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LASIK Eye Surgery


The most common vision correction procedure today is LASIK.  LASIK is a surgical procedure intended to reduce a person’s dependency on glasses or contact lenses. LASIK stands for Laser-Assisted In Situ Keratomileusis and is a procedure that permanently changes the shape of the cornea, the clear covering of the front of the eye, using an excimer laser. A mechanical microkeratome (a blade device) or a laser keratome (a laser device) is used to cut a flap in the cornea. A hinge is left at one end of this flap. The flap is folded back revealing the stroma, the middlesection of the cornea. Pulses from a computer-controlled laser vaporize a portion of the stroma and the flap is replaced.

Wavefront Lasik

Wavefront adds an automatic measurement of more subtle distortions (called higher order aberrations) than just nearsightedness, farsightedness, and astigmatism corrected by conventional LASIK. However, these “higher order aberrations” account for only a small amount (probably no more than 10%) of the total refractive error of the average person’s eye. Conventional LASIK increases higher order aberrations. Although wavefront-guided treatments attempt to eliminate higher order aberrations, results from the clinical studies have shown that the average aberrations still increase, but less than they do after conventional LASIK. In a few studies comparing wavefront-guided LASIK to conventional LASIK, a slightly larger percentage of subjects treated with wavefront LASIK achieved 20/20 vision without glasses or contact lenses compared to subjects treated with conventional LASIK. Patient selection and the experience and competence of the surgeon are still the most important considerations.

All Laser Lasik

The difference between traditional LASIK and “All-Laser LASIK” (also known as “Bladeless LASIK”) is the method by which the LASIK flap is created. In “All Laser LASIK”, a laser device called a laser keratome, is used to cut a corneal flap for LASIK surgery. This is a newer method to create a corneal flap than the traditional method of using a microkeratome, a mechanical device with a blade. There is no absolute agreement among eye surgeons on the better choice for flap creation. Some of the factors a lasik eye surgeon considers when choosing a preferred method of flap creation during LASIK are as follows:

  • Quality of vision
  • Rate of complications
  • Pain during and after surgery
  • Precision of flap size and thickness
  • Time to recovery of vision
  • Expense

Lasik Risks

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 are 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.