure inside
the eye causes the corneal bed to steepen, the opposite of what
occurs in LVC. The cap was placed back into position without the
removal of additional tissue. Although it has been shown to effectively
reduce or eliminate farsightedness in the +1.00 to +5.00 range,
enough cases of corneal instability have been reported nationwide
that this procedure is falling out of favor. Now LVC for hyperopia
is the best option.
51.
How does laser vision correction for hyperopia work?
Now
both PRK and LASIK are possible and effective for hyperopia. The
procedure is identical to the myopic (nearsighted) procedure,
however by blocking the laser from treating centrally and allowing
it to remove more tissue in the periphery of the cornea, a steepening
rather than a flattening of the cornea is produced.
52.
How do I know LVC is safe?
In
the U.S. clinical trials' 3-year follow-up, no sight-threatening
complications have occurred. And over 250,000 treatments have
been performed abroad over the past six years.
53.
Will the effects of the treatment be permanent?
Given
the results of the U.S. clinical trials and the results reported
internationally, the treatment appears to be permanent.
54.
Can I afford LVC?
Eyeglasses
usually have to be replaced once a year or so. Contact lenses
depending on the type you use -- can be extremely costly, especially
when you add in the cost of solutions. You'll find that laser
correction of nearsightedness can probably pay for itself in a
few year's time. (See Cost Analysis) There's even a convenient
payment (See Financing) option.
55.
What is the process for patients who reside outside of Southern
California?
A
telephone consultation can be arranged and in most cases, the
preoperative examination can be performed by your local family
eye doctor. You should plan a three day stay in San Diego. For
most procedures, we will need to see you in our office the day
before your procedure and the day after. Your remaining postoperative
appointments can also be arranged with your local eye doctor.
Many of our patients have been referred to us for refractive surgery
by other eye doctors or have come to us from other cities or states
and wish to have their follow-up care performed by their own eye
doctor or in their home town. Typically, this is not a problem
and we are happy to provide information to and work closely with
another doctor for your convenience. It is important, however,
to be aware that there is about a 1 in 10 chance that you might
need to return to Advanced Ophthalmology Institute for some aspect of your
care including possible enhancements or the assessment and management
of possible complications. In general, this probability increases
slightly the more highly nearsighted you are to begin with. A
small number of patients might need to return more than once.
We ask that you not put yourself in the position of beginning
the process and then finding it difficult to return, if necessary,
for additional care.
56.
I'd like to have LVC. How do I proceed?
Please
contact Advanced Ophthalmology Institute toll free at 1-877-484-2020 to speak
with a counselor who will be happy to schedule your private consultation,
or you can submit an online form by clicking on the Free Consultation
button.
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