Most Frequently Asked Questions About Refractive Surgery
1. My glasses are very thick, can refractive surgery work for me?
LASIK (Laser Assisted in-situ Keratomileusis) can correct from –0.50 to –14.00 myopic sphere, up to –6.00 astigmatic cylinder, and from +1.00 to +6.00 hyperopic sphere. PTK(Phototherapeutic Keratectomy) is for corneal scar removal; Phakic Intraocular Lenses and Corneal Rings are also options to be considered.
2. How old do I have to be?
You must have generally healthy eyes and a stable prescription; normally, this is around the age of eighteen. There is no upper age limit.
3. Is excimer laser experimental?
No, more than 4,000,000 excimer laser surgeries have been performed since 1990 in the Middle East and worldwide. We have been on the cutting edge of technology and world leaders in the presentation of data on refractive surgery.
4. My doctor told me I have keratoconus, can I have refractive surgery?
No, unfortunateley, at this time keratoconus is the only absolute contraindication to LASIK. Results on keratoconic eyes are unpredictable. With medication controlled diabetes, glaucoma and collagen vascular diseases, we can normally proceed with refractive surgery.
5. What will I see after surgery? 6/6? 20/20?
98% of our refractive surgery patients function without glasses or contact lenses 90% of the time. Actual studies show that 95% of patients see 20/20 (or better) without glasses. This is a sample over a wide range of prescriptions.
6. How much time do I take off from work?
Most of our patients return after one day; however, we can prescribe up to 3 days sick leave from work, if it is necessary.
7. I wear contact lenses now, what must I do?
Leave your soft lenses out 7 days prior to your comprehensive examination; if you wear RGP or rigid contact lenses, leave them out for a minimum of two weeks prior to the comprehensive consultation. Sometimes more time is needed out of the contact lenses due to its effect on the shape of the cornea.
8. Is it safe? What is the worst that could happen?
A bilateral infection leading to loss of vision is the worst possible complication. We use strong antibiotics to prevent this complication. Temporary glare and haloes, some discomfort, dryness and fluctuating vision are normal for the first weeks following LASIK. Some temporary corneal haze is normal and, though scarring has been reported, it is rare. LASIK is safe, effective, predictable, and permanent in its effect.
9. What is Laser Vision Correction and what problems can it correct?
With the advent of excimer laser technology, vision correction has entered a new era. Correction of nearsightedness, farsightedness and astigmatism with the excimer laser is the most technological advanced method available to reduce your dependence on glasses and contact lenses. This exciting refractive technology uses a cool, gentle laser beam of light at a wavelength of 193nm to gently reshape the front surface of your eye. Over 4 million Laser Vision Correction procedures have been performed in 55 countries around the world over the last ten years.
10. How can it change my life?
This remarkable procedure takes only about 15 minutes to perform, but can have a tremendous impact on your life. Before having Laser Vision Correction, most of our patients could not imagine waking up in the morning and seeing the clock. They never dreamed they would be able to drive a car, watch TV, or enjoy sports without contact lenses or glasses. For many, poor eyesight has been a barrier to entering the career they wanted. Since they were children, this dependence on glasses and contact lenses has shaped their lives, memories, and the way feel about themselves. Now, these same patients are pursuing life with new confidence, enthusiasm and chosen a new freedom from dependence on glasses and contact lenses.
11. Am I a candidate?
If you have a stable refractive error, and have generally good eye health, Laser Vision Correction can treat a broad range of nearsightedness, farsightedness, and astigmatism. Laser Vision Correction isn’t for everyone, good candidates MUST have realistic expectations. The best way for you to determine if you are a good candidate is to have an extended comprehensive consultation.
12. What kind of result can I expect?
While Laser Vision Correction has been proven overwhelmingly successful in reducing dependence on glasses and contact lenses, the degree of improvement may vary form individual to individual. How well and how quickly your vision improves depends on how you heal and the severity of your prescription. Although we cannot promise patients “perfect” vision, most laser patients do achieve 20/20 (6/6) vision or better or are within 1 or line of 20/20 on the eye chart. This mean they no longer need glasses or contacts to drive, play sports, watch TV, participate in careers requiring excellent vision such as the police or the military. With remarkable results, we know that LASIK is safe, effective, predictable and permanent.
13. Will my vision be corrected forever?
Today, most experts around the world are confident that they will discover no long-term problems with Laser Vision Correction. Based on the excellent results, they also believe that LASIK has become the most commonly performed refractive surgery procedure in the world. The first nearsighted laser patient was treated in 1987. That patient achieved 20/20 vision and is still 20/20 more than a decade later. Only unforeseen eye conditions may change this expectation.
14. How does the excimer laser work?
The excimer laser was invented more than 20 years ago by IBM to etch microchips. Today, the excimer provides accuracy, predictability and the capability to correct a wide range of refractive errors. The Argon-Fluoride gas laser emits computer-controlled pulses of cool, ultraviolet light with unparalleled degree of precision. Each pulse of laser can remove 39 millionths of an inch of tissue in as little as 12 billionths of a second. In other words, the excimer can remove as little as 1/40th of a human cell. Our Nidek Excimer works by breaking molecular bonds. It is this ability to remove a single cell without damaging the remaining cells that allows doctors to perform laser vision correction with such precision. Because the laser beam does not penetrate the eye, there will be no effect on pregnant patients.
The post-op drop regime may, however, be modified. Gulf Eye Center is using the latest upgrades and technology to ensure you achieve hypervision.
15. What is the difference between PRK and LASIK?
Both are laser procedures for the correction of farsightedness, nearsightedness, and astigmatism. Previously, doctors and patients were comfortable with the PRK procedure; however, most doctors and patients now prefer LASIK because of the following advantages:
* Faster visual recovery
* Less risk of prolonged pain after surgery
* Less risk of infection
* Less risk of corneal haze or scarring
* Less need to use anti-inflammatory drops
* Ability to treat a wider range of prescriptions
* Adjustable
* Anticipated hyper vision
Since the surface of the cornea is preserved, LASIK patients will have functional vision the day following their surgery. Your eye doctor will explain the details of your personal case and help you decide which procedure is best for you.
16. Will it hurt?
LASIK and PRK procedures are themselves completely painless. There are no needles or injections. Instead, anesthetic eye drops are used to numb the eye just before the surgery begins. Your surgeon uses a speculum clip to hold your eyelid so you cannot blink during the surgery. LASIK takes less than fifteen minutes per eye to perform. However, you will be with our team in the office for two to three hours. After the LASIK procedure, it will feel as if you have sand in your eye for a few hours; most patients are quite comfortable after sleeping. Haloes around lights at night and dryness are temporary side effects.
17. How should I prepare for my procedure?
Contact lenses can change the shape of your cornea. Soft contact lenses should be removed at least one week prior to your examination. Hard lenses should be removed two weeks or longer. The success of your laser procedure depends on the expertise of your doctors and also the safety, accuracy and sophistication of the equipment and measurements. At Gulf Eye Center, our primary objective is to provide you with the most advanced technology, best results and greatest degree of safety. Automated equipment will be used to map your eyes; your doctors will review your clinical findings and explain what you can expect during and after the procedure.
18. Why have I always had poor vision?
Certain vision problems such as nearsightedness (myopia), farsightedness (hyperopia), astigmatism, and presbyopia are considered “refractive” because they relate to your eye’s ability to focus light rays entering the eye. The proper refraction of light onto the retina creates “normal” eyesight. Refractive visual problems are measured in units called Diopters. The more nearsighted or farsighted you are, the higher your prescription in Diopters, and the worse your uncorrected vision.
19. What about reading glasses?
Presbyopia is part of the normal process of aging. Everyone experiences the onset of presbyopia, typically between the ages of 40 and 50. Nearsightedness counteracts presbyopia. This is why, if you’re slightly myopic, you can remove your glasses to read, even after presbyopia begins. After having laser vision correction, your myopia will be gone and you will need reading glasses when you become presbyopic. When you have LASIK, one eye can be intentionally left slightly nearsighted. This is called monovision and it allows you to maintain your reading ability after presbyopia begins.
20. Are there any risks?
Nothing in life is without inherent risk; the chance of having a vision reducing complication has been documented in a number of clinical studies to be less than 1%. There have been no reported cases of blindness with LASIK.
While only a very small number of patients experience a complication, all patients have certain expectations. It is vital to make sure that your expectations are realistic BEFORE YOU reach the decision to proceed with LASIK. The most common expectations is to become free of glasses and contact lenses, most patients eventually require reading glasses and a few may even require a thin pair of glasses for critical distance activities such as night driving. With the emerging technology, we plan to give you hypervision.
* Under and over correction.
There are two phases to your procedure, the surgical phase and the healing phase. The speed of your visual recovery, the quality and sharpness of your vision and your final outcome will be determined by your healing pattern, the preoperative prescription, ocular findings and corneal shape. Typically, distance vision clears first, followed by reading vision. LASIK is an adjustable procedure. If an enhancement procedure for over correction becomes necessary, it will normally be performed at three months following the initial procedure. This occurs in less than 2% of patients.
* Infection
Infection rarely occurs since patients receive antibiotic drops. Following the prescribed eye drop instruction exactly is very important. Minor infections are treated easily, but should be treated quickly; less than 00.25% of patients experience infection.
* Haze
Patients with a history of unusual scar formation, poor healing and previous recurrent corneal infection or with higher prescriptions are at a greater risk of developing healing haze. Corneal haze normally clears over time and it’s risk is reduced with the LASIK procedure.
* Night glare.
Before laser vision correction, many people experienced poor night vision or night glare such as halo’s and star bursts. Night glare is typical after LASIK and normally disappears at between three and six months. Two to three percent of patients continue to complain about reduced night vision and glare.
* Corneal flap risks
While LASIK offers a faster recovery, this procedure does have specific risks due to the creation of a corneal flap. A corneal flap, which is irregular, too short or too thin can prevent the procedure from being completed. As long as the corneal flap heals smoothly, patients can achieve an excellent result. If irregularities in the flap persist, a loss of best corrected vision may result. Other corneal flap risks include wrinkles, displacement of the flap by rubbing the eyes, and epithelial ingrowth. Only severe epithelial ingrowth affects the surgical result and this can be corrected by lifting the flap and cleaning the interface.
* Dryness
Many LASIK patients in the Gulf experience post operative dryness. After LASIK your doctor may prescribe lubrication therapy or insert temporary collagen plugs, if necessary.
21. What happens on the day of my procedure?
It is natural to feel a mixture of eager anticipation and nerveousness.
Following these guidelines will make your day easier:
* Arrange transportation.
* Be sure to bring someone to drive you home.
* Make up and jewellery.
* DO NOT wear any make-up, perfume, cologne, hair-spray or earrings.
* Dress comfortably
* Wear comfortable clothing that will help you feel relaxed.
* Remember to bring a pair of sunglasses. And no perfume please.
* Examinations and paper work.
22. What will my recovery be like?
After your procedure is completed, you will relax for about an hour. After your post-operative check, you may go home and rest. Taking a nap will relieve any discomfort you may feel during the first few hours. Many patients return to work the next day.
Follow these guide lines:
* Wait until the morning to shower NORMALLY.
* Clean your eyelids gently for 1 week.
* Resume driving when you feel comfortable.
* Wear sunglasses a few days only for your comfort and protection.
* Do not wear eye make-up for one week.
* Do not rub your eyes vigorously.
* Avoid swimming pools for one week because of the chlorine.
* Avoid contact sports that could result in an eye injury.
* Avoid dusty environments for one week.
* Watching TV and using a computer are OK.
23. When will I see the results?
Most LASIK patients notice dramatic visual results in the first 24 hours, with gradual improvement over the next month. Most patients resume normal daily activities in one to two days after LASIK. Some patents note a misty vision and reading blur; this normally disappears towards the first week to a month. We normally achieve better than 20/20 ( 6/6) vision with the new millenium software and hardware upgrades
Dr Millicent M. Grim
Specialist Ophthalmologist / LASIK Specialist
MBChB (Pretoria), DTM & H (WITS), MMed (Ophth) (Pretoria)
AAO, ASCRS, ISRS (US), GMC (UK)
