The precursor procedure to LASIK was a procedure called Keratomileusis. This was developed by Dr. Barraquer who's from Colombia. What this process was, was a corneal reshaping procedure using a cryo lave, so it was a freezing treatment designed to reshape the cornea. With that Cryo lave, they would have this partial thickness flap of corneal tissue. It was really a disc of tissue and then that disc of tissue was reshaped. It was placed back into position on the remaining part of the cornea and using a bunch of sutures. It was sewn into place. Now we've obviously come an extremely long way from the days of Dr. Barraquer. In the 1990s there's a husband and wife team, ophthalmology team, who are from Brazil and the wife is an ocular pathologist and the husband is an ophthalmic surgeon. Understanding the anatomy and the physiology of the cornea, the ocular pathologist wife said to the husband, "why don't you try putting that flat back on without putting a bunch of stitches in it? Because I think it's going to seal up just fine because of the natural pumping capacity of some of the other cells in the cornea." Lo and behold, LASIK was conceived.
Once you've decided that you may want to proceed with the LASIK procedure, it's important to have a preoperative consultation. Prior to that visit, you need to go out and your contact lenses for a good week. If you wear hard lenses, you need to be out of them for about two to three weeks prior to that preoperative consultation. The reason is is that contact lenses do have an effect on the curvature and also on the general health of the surface of the eye. We want the cornea, the front part of the eye to go back to its natural position prior to obtaining the final measurements. It is these measurements that go into determining the final prescription that we put into the laser. Some of the additional tests that are performed at a LASIK consultation will be the measurement of one's pupil size. The corneal curvature and shape will be measured. And an exam of one's glasses, prescription after dilation, will also be performed.
Patients often ask, well, what if I move my eye? I don't want to not see well, because I did something wrong, doc, what can I do to make sure that that doesn't happen? Well, rest assured, there's an eye tracker on the excimer laser and that eye tracker will follow the eye as it has it's small movements during the procedure. The changes that are made in the patient's eye with Lasik are permanent. We can see those changes years down the road. Now, we're not putting a brace on the patient's eye. In other words, eyes can change a little bit over time. If the vision changes significantly. However, patients can undergo the procedure again for a little fine tuning. Usually, that's not necessary, but it is available to patients if they feel the need.
Patients are prepped for the procedure. They're given the opportunity to take a relaxing medicine like a Valium prior to proceeding. After about 20 minutes they are then brought into the laser room. Now patients are in the room for about 15 minutes, but understand that they're not being operated on for 15 minutes. The laser treatment times are extremely short. For an example, the longest treatment time would be about 20 seconds with the laser. The first part of the procedure involves making a corneal flap in the front part of the eye. If you think of the cornea is being about a half a millimeter in thickness, the first laser will create a thin plane in the front part of that front window. Part of the eye. It goes about say 15% depth. Once that flap is created, the patient's moved under the other laser, which is called an excimer laser and after the flap is elevated, the permanent layers of the cornea are exposed. The excimer laser then essentially etches a lens into the patient's cornea. Once the eximer lasers done it's treatment. We reposition the corneal flap, and the procedure is then complete. We do one eye at a time. We first make the flap with the first eye, and then we do the same thing with the second eye. It's then that the patient's moved under the second laser.
LASIK is a surgical procedure, and as with any procedure, there are some risks. The good news is the chance of a serious problem with LASIK procedure is very, very low. Some of the common things that patients may experience would be temporary increase in dry eye symptoms. Usually this gets better over a relatively short period of time, but there are some very unusual cases where increased dry eye does persist. Some patients may require a slight additional treatment. We call these enhancement procedures or retreatments. It's not very common anymore with with current lasers and treatment nomograms, but some patients may need a slight fine tuning of the outcome. For refractive cataract surgery patients who have selected the multifocal or extended range vision lenses, they do have a slightly higher incidence of seeing a special type of halo or ring pattern around lights. Driving at night headlights, taillights, streetlights can all precipitate these types of symptoms. The good news is, it is very uncommon for these halos or rings to bother a patient once they've passed through the recovery process.
After doing the laser resurfacing procedure, we place a clear contact lens over the eye. The surface cells that were removed during the procedure need to grow back over the ensuing few days. During that time, there is a period where patients may experience some discomfort or even pain. The visions typically quite blurry for the few days after the treatment. Fortunately, these symptoms are very temporary. Once the bandage contact lens is removed, patients usually are able to function pretty well. Please understand that the results vary a little bit in that immediate postoperative period, and some patients may notice a bit of fluctuation for the first couple of weeks after their procedure.
Some people who would like to see without glasses aren't candidates for LASIK, but are still candidates for another corneal reshaping procedure called PRK or advanced surface ablation or LASEK. What this is, is it utilizes the exact same laser that we use with LASIK, except instead of making a flap of tissue prior to reshaping the eye, we simply reshape the surface of the eye. Now, that procedure is generally thought of as the safest of all the laser vision correction procedures out there. The results are indistinguishable from LASIK. It's the same from that standpoint. The one difference is is that with the surface laser ablation treatments, the visual recovery is a little bit slower.
In essence, LASIK is like sculpting a diamond. We're creating a pair of glasses in the patient's eye. We're allowing the changed curvature, the new shape of the patient's cornea to allow the light to focus better and allow patients to see without having to wear glasses and without having to wear contact lenses. It's commonly performed. The FDA estimates that over a half a million people every year undergo the procedure in the United States. So for patients who are tired of wearing their glasses, are tired of wearing the contact lenses, the contact lens solutions, the eyes are getting irritated or they simply just want to see without the need for visual aids, they may in fact be excellent candidates for the procedure. Most people who wear glasses or contact lenses are good candidates for LASIK.
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