Laser Eye Surgery

I’ve had quite a few patients ask me about my thoughts on laser eye surgery. To date, none of these patients have actually gone through with having it done (was it something I said?).

Why on earth would you want laser to your eyes?

At first glance, it looks like lasers and eyes shouldn’t be friends. In the United States it is actually illegal to shine a laser pointer at any uniformed officer, such as a paramedic or policeman, and in 2012 Obama passed a law making it a federal offence to point a laser beam at, or in the path of, any aircraft. Aside from the risk of frying the pilot’s retina, I imagine with the current state of global affairs that seeing a laser dot on your windscreen is pretty terrifying (employ evasive manoeuvres now!). Despite this, in the correct hands, such as that of a qualified ophthalmologist, a laser and the eye can actually be best buds.

Laser eye surgery, such as LASIK, LASEK, or PRK, can be a convenient way of reducing your dependency on glasses and contact lenses by providing you with clear long distance vision without the need for refractive correction. This can be useful in situations such as:

  • running from zombies without worrying about breaking your glasses or your contacts getting dry
  • if you’re on a cruise and have a Titanic incident
  • working in a kitchen without your spectacles constantly steaming up
  • you need to run to the bathroom in the middle of the night but can’t find your glasses
  • if your child likes to grab things off your face, such as glasses, your nose etc
  • you’re just sick and tired of spectacles and contact lenses

How it works

All these procedures involve reshaping the corneal tissue (that clear bubble over the coloured part of your eye) such that light entering the eye is refracted to the degree needed to form a clear image on the retina. (For further explanation on refractive error read this). Different techniques will be suited to different eyes. One of the main determining factors will be the thickness of your cornea and how much tissue there is to manipulate. In Australia, laser eye surgery starts from around $2500 per eye.

lasik-diagram-2
The LASIK procedure: remove top flap of cornea -> blast off  corneal tissue -> replace flap (image credit http://theeyemds.com/lasik-surgery)

 

Eligibility criteria applies and ultimately it is up to the attending ophthalmologist to decide whether you’re suitable for refractive surgery and which procedure is best. Typically, a surgeon will want:

  • the patient to be over the age of 18 as it means the eyeball is no longer growing and the script less likely to change
  • the script to be demonstrably stable for the last two years (this time period may vary from ophthal to ophthal)
  • the script to be within range for the procedure and your individual corneas, from about -10D myopia to +6D hyperopia, and up to -6D astigmatism (if you decided you didn’t need to read that previous link on refractive error but have no idea what I just said, here’s your second chance)
  • no presence of any corneal disease or dystrophy such as keratoconus since messing around with the cornea could just make things worse

It’s also important to know that other eye diseases that interfere with vision will not be corrected by refractive surgery. For example, a patient with poor vision from macular degeneration or a lazy eye will not benefit as much from undergoing LASIK as someone with a healthy visual system.

As with any type of surgery, there are associated risks, such as infection or the prescription regressing and beginning to develop again; the higher the original prescription, the greater the likelihood of regression. This can sometimes be corrected with some further laser treatment. Other complications include an increased severity of dry eye symptoms and experiencing glare or haloes at night. And since the LASIK procedure involves removing and later replacing a thin flap of the cornea to access the underlying tissue for reshaping by the laser, an interesting potential risk is this flap may dislodge and fall off, which I imagine could make for a really awkward date night.

2c3fc7396f40f19336861e04cca7a4aa5b0018e1b8e863389277ff156808a592
Another potential risk of combining lasers with eyes

 

Other things you should know

Having a refractive laser procedure done doesn’t necessarily mean the end of glasses or contacts ever. Pre-presbyopic (third and last chance to read about refractive error) patients will do well without glasses until they hit the mid-40s (which is when I believe absolutely everything starts to go downhill), and find they need some optical aid for their near vision. If the surgery wasn’t perfect to begin with or if the script starts to regress you may also need distance glasses for certain situations, such as night driving or if you want to win at darts.

There are other refractive surgeries that don’t involve a laser to the cornea, and some of these can even address presbyopia. One of these is a variant of cataract surgery, which involves removing the natural lens inside the eye (the one your mamma gave you) and replacing it with an implant (an silicon intraocular lens) that actually corrects for your prescription, kind of like having a permanent contact lens inside the eye. This procedure is the same as cataract surgery but minus the cataract, and is known as clear lens exchange. The intraocular lens can be multifocal, which will correct for both distance and near vision, but isn’t suitable for everyone. There are also corneal inlays, such as Kamra or Raindrop which are surgically implanted into the cornea to improve near vision.

What’s really important to realise is that refractive error is only one aspect of eye care. Even after gaining perfect vision post-laser surgery, there are still other things that can go wrong with the eye, so keeping up with routine visits to your optometrist is still just as important. Glaucoma, cataracts, macular degeneration, retinal detachments, ocular cancers, dry eye syndrome, and diabetic eye disease are not at all impressed if you no longer need glasses or spectacles and can still affect you just as much as the next person. If you need further persuasion about maintain regular eye tests, read this.

If you’re interested in your options speak to your trusted optometrist or ophthalmologist about whether they believe you’ll be suitable for refractive surgery. It might just be the thing you need to survive the zombie apocalypse.

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