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This is a new movement started by women who are fed up with guys who do not wish to shave their faces. They are not going to shave either! Not just their face, but everywhere on their body!

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Lasik Eye Surgery And Its Complications

Every adult spectacles or contact lens wearers must have asked themselves this question: "Should I do Lasik? It seems safe, everyone does it and they can SEE without their glasses!"

It may seems so, but there are complications which many doctors might not discuss in details and that you might not realise. So here, I will attempt to explain what Lasik does and even try to let you weigh the good effects it offers and the complications that may arise.

What 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 knife, called a microkeratome, 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. There are other techniques and many new terms related to Lasik that you may hear about. One of the latest is IntraLase, a special laser used instead of the knife to create the flap. I will describe later some of the differences and advantages in both types of flap cutters.

Some Reasons to do Lasik
The cornea of your eye, that helps focus light to create an image on the retina, sometimes is not perfect and hence may cause one of these three primary types of refractive errors: myopia, hyperopia and astigmatism. With myopia (short-sightedness), you will have more difficulty seeing distant objects as clearly as near objects. With hyperopia (long-sightedness), you will have more difficulty seeing near objects as clearly as distant objects. Astigmatism is a distortion of the image on the retina (sometimes also referred to as 'double image') caused by irregularities in the cornea or lens of the eye. Lasik can help by reshaping the cornea, changing its focusing power.

After Lasik, you will look better (without the spectacles), save time and trouble (if you wear contacts in the morning), become more confident, and generally have a more positive attitude towards life (kind of similar to a successful weight loss, except that it is milder).

Other Types of Refractive Surgery
Radial Keratotomy or RK and Photorefractive Keratectomy or PRK are other refractive surgeries used to reshape the cornea. In RK, a very sharp knife is used to cut slits in the cornea changing its shape. PRK was the first surgical procedure developed to reshape the cornea, by sculpting, using a laser similar to the ones used in Lasik. Lasik was introduced after PRK. The difference is in the way that the stroma, the middle layer of the cornea, is exposed before it is vaporized with the laser. In PRK, the top layer of the cornea, called the epithelium, is scraped away to expose the stromal layer underneath. In Lasik, a flap is cut in the stromal layer and the flap is folded back.

There is even another type of refractive surgery called thermokeratoplasty in which heat is used to reshape the cornea, but Lasik, by far, is the most popular method as it is relatively safer. However, I will not suggest that you take it so lightly because it is still a surgery and with every surgery comes possible complications.

Blade versus Bladeless
While Lasik complications are relatively rare, they are sometimes associated with the oscillating blade used with traditional microkeratomes. Metal blades might create uneven flap edges, resulting in abnormal corneal surfaces and vision defects such as irregular astigmatism. Metal blades also have been associated with formation of incomplete or improperly formed "buttonhole" flaps that can cause vision-threatening scars. Many eye surgeons report these types of complications are far less likely with laser-created flaps.

As a replacement for microkeratomes, IntraLase creates flaps through infrared laser energy that inserts a precise pattern of tiny, overlapping spaces just below the corneal surface. The IntraLase laser operates at extremely high speeds (pulses of one quadrillionth of a second), allowing tissue to be targeted and divided at a molecular level without heat or impact to surrounding tissue.

Studies indicate that IntraLase is associated with significantly fewer overall Lasik complication rates. Nevertheless, eye surgeons recently have reported one postoperative complication of unusual light sensitivity such as photophobia that appears unique to the use of the IntraLase in Lasik. Published reports mention this complication has occurred in as few as 1% or as many as 20% of patients undergoing Lasik with IntraLase, according to an article in Review of Ophthalmology, October 2004. (The 20% figure was reported by one surgeon, whose IntraLase laser was replaced by the company because compared with other surgeons' experiences, the figure was abnormally high, according to the article.) However, many eye surgeons report that the photophobia complication is temporary and can be resolved with steroid treatment (eye drops) lasting a few weeks. Eye surgeons favoring IntraLase emphasize that light sensitivity is a transient side effect that soon resolves, unlike more serious and potentially permanent vision-threatening complications that might result from defective flaps.

Of course, Lasik with IntraLase will be more expensive than with microkeratomes. However, depending on the skill and experience of the surgeon, it may not make much of a difference. Some surgeons, however, prefer to do Lasik only with IntraLase and may factor that into the price of the whole package, reducing the overall cost.

Can I do Lasik?
Common misconceptions is that everyone can do Lasik. Not true. There are many cases where it is not suggested that you do Lasik. I will list out a few here. Always ask the doctor for a full diagnosis. Lasik is not recommended

1. If you required a change in your contact lens or glasses prescription in the past year. This is called refractive instability and may be caused by age (if you are 20 years or younger); hormones fluctuation due to disease such as diabetes; pregnancy or breastfeeding; medications that may cause fluctuations in vision.


2. If 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.


3. If you actively participate in contact sports. You may be participating in boxing, wrestling, martial arts or other activities in which blows to the face and eyes are a normal occurrence.


4. If you have any of the following:
   1. Blepharitis (Inflammation of the eyelids with crusting of the eyelashes)
   
   
   2. Large pupils (May get complications such as glare, halos, starbursts, and ghost images after surgery)
   
   
   3. Thin Corneas (May become blind after surgery)
   
   
   4. Dry Eyes (Will further aggravate it)
   
   
   5. Previous refractive surgery (e.g., RK, PRK, Lasik)


5. If you are not an adult over 18 years of age.
   

Risk and Complications of Lasik


Seeing Stars


Seeing Halos

There are many risks and complications of Lasik that many people do not know about. Early studies had shown that about 5% of Lasik patients experienced some type of problem. Lasik surgeons now are reporting that complication rates can be held below 1% if surgical candidates are selected carefully. I will list them out in details so that you will know what you will be getting into.

• 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. They may never be able to drive or open their eyes for long periods of time as any light source may be extremely glaring. 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.

Find the Right Doctor
If you are considering refractive surgery, you must ask around and:

• Compare. The levels of risk and benefit vary slightly not only from procedure to procedure, but from device to device depending on the manufacturer, and from surgeon to surgeon depending on their level of experience with a particular procedure. The experience and reputation of the surgeon is especially important as the equipment will still be the same, but the surgeon will get better with more eyes treated.


• Don't base your decision simply on cost and don't settle for the first eye centre, doctor, or procedure you investigate. Remember that the decisions you make about your eyes and refractive surgery will affect you for the rest of your life.


• Be wary of eye centres that advertise amazing results, such as "20/20 vision or your money back" or "package deals." There are no guarantees in medicine. Do not believe a surgeon when he says "I've been using a laser for more than 15 years". You know Lasik has only been around for so long, and that is probably another type of laser.


• Read. It is important for you to read the patient handbook provided to your doctor by the manufacturer of the device used to perform the refractive procedure. Your doctor should provide you with this handbook and be willing to discuss his/her outcomes (successes as well as complications) compared to the results of studies outlined in the handbook. If not, find yourself another who will, as he probably cares more about earning money than taking care of your eyes.


• Long term care. Lasik is not a procedure which you can do and forget. Your doctor must be able to provide you with long term examinations and care for your eyes to prevent or detect complications that may arise.
  

Things You Can Ask the Surgeon Before Lasik
After you find a surgeon, make an appointment for a consultation. This is an important meeting. To take full advantage of it, write down every single question you can think of, and ask every single one during your visit.

Here are a few of them (print it out, or copy it into your PDA or mobile phone):

• How long have you been performing refractive surgery procedures? (Not less than three years.)


• How many total procedures have you done? (Not less than 500.)


• How many refractive procedures of the exact type you intend to use for me, with the same equipment, and the same refractive error, have you performed? (Not less than 100.)


• What percent of your refractive surgery patients receive Snellen Uncorrected Visual Acuity (UCVA) of 20/40 or better? (you should be suspicious of any number that is greater than 90%, which is the norm.)


• What percentage achieved 20/20 or better? (Around 50% is the norm; ask for proof if a higher number is stated.)


• Will you provide me the names and contact information of at least ten previous patients who have had the exact same surgery with similar refractive error?


• Have you ever had malpractice insurance coverage denied?


• Have you had your license to perform refractive surgery revoked, suspended or restricted?


• Have you been convicted of a felony? etc.

And Finally
Even the best screened patients under the care of most skilled surgeons can experience serious complications. During surgery, malfunction of a device or other error, such as cutting a flap of cornea through and through instead of making a hinge during Lasik surgery, may lead to discontinuation of the procedure or irreversible damage to the eye. After surgery, some complications, such as migration of the flap, inflammation or infection, may require another procedure and/or intensive treatment with drops. Even with aggressive therapy, such complications may lead to temporary loss of vision or even irreversible blindness.

Under the care of an experienced doctor, carefully screened candidates with reasonable expectations and a clear understanding of the risks and alternatives are likely to be happy with the results of their refractive procedure.