Lasik 

LASIK (Laser Assisted In Situ Keratomileusis) is one of the most amazing technological breakthroughs in eye care in past decades.

The laser is extremely precise and quick, taking approximately 10-15 seconds to create a thin corneal flap and around 30 seconds of pulsed laser that removes a microscopic layer of the cornea, altering its curvature, to correct your spectacle or contact lens prescription. (to be precise it is 0.25 microns of corneal tissue or 1/400 of a millimetre). 

The flap is replaced and the healing process begins immediately (taking around 5 days to heal completely). Visual recovery is rapid and it is virtually painless.

At 6/6 vision Professor Aggarwal performs Custom Wavefront-guided LASIK, using 3-dimensional measurements of the eye which permit a level of precision and personalisation, previously unattainable with traditional LASIK equipment. This has an improved safety profile and can also correct disorders that previously could not even be detected.

 

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Lasek

Laser Epithelial Keratomileusis is similar to PRK, but the corneal surface (epithelium) is lifted without laser, and replaced after the procedure. PRK stands for Photo Refractive Keratectomy and this was the original technique used before the introduction of Lasik and Lasek.

There are fewer side effects with LASEK than PRK and the healing process is faster. It can be beneficial to wear a soft contact lens for a week after the procedure to promote healing.

 

LASEK is a good option for some people, unable to have LASIK. The laser procedure is exactly the same.

 Frequently Asked Questions about Laser eye surgery

Is the procedure painful?

The procedure itself is not painful, although a feeling of pressure is frequently experienced. Drops are used to numb the eye and a mild sedative is given to relax patients before the procedure. 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.

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 be treated but surgical alternatives to LASIK might be best. With alternative techniques, short-sightedness up to -25.00D and astigmatism up to 12.00D can be treated. Professor Aggarwal will advise you if you are a suitable candidate for LASIK or 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 accuracy.

e) Those fitted with a pacemaker.

f) Any other patients considered unsuitable by Professor 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 sport proves 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, Professor 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 when making their decision. 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?

 

For lower refractive errors LASIK is as extremely successful. For higher degrees of refractive error, LASIK is much more predictable than it used to be. When LASIK is carried out by an experienced Consultant Ophthalmologist, using state-of-the-art equipment, it can resolve a number of issues in one short procedure. 

 

In the FDA study, one year after the procedure, (using the Laser used by Professor Aggarwal) 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. Corneal flap issues. The flap of the cornea may become dislodged either during or a few days after the procedure, especially if it is rubbed.  Every possible precaution is taken to avoid this problem and the complication is extremely rare because the cornea heals quickly. Potential issues with the corneal flap are highly unlikely to occur as Professor Aggarwal uses a laser to create the corneal flap rather than a blade. The laser produced flaps have a better safety profile and heal more quickly.

2. 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.

3. Theoretically, there is a small risk of weakening the cornea by the removal of tissue by the laser. The Victus Laser used to make the corneal flap and the Custom laser used to profile the cornea offer maximum precision. The exact amount of tissue is removed, hence 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 the tiniest of imperfections in a person’s vision and design an individualised treatment for them.

The technology used was originally used for astronomical telescopes. Today it precisely measures optical imperfections and the information is then transferred digitally to the laser, where this treatment is delivered. The system recognises and corrects the tiniest anomaly hence no two prescriptions or treatments are the exactly the same. 

 

Will I still need glasses after my treatment?

The vast majority of patients will not need glasses or contact lenses.

Some patients may need to wear glasses or contact lenses occasionally and this is usually as a result of an under or overcorrection (which can be corrected via a secondary enhancement procedure). 

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 be required later in life.

 

When can I drive?

 

The legal requirement to drive is visual 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 until an optician, optometrist or ophthalmologist has confirmed the post-op result. 

 

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 contact lens 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. 

  

Further Reading

Laser Vision Correction

Implantable Contact Lens (ICL) for high prescriptions

For age 50+ or those with cataract 

Make an appointment to see Professor Aggarwal

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Professor Rajesh Aggarwal

BM MRCP FRCS FRCOphth Pg.Cert Med.Ed

Consultant Ophthalmologist