The name "LASIK" is short for Laser In-situ Keratomileusis. Like Photorefractive Keratectomy, which utilizes the Excimer Laser, LASIK reshapes the cornea with laser technology. The shape of the cornea is what determines whether you are nearsighted, farsighted, have astigmatism or have
normal vision. The Excimer Laser emits a "cool" laser light that can remove microscopic amounts of tissue with extreme precision. Physicians can program the laser to sculpt the corneas.

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To determine whether LASIK is right for you, you should undergo an evaluation with your eye care professional. The evaluation can confirm that your degree of myopia, hyperopia or astigmatism is within the proper range, make sure that your are currently free of any eye disease and discuss other details of both your case and the LASIK procedure. At the time of the evaluation, you should bring your glasses or contacts with you.

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You are probably NOT a good candidate for refractive surgery
if:

• You are not a risk taker. Certain complications are
  unavoidable in a percentage of patients, and there are no long-term data
  available for current procedures.

• It will jeopardize your career. Some jobs prohibit certain refractive procedures. Be sure to check with your employer/professional society/military service before undergoing any procedure.

• Cost is an issue. Most medical insurance will not pay for refractive surgery. Although the cost is coming down, it is still significant.
  

• You required a change in your contact lens or glasses prescription in the past year. This is called refractive instability. Patients who are in their early 20s or younger, whose hormones are fluctuating due to disease such as diabetes, who are pregnant or breastfeeding or who are taking medications that may cause fluctuations in vision are more likely to have refractive instability and should discuss the possible additional risks with their doctor.
  

• You have a disease or are on medications that may affect wound healing. Certain conditions, such as autoimmune diseases (e.g., lupus, rheumatoid arthritis), immunodeficiency states (e.g., HIV) and diabetes, and some medications (e.g., retinoic acid and steroids) may prevent proper healing after a refractive procedure.

• You actively participate in contact sports. You participate in boxing, wrestling, martial arts or other activities in which blows to the face and eyes are a normal occurrence.

• You are not an adult. Currently, no lasers are approved for LASIK on persons under the age of 18.
  

Precautions
The safety and effectiveness of refractive procedures has not been determined in patients with some diseases. Discuss with your doctor if you have a history of any of the following:

• Herpes simplex or Herpes zoster (shingles) involving the eye area

• Glaucoma, glaucoma suspect or ocular hypertension

• Eye diseases, such as uveitis/iritis (inflammations of the eye)

• Eye injuries or previous eye surgeries

• Keratoconus

Other Risk Factors
Your doctor should screen you for the following conditions or indicators of risk:

• Blepharitis. Inflammation of the eyelids with crusting of the eyelashes, that may increase the risk of infection or inflammation of the cornea after LASIK.

• Large pupils. Make sure this evaluation is done in a dark room. Younger patients and patients on certain medications may be prone to having large pupils under dim lighting conditions. This can cause symptoms such as glare, halos, starbursts and ghost images (double vision) after surgery. In some patients these symptoms may be debilitating. For example, a patient may no longer be able to drive a car at night or in certain weather conditions, such as fog.

• Thin Corneas. The cornea is the thin clear covering of the eye that is over the iris, the colored part of the eye. Most refractive procedures change the eye’s focusing power by reshaping the cornea (for example, by removing tissue). Performing a refractive procedure on a cornea that is too thin may result in blinding complications.

• Previous refractive surgery (e.g., RK, PRK, LASIK). Additional refractive surgery may not be recommended. The decision to have additional refractive surgery must be made in consultation with your doctor after careful consideration of your unique situation.

• Dry Eyes. LASIK surgery tends to aggravate this condition.
  
  

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Probably not! At this time, most insurance companies consider LASIK surgery as a cosmetic surgical procedure. There are a few
employers who have put special riders on their company's insurance policy to
cover this procedure. Our staff will be glad to investigate if your insurance
policy will cover LASIK.

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YES! Once your vision has been fully corrected the results are permanent. It is still possible to develop other medical conditions as you age that would change your vision.

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What to expect before, during and after surgery will vary from doctor to doctor and patient to patient. This section is a compilation of patient information developed by manufacturers and healthcare professionals, but it cannot replace the dialogue you should have with your doctor. Read this information carefully and discuss your expectations with your doctor.

Before Surgery
If you decide to go ahead with LASIK surgery, you will need an initial or baseline evaluation by your eye doctor to determine if you are a good candidate. This is what you need to know to prepare for the exam and what you should expect:

If you wear contact lenses, it is a good idea to stop wearing them before your baseline evaluation and switch to wearing your glasses full-time. Contact lenses change the shape of your cornea for up to several weeks after you have stopped using them depending on the type of contact lenses you wear. Not leaving your contact lenses out long enough for your cornea to assume its natural shape before surgery can have negative consequences. These consequences include inaccurate measurements and a poor surgical plan, resulting in poor vision after surgery. These measurements, which determine how much corneal tissue to remove, may need to be repeated at least a week after your initial evaluation and before surgery to make sure they have not changed, especially if you wear RGP or hard lenses. If you wear:

• soft contact lenses and toric soft lenses, you should stop wearing them for 1 week before your initial evaluation.

• rigid gas permeable (RGP) lenses and hard lenses, you should stop wearing them for at least 3 weeks before your initial evaluation.
  

You should tell your doctor:

• about your past and present medical and eye conditions

• about all the medications you are taking, including over-the-counter medications and any medications you may be allergic to
  

Your doctor should perform a thorough eye exam and discuss:

• whether you are a good candidate

• what the risks, benefits and alternatives of the surgery are

• what you should expect before, during and after surgery

• what your responsibilities will be before, during and after surgery
  

You should have the opportunity to ask your doctor questions during this discussion. Give yourself plenty of time to think about the risk/benefit discussion, to review any informational literature provided by your doctor, and to have any additional questions answered by your doctor before deciding to go through with surgery and before signing the informed consent form.

You should not feel pressured by your doctor, family, friends or anyone else to make a decision about having surgery. Carefully consider the pros and cons.

The day before surgery, you should stop using:

• creams

• lotions

• makeup

• perfumes

These products as well as debris along the eyelashes may increase the risk of infection during and after surgery. Your doctor may ask you to scrub your eyelashes for a period of time before surgery to get rid of residues and debris along the lashes.

Also before surgery, arrange for transportation to and from your surgery and your first follow-up visit. On the day of surgery, your doctor may give you some medicine to make you relax. Because this medicine impairs your ability to drive and because your vision may be blurry, make sure someone can bring you home after surgery.

During Surgery
The surgery should take less than 15 minutes. You will lie on your back in a reclining chair in an exam room containing the laser system. The laser system includes a large machine with a microscope attached to it and a computer screen.

A numbing drop will be placed in your eye, the area around your eye will be cleaned, and an instrument called a lid speculum will be used to hold your eyelids open. A ring will be placed on your eye and very high pressures will be applied to create suction to the cornea. Your vision will dim while the suction ring is on and you may feel the pressure and experience some discomfort during this part of the procedure. The microkeratome, a cutting instrument, is attached to the suction ring. Your doctor will use the blade of the microkeratome to cut a flap in your cornea.

The microkeratome and the suction ring are then removed. You will be able to see, but you will experience fluctuating degrees of blurred vision during the rest of the procedure. The doctor will then lift the flap and fold it back on its hinge, and dry the exposed tissue.

The laser will be positioned over your eye and you will be asked to stare at a light. This is not the laser used to remove tissue from the cornea. This light is to help you keep your eye fixed on one spot once the laser comes on. NOTE: If you cannot stare at a fixed object for at least 60 seconds, you may not be a good candidate for this surgery.

When your eye is in the correct position, your doctor will start the laser. At this point in the surgery, you may become aware of new sounds and smells. The pulse of the laser makes a ticking sound. As the laser removes corneal tissue, some people have reported a smell similar to burning hair. A computer controls the
amount of laser energy delivered to your eye. Before the start of surgery, your
doctor will have programmed the computer to vaporize a particular amount of tissue based on the measurements taken at your initial evaluation. After the pulses of laser energy vaporize the corneal tissue, the flap is put back into position.

A shield should be placed over your eye at the end of the procedure as protection, since no stitches are used to hold the flap in place. It is important for you to wear this shield to prevent you from rubbing your eye and putting pressure on your eye while you sleep, and to protect your eye from accidentally being hit or poked until the flap has healed.

After Surgery
Immediately after the procedure, your eye may burn, itch or feel like there is something in it. You may experience some discomfort, or in some cases, mild pain and your doctor may suggest you take a mild pain reliever. Both your eyes may tear or water. Your vision will probably be hazy or blurry. You will instinctively want to rub your eye, but don't! Rubbing your eye could dislodge the flap, requiring further treatment. In addition, you may experience sensitivity to light, glare, starbursts or haloes around lights, or the whites of your eye may look red or bloodshot. These symptoms should improve considerably within the first few days after surgery. You should plan on taking a few days off from work until these symptoms subside. You should contact your doctor immediately and not wait for your scheduled visit, if you experience severe pain, or if your vision or other symptoms get worse instead of better.

You should see your doctor within the first 24 to 48 hours after surgery and at regular intervals after that for at least the first six months. At the first postoperative visit, your doctor will remove the eye shield, test your vision and examine your eye. Your doctor may give you one or more types of eye drops to take at home to help prevent infection and/or inflammation. You may also be advised to use artificial tears to help lubricate the eye. Do not resume wearing a contact lens in the operated eye, even if your vision is blurry.

You should wait one to three days following surgery before beginning any non-contact sports, depending on the amount of activity required, how you feel and your doctor's instructions.

To help prevent infection, you may need to wait for up to two weeks after surgery or until your doctor advises you otherwise before using lotions, creams or make-up around the eye. Your doctor may advise you to continue scrubbing your eyelashes for a period of time after surgery. You should also avoid swimming and using hot tubs or whirlpools for 2 weeks.

Strenuous contact sports such as boxing, football, karate, etc. should not be attempted for at least four weeks after surgery. It is important to protect your eyes from anything that might get in them and from being hit or bumped.

During the first few months after surgery, your vision may fluctuate.

• It may take up to three to six months for your vision to stabilize after surgery.
  

• Glare, haloes, difficulty driving at night and other visual symptoms may also persist during this stabilization period. If further correction or enhancement is necessary, you should wait until your eye measurements are consistent for two consecutive visits at least 3 months apart before re-operation.

• It is important to realize that although distance vision may improve after re-operation, it is unlikely that other visual symptoms such as glare or haloes will improve.

• It is also important to note that no laser company has presented enough evidence for the FDA to make conclusions about the safety or effectiveness of enhancement surgery.

Contact your eye doctor immediately, if you develop any new, unusual or worsening symptoms at any point after surgery. Such symptoms could signal a problem that, if not treated early enough, may lead to a loss of vision.

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Most patients are very pleased with the results of their refractive surgery. However, like any other medical procedure, there are risks involved. That's why it is important for you to understand the limitations and possible complications of refractive surgery.

Before undergoing a refractive procedure, you should carefully weigh the risks and benefits based on your own personal value system, and try to avoid being influenced by friends that have had the procedure or doctors encouraging you to do so.

• Some patients lose vision. Some patients lose lines of vision on the vision chart that cannot be corrected with glasses, contact lenses or surgery as a result of treatment.
  

• Some patients develop debilitating visual symptoms. Some patients develop glare, halos and/or double vision that can seriously affect nighttime vision. Even with good vision on the vision chart, some patients do not see as well in situations of low contrast, such as at night or in fog, after treatment as compared to before treatment.
  

• You may be under treated or over treated. Only a certain percent of patients achieve 20/20 vision without glasses or contacts. You may require additional treatment, but additional treatment may not be possible. You may still need glasses or contact lenses after surgery. This may be true even if you only required a very weak prescription before surgery. If you used reading glasses before surgery, you may still need reading glasses after surgery.
  

• Some patients may develop severe dry eye syndrome. As a result of surgery, your eye may not be able to produce enough tears to keep the eye moist and comfortable. Dry eye not only causes discomfort, but can reduce visual quality due to intermittent blurring and other visual symptoms. This condition may be permanent. Intensive drop therapy and use of plugs or other procedures may be required.
  

• Results are generally not as good in patients with very large refractive errors of any type. You should discuss your expectations with your doctor and realize that you may still require glasses or contacts after the surgery.
  

• For some farsighted patients, results may diminish with age.
  If you are farsighted, the level of improved vision you experience after surgery may decrease with age. This can occur if your manifest refraction (a vision exam with lenses before dilating drops) is very different from your cycloplegic refraction (a vision exam with lenses after dilating drops).
  

• Long-term data is not available. LASIK is a relatively new technology. The first laser was approved for LASIK eye surgery in 1998. Therefore, the long-term safety and effectiveness of LASIK surgery is not known.
  

Additional Risks if You are Considering the
Following:

Monovision
Monovision is one clinical technique used to deal with the correction of presbyopia, the gradual loss of the eye's ability to change focus for close-up tasks that progresses with age. The intent of monovision is for the presbyopic patient to use one eye for distance viewing and one eye for near viewing. This practice was first applied to fit contact lens wearers and more recently to LASIK and other refractive surgeries. With contact lenses, a presbyopic patient has one eye fit with a contact lens to correct distance vision, and the other eye fit with a contact lens to correct near vision. In the same way, with LASIK, a presbyopic patient has one eye operated on to correct the distance vision, and the other operated on to correct the near vision. In other words, the goal of the surgery is for one eye to have vision worse than 20/20, the commonly referred to goal for LASIK surgical correction of distance vision. Since one eye is corrected for distance viewing and the other eye is corrected for near viewing, the two eyes no longer work together. This results in poorer quality vision and a decrease in depth perception. These effects of monovision are most noticeable in low lighting
conditions and when performing tasks requiring very sharp vision. Therefore, you
may need to wear glasses or contact lenses to fully correct both eyes for
distance or near when performing visually demanding tasks, such as driving at
night, operating dangerous equipment or performing occupational tasks requiring
very sharp close vision (e.g., reading small print for long periods of time).

Many patients cannot get used to having one eye blurred at all times.
Therefore, if you are considering monovision with LASIK, make sure you go
through a trial period with contact lenses to see if you can tolerate monovision
before having the surgery performed on your eyes. Find out if you pass your
state's driver's license requirements with monovision.

In addition, you should consider how much your presbyopia is expected to increase in the future. Ask your doctor when you should expect the results of your monovision surgery to no longer be enough for you to see near-by objects clearly without the aid of glasses or contacts, or when a second surgery might be required to further correct your near vision.

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YES! Other options are available. Patients not eligible for LASIK can explore other procedures available to correct their nearsightedness, farsightedness and/or astigmatism. You can discuss these options with your doctor. Alternative procedures may include Photorefractive Keratectomy (PRK) and implantable contact lenses (soon to be available).

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VISX CustomVue is an individual laser vision correction procedure that is WaveScan driven. This enables the doctor to measure and correct unique imperfections in each individual's vision. Many of these imperfections could never be measured before by standard methods used for glasses and contact lenses.

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