Who can be treated?
Patients who are myopic (shortsighted) up to around -10.00 dioptres either with or without astigmatism are normally good candidates for LASIK surgery. Hyperopic (longsighted) patients up to around +5.00D can also be treated. Astigmatism up to around 4.00D. Higher levels of myopia, hyperopia and astigmatism can certainly be treated but a surgical alternative to LASIK might be best. With alternative techniques myopia up to -25.00D and astigmatism up to 12.00D can be treated. Mr aggarwal will advise you if you are a suitable candidate for LASIK a an alternative procedure after a full consultation.
Who cannot be treated?
a) Those with collagen vascular disease (e.g. rheumatoid arthritis), auto-immune (e.g. Lupus), or immunodeficiency diseases (e.g. AIDS), as these conditions affect the ability to heal adequately and predictably.
b) Anyone who has signs of keratoconus or other corneal conditions e.g. degenerative corneal disease. These conditions could create complications and poor vision. Before treatment you will be assessed for any corneal problems.
c) Pregnant or nursing women as there may be fluctuations in vision with unpredictable results.
d) Patients taking medications which have ocular side-effects, e.g. Isotretinoin for acne treatment, Amiodarone for abnormal heart rhythm. These or other specific medications may affect the accuracy.
e) Those fitted with a pacemaker.
f) Any other patients considered unsuitable by Mr aggarwal e.g. in cases of severe diabetes, glaucoma, history of Herpes infection affecting the eyes, severely dry eyes or severe allergies.
What are the potential benefits of LASIK?
Less dependency on spectacles or contact lenses
Visual freedom particularly important to those with active lifestyles and activities such as skiing, water sports and contact sports prove to be more enjoyable.
Contact lens wearers no longer need to clean, disinfect or purchase new lenses or solutions, which are both costly and time consuming.
Reasons for wanting refractive surgery are many and varied or may simply be cosmetic.
Your potential benefits as well as potential complications will be fully discussed with you at your consultation and you will be given a clear idea whether your desires and expectations from surgery are realistic.
Following your consultation, Mr Aggarwal can arrange for you to talk to one or two previous patients of a similar prescription and age to yours who have undergone the same procedure. Patients quite often find this useful in their decision making process. The final decision on whether refractive surgery is for you must be your own. You will be given as much support, information and advice as possible and as much time as you need to decide. For this reason, your consultation and treatment will not be on the same day. For informed consent you need to have had adequate time to reflect on the information you have been given.
How successful is LASIK?
LASIK builds on the success of the previous PRK (photorefractive keratoplasty) procedure. By performing the laser surgery within the cornea, LASIK allows higher degrees of refractive errors to be treated more safely and more predictably. For lower refractive errors LASIK is as successful as PRK (but less painfull and with faster recovery). For higher degrees of refractive errors LASIK is much more predictable and the end result is more stable. The quality of vision is improved and there is even lower incidence of reported complications such as glare and haloes.
In the FDA Study, one year after the VISX CustomVue procedure, the results were as follows:
100% of participants could pass a driving test without glasses or contact lenses.
98% of participants could see 20/20 (or 6/6) or better, without glasses or contact lenses.
70% of participants could see better than 20/20 without glasses or contact lenses.
What are the possible risks of LASIK?
LASIK in experienced hands is a safe procedure. An expert consultant ophthalmologist will take all necessary steps to ensure the procedure goes as smoothly as possible and to minimize the risk of complications. Such a surgeon will also be capable of dealing with potential complications should they occur. No procedure is totally risk free and it would be wrong of any surgeon not to mention potential complications.
1. Loss of corneal flap The flap of cornea may become dislodged either during or a few days after the procedure. This can lead to serious inaccuracies in the final result. Every possible precaution is taken to avoid this problem and the complication is extremely rare.
2. Incomplete or irregular flap This complication is often related to poor quality instruments or dust particles jamming the automatic blade. Mr Aggarwal insists on using only the best quality equipment and blades. The operation is performed under strict aseptic theatre conditions with clean air filtration and air conditioning for optimum cleanliness.
3. Interface problems Very rarely, the surface cells on the cornea can grow under the flap or debris may become trapped under the flap. This can seriously affect vision. Careful attention to detail makes this complication extremely rare.
4. Weakness of the cornea Theoretically, there is a small risk of permanent weakness of the cornea from removal of the tissue by the laser and the automatic blade. By taking care to calculate and measure the exact amount of tissue removed this complication is very rare indeed.
What is Custom laser vision correction?
This is an individualised laser correction procedure that enables the ophthalmologist to measure unique imperfections (higher order aberrations) in a person’s vision and design an individualised treatment for them.
First the WaveScan technology precisely measures these imperfections and the information is then transferred digitally to the laser, where this treatment is delivered.
What is WaveScan® Technology?
Originally developed for use in astronomical telescopes, today it is applied to laser vision correction and measures minute imperfections in the optical system of the eye.
How accurate is WaveScan® Technology?
WaveScan measures imperfections in an individual’s vision 25 times more precisely than standard methods used for glasses or contact lenses. Thousands of individuals may have the same glasses or contact lens prescription, but with Custom Vis, no two prescriptions are identical.
Is LASIK similar to PRK?
LASIK has several advantages over PRK. These are all related to the fact that LASIK avoids removing the highly active surface cells (epithelium) of the cornea. As a result :
The surface of the cornea heals more evenly after LASIK compared to PRK
The healing is almost painless
The correct vision can be attained within hours of surgery
The vision attained is stable within a few days in higher myopes compared to PRK which may take weeks or months to stabilise
Any modifications/enhancements to the treatment can be performed simply by lifting the flap to allow more laser treatment.
These factors make LASIK preferable to PRK in many respects.
Will I still need glasses after my treatment?
Some patients may not achieve full independence from their glasses or contact lenses, usually as a result of an under or over -correction. Although usually very pleased following the treatment, an enhancement (further LASIK) can be performed in most cases for those who wish to further improve their vision.
It should be remembered however, that vision is dynamic; it can vary at different distances, changes with age, and is affected by other factors such as lighting, fatigue, medication or alcohol.
Will I still need reading glasses after my treatment?
As we age, our ability to focus on near objects e.g. reading, diminishes and this is called presbyopia.
LASIK treatment does not improve the focusing power of our eyes so reading glasses may still be required for close tasks.
Close vision can be improved using an option called monovision. This is a method whereby one eye is corrected for distance, and the other eye is corrected to leave it slightly short-sighted for clearer near vision.
The advantage of monovision is that it provides good vision for normal daily tasks, but glasses may be required for more demanding work such as reading small print or driving at night.
If monovision is an option for you, it will be discussed with you at your consultation.
When can I drive?
The legal requirement to drive is acuity of around 6/12 or better. This means that most patients would be able to drive the following day after the surgery. Even if the patient feels comfortable with their vision it is advisable to wait for this to be confirmed.
Should I leave my contact lenses out before my consultation?
We recommend that you leave your lenses out for as long as possible before your consultation. This will allow your cornea to revert to its natural shape. This is necessary so that all the measurements taken are very precise.
In general we recommend the following:
Soft and extended wearers – leave out for two weeks prior to consultation and surgery.
Gas permeable and hard lenses – leave out for three weeks prior to consultation and surgery.
When can I return to work?
Most people can return to work within a few days, provided they work in a clean and dust-free environment.
When will I be able to see clearly and when will my vision be stable?
Patients can expect to see clearly within days of surgery although this varies depending on the patient’s individual healing processes and degree of short sight. Some patients can even see well within a few hours of surgery. Generally speaking the vision stabilises much more rapidly than PRK.
Is the procedure painful?
The procedure itself is not painful, although a feeling of pressure is frequently experienced. There may be some mild burning or stinging or very mild discomfort for several hours after treatment. By using anti-inflammatory eye drops and a protective soft contact lens in the early healing stages, the incidence of discomfort is greatly reduced.
Can I have both eyes treated on the same day?
Yes, it is usually possible to treat both eyes on the same day. The surgeon will check the first eye on his biomicroscope to ensure all is well prior to the second eye being treated.