“The excimer laser is an instrument that can reshape the cornea (front surface) of the eye with extremely fine precision.
“This can correct certain optical problems such as myopia (shortsight) and astigmatism with greater accuracy than the old radial keratotomy procedure which involved making cuts into the eye,” he says.
Can anyone have this treatment?
No. Your eye specialist will tell you if it is possible to perform the treatment on your particular eyes.
Children under 18 are usually excluded from this treatment, but there is no upper age limit and people as old as 85 have had this therapy.
The procedure is begun by first making a thin flap of tissue on the cornea.
This flap (which looks like a small soft contact lens) is then lifted up and the laser is applied to the tissue bed below.
The flap is then replaced over the treated area of cornea.
The correct name for this procedure is Laser In-situ Keratomileusis but this is abbreviated to Lasik.
Lasik is the most modern, state-of-the-art technique available in the world today.
Occasionally it is not technically possible to make the flap. In such cases the laser is applied directly to the cornea and the name of this procedure is PRK.
PRK is usually as good as Lasik in the long term but healing is slower and more painful.
Risks and complications
Excimer laser treatment has proven to be a safe and reliable procedure.
Millions of people all over the world have had their eyes corrected by this laser. “However, as with any surgical procedure there are risks and possible complications and results can never be guaranteed even by the best surgeons.
“There is approximately a 1 per cent risk for serious complications,” Novis says.
The most common serious complications with Lasik are flap problems.
If the flap is not cut perfectly smoothly or if the flap tears or tatters, then the procedure usually has to be cancelled and the procedure may be repeated later.
Occasionally a flap problem can lead to irregularities that only a hard contact lens can correct.
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Another common serious complication with PRK or Lasik is scarring of the cornea.
Scar formation can sometimes be removed by a different type of laser procedure or the scars may reduce spontaneously over time (months or even years) but occasionally they are permanent.
Another serious complication is irregular astigmatism.
This is when the surface of the cornea is no longer smooth and regular.
A hard contact lens can correct this problem.
Novis adds: “Total blindness is an extremely rare complication but has been reported overseas from severe infection after the operation.”
You must carefully consider these risks before deciding on laser surgery.
Side-effects
Minor temporary side effects include pain and discomfort for a few days after the surgery.
Your vision will be blurred for a few days or even a few weeks and it may fluctuate.
Some people complain of glare, light-sensitivity, haloes around lights, double vision or ghost images.
These are usually temporary and disappear after a few months but occasionally these symptoms may be permanent.
If they are permanent, a hard contact lens may need to be worn permanently to eliminate them.
Will I never have to wear glasses again?
This can never be guaranteed and depends on your particular eye condition. Most (not all) people under the age of 40 do not have to wear glasses at all after the operation.
Most people over 40 will need the usual reading glasses for “old-sight” after the operation.
Many people of all ages need weak driving glasses, especially for night driving, or weak glasses for TV, reading and computer work after the operation.
In the unlikely event that permanent glasses are still needed after the operation then a second enhancement operation may be considered (but this has higher risks) or contact lenses can be worn.
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No two operations are exactly the same and so the two eyes will never be exactly equal afterwards.
This imbalance between the two eyes is usually not a long-term problem but occasionally glasses are needed to balance the eyes.
All patients are advised to see an optometrist a month after the laser surgery to see if glasses are needed.
How long does it take?
The operation is not painful and is done under local anaesthetic drops (no injections), so you can eat or drink as you wish before the surgery.
You may feel a pressure or stretching sensation as your eyelids are held open by a metal speculum.
This prevents you from blinking during the procedure.
The operation only takes five minutes but be prepared to spend two to four hours at the hospital.
You will then need two or three post-op check-ups over the next week.
You will probably need someone to drive you home afterwards.
Most people are back at work the next day but your doctor will book you off for a few days if necessary.
Contact lens wearers.
Note that soft contact lenses should be removed at least 3 days before the operation. Hard contact lenses must be removed 3 weeks before.
Contact lenses can be worn after the laser treatment but this is rarely necessary.
Remove your contact lenses before your pre-op consultation too.
Arrive at this appointment wearing your glasses but bring your contact lens details with.
Preparing for Lasik
Novis says “most cases of laser therapy go smoothly and painlessly but now and again the procedure is difficult and uncomfortable.
“The most common problem is a thin or torn flap which will result in the procedure being cancelled.
“Over the years we have found that most flap problems occur in patients who do not co-operate properly at the time of surgery.
“These are usually patients who are very nervous and have not learnt to control their eye movements and to relax their eyelids.”
He adds most people do not need any training to control their eyes and relax their lids but if you are unsure or nervous then it is important that you prepare yourself for Lasik by doing the following exercise for a few minutes a few days before:
• Lie on your bed, remove your glasses, and look at a dot on the ceiling. You may want to stick a red piece of paper on the ceiling (about the size of a stamp) to see it more easily.
• Cover one eye with a tissue or cloth but do not close the eye that is covered. It is much easier to control your eyes when both of them are open.
• Practice looking at the spot on the ceiling with the eye that is not covered.
• You can blink as much as you like (your eye will be held open during the actual procedure) but you must not look around, your eyes and head must remain still.
• Keep your hands at your sides, your legs straight, breath deeply and relax.
• Relax the muscles of your face especially around your eyes.
Novis advises that you should have someone to check that you are doing this exercise properly.
Your partner must look at your eyes to see if they are keeping still.
• Your partner should gently stretch your lids apart to see that they are relaxed and that you remain staring at the spot on the ceiling while the eyelids are being stretched apart. During the actual procedure the doctor or sister will stretch your eyelids open with a metal speculum.
This stretching may be uncomfortable if you have not experienced it before.
• Your partner should then put a hand over your eye blocking your view of the spot on the ceiling while you maintain your eye position. This is because sometimes during the laser procedure the target light disappears but your eye must remain looking in the same position.
• Pretend you are looking through your partner’s hand at the spot on the ceiling while your partner checks to see if your eye is still.
• Next your partner should lift up your chin (extending your head back slightly) while you maintain your eye fixed at the spot on the ceiling.
This is because the doctor may need to do this during the actual procedure.
Remember that you can blink as much as you like during these training sessions but you must keep your eyeballs still by only looking at one place (the spot on the ceiling).
During the actual procedure you will look at a red or green flashing light.
The doctor may ask you to look slightly downwards or slightly upwards during the procedure as if looking towards your toes or towards the top of your head.
• Practice this at home with your partner checking that your head is kept perfectly still while your eye moves slightly upward or downward.
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