Lasik

What is Lasik?

Lasik (laser in situ keratomileusis) refers to the procedure where an eye doctor or ophthalmologist uses a laser to reshape the cornea. If you suffer from myopia(nearsightedness), hyperopia(farsightedness) or astigmatism (a “rugby ball” shaped cornea resulting in blurry vision) and prefer not to wear glasses or contact lenses, one should consider Lasik eye surgery.  It’s simple and effective. It’s been done globally since 1990.  About 20 million procedures have been performed worldwide.

How do I know if I am a candidate?

Lasik surgery is an option if you:

  • Have  a stable spectacle prescription for at least 1 year
  • Have no eye disease
  • Have sufficient corneal thickness
  • Are 18 years or older
  • Can take a few days off work for recovery
  • Are in good health

We offer a free assessment to see if you are a suitable candidate or not.

What are the advantages of Lasik?

  1. It is a quick outpatient procedure which is done with the patient awake.
  2. It is a relatively painless procedure.  Several patients do have a feeling of pressure when the suction ring is applied.
  3. There is rapid visual rehabilitation.  The patient has good vision within a few days and stable vision within 2-3 weeks.
  4. The results are accurate and reproducible, i.e. 98% of patients have 20/30 or better vision after two months.

What is involved in the surgery?

FIRST STEP.  The cutting of a thin flap of tissue to prepare the laser site.  A suction ring is applied to the white of the eye.  This stabilizes the eye.  A keratome, which is a sophisticated machine, then makes a very thin flap across the surface of the cornea.  This takes approximately 20 seconds to do.

SECOND STEP.  The excimer laser is then applied under computer control to the corneal bed to vaporize a pre-determined amount of tissue, which re-shapes the surface of the eye.  This takes approximately 10-30 seconds.  The thin flap of cornea is then replaced and heals down.

What are the possible complications?

  1. During the suction phase of the procedure, the pressure in the eye is raised.   In rare cases, it has been documented that patients have had a small bleed in the retina, which can produce distortion of vision.   This is an extremely rare occurrence, but has been documented. We have never seen a case.
  2. The thin corneal flap can be damaged due to mechanical malfunction during the surgical procedure.   Damage to this flap can cause gross distortions of the final visual outcome.   This complication is uncommon.
  3. Infection of the eye following surgery.   If a patient is unlucky enough to come in contact with a virulent bacteria, infection can enter the flap.   Powerful antibiotics are routinely used at the time of surgery and afterwards, to prevent this.  (Hence the need for the rigorous pre-procedure cleaning regime).
  4. Interface healing.   It is possible for scar tissue or debris from the tear film or epithelial tissue to become lodged in the interface between the flap and the corneal stromal bed that has been lasered.   This can produce distortion, poor healing and a poor visual result.   This is treated by returning the patient to theatre, lifting the flap and cleaning the interface. This is a relatively uncommon complication.
  5. Dry Eye. While most patients experience some dry eye following surgery, a few patients can experience extreme dryness. This is treated with special drops, ointments and sometimes punctual plugs.

What are the disadvantages/risks?

  1. DRY EYE.
  2. POST-OP  DISCOMFORT. While the surgery itself is not painful, for 2 – 3 days post-operatively, the eyes can be irritable and scratchy.   Painkillers and sleeping pills are prescribed to make this period comfortable.   The vision during this period is also fuzzy and is still settling down   – some patients find this distressing.
  3. VISUAL RECOVERY. Is not instantaneous.  Some people obtain remarkably good vision within two to four days, but the very short-sighted people with a lot of astigmatism, take several days to a week for vision to return.   Vision will often fluctuate in the first few weeks. This is normal.
  4. ENHANCEMENT. Up to 10% of patients require an enhancement, and this is usually done at 12 weeks. This is more common in the very short-sighted  i.e. over -6:00.  It can happen to any patient. Be prepared to have to undergo a second procedure in some cases. The cost thereof is minimal.
  5. READING VISION. All short-sighted people can read without their glasses or contact lenses, by holding the book very close. This is lost after the laser. If you are 40 years and older, this is VERY MARKED and some patients may even be required to start using reading glasses after the laser surgery.
  6. HAZE AT NIGHT. In a small percentage of patients, haloes at night are a troublesome feature. Initially, they produce marked problems, particularly when driving into the lights of oncoming traffic. This takes up to three months to settle and in a small percentage of patients, never clears. In some cases, it can be treated by using spectacles for driving at night.
  7. SPECTACLE DEPENDENCE. Before having the laser, patients are usually 100% dependent on either spectacles or contact lenses. The laser, in some patients, does not remove total dependence on spectacles or contact lenses. Many patients will still need some form of back-up spectacles, particularly for night driving or long distance driving, or for reading.   Instead of being 100% dependent on some optical aid, after the excimer laser, those patients are about 10% dependent on some optical aid.
  8. CLARITY OF VISION. The final vision produced by excimer laser in most patients is not as clear as the vision that the patient had with their glasses or contact lenses prior to surgery.  Occasionally some patients vision is slightly reduced.
  9. OVER-CORRECTION. In some patients, there is a variation in response of tissue to the laser and the patient becomes long-sighted after the procedure. This is an uncommon complication, but is very distressing, as the patient can now not see clearly at distance or near. Treatment for this can be instituted and totally or partially reversed in most cases.

Making your decision

Few people enjoy wearing spectacles and many consider being short-sighted a problem. To be able to surgically correct this problem is a blessing for most people. Despite this modern advance, one must weigh the relative risks versus the benefits that can be obtained by correcting the problem. This assessment must be made by each individual on its’ merits for that patient. It is worth remembering the following facts:-

  1. Wearing spectacles is the safest option.
  2. Contact lenses are also relatively safe with few complications, although they may occur. Most people do not realise that a small number of eyes are severely damaged  each year by wearing contact lenses. We have had more complications from contact lenses than laser in the last 15 years.
  3. Excimer laser is more of a risk than the above two methods and is more related to quality of vision and the small nuisance side effects that can occur for the first few months post-operatively.
  4. SURGERY,  ONCE PERFORMED,  CANNOT BE UNDONE.
  5. Most patients undergoing excimer laser are pleased with the result they obtain.   For them, the advantages of no longer being short-sighted and not having to wear spectacles outweigh the side-effects that can occur.   We will give you a list of patients that have undergone the procedure, including those who have had problems, in order that you may compare notes.

What is PRK?

PRK(Photorefractive Keratectomy) is a laser technique used for thinner corneas. No flap is cut. The laser beam is applied directly onto the cornea. No pain is experienced during the procedure since the cornea is anaethetised. A bandage contact lens is used for a few days after the procedure for pain relief while the tissues underneath heal. Unlike Lasik, PRK results in some pain and discomfort lasting a few days after the surgery. The vision also takes a few days longer to return and for higher prescriptions, the surgeon may opt to do surgery on one eye at a time, approximately a month apart.

AN OPTOMETRISTS PERSONAL EXPERIENCE – by NEERISHA MAHARAJ

I started wearing spectacles for short sightedness from the age of 12. This influenced my choice of career. Ten years ago my prescription stabilized to about -4.00 in both eyes but I was still not confident to have Lasik done. As optometrists, we don’t see all the successful Lasik patients since they don’t come back for spectacles. We only see those patients that have regressed or still need mild correction post Lasik, hence the negative impression optometrists get of the procedure.

After working with pre and post Lasik patients and seeing the success rate, I realized that for ten years I had been telling all my patients that there was not enough evidence to prove the safety or success of Lasik but it was being practiced for more than ten years already. More than 90% of the patients lasered were thrilled with the outcome. I had spent 20 years wearing glasses, as due to allergies I could not wear contact lenses on a daily basis.

I was fully confident that I was in good hands and that Dr Nortje would not do anything to compromise my vision. On the morning of surgery I was not at all anxious. I had watched him operate on numerous people. The procedure was not as intimidating as the information I had read, had made it out to be. I did have slight hemorrhages on the white part of my eyes but that disappeared after four weeks. On the same day of surgery I was overjoyed to find that I could see individual leaves and petals with no spectacles. I had 90% vision back that same day and 100% vision by the next day.

It was wonderful to be able to see the alarm clock in the middle of the night, ( I used to sleep with my cell phone close by for this purpose). Recognizing people who waved to me and seeing the individual mosaic tiles in the shower or on the pool floor was unbelievable. People who have normal vision take these things for granted, but for someone who has worn glasses for 20 years it was a whole new beautiful world out there.

Admittedly, I had a small hiccup during my visual recovery. After two weeks, I noticed that my right eye was not seeing as well as my left eye. It was particularly noticeable while driving at night otherwise it did not bother me at all. My right eye had become extremely dry post operatively. The vision in this eye fluctuated a lot. It would start off clear in the morning and get a bit fuzzy by the afternoon. Dr Nortje was more bothered by it than I was and did everything he could to combat the dryness. I used lots of lubricating drops during the day and inserted teargel at night. I also took dry eye capsules to improve the quality of my tear film. He inserted plugs into my tear duct so that my tears  would not drain away and would stay in my eye. Two months later we were both relieved to find that I woke up one morning to perfect vision.

Of course when I am about 40 years old I will probably need some reading glasses which would happen regardless of having Lasik surgery. In the meantime I can enjoy ten years of spectacle free life and then with reading spectacles I will only be dependent on them 10-20% of the day as opposed to 100% of the time as before. The improvement in quality of life is definitely worth it.

I sometimes still reach for my spectacles after a shower or try to adjust them on my face. It’s like missing an old friend but it’s probably the only friend I don’t mind saying good bye to.

2010 – Its been five years since I had lasik and I am still enjoying it. My vision is still good and there has not been a need for spectacles or an enhancement yet.