Laser eye surgery is revolutionary and life-changing for patients. Like all surgical procedures, there are risks involved that can be minimized or eliminated. The most important way to reduce risk is to seek out a good surgeon that you can trust with a known track record. The operating surgeon or one who can perform the surgery personally must examine you at consultation. Additionally, the functional Centre must have all the necessary diagnostic technology and care pathways and trained staff to ensure that all testing performed is complete and high standard.
You MUST educate yourself well, and here are some of the specific risks reported and how they can be minimized or eliminated.
1. Dry eye
Dry eye following laser eye surgery is typically a temporary phenomenon but can become a long-term problem if patients are not appropriately evaluated before surgery. Learn more about Laser Eye Surgery at https://www.personaleyes.com.au/costs/lasiklaser-eye-surgery-cost
Dry eye following LASIK and PRK occurs because the superficial nerve endings on the cornea’s surface need to regenerate and heal. The cornea is a little numb and does not have the sensation required to trigger tear production. Additionally, nerve endings produce chemical messengers (cytokines), which act as growth factors coordinating interaction between surface cells. Nerves regenerate in 6 to 12 weeks, and during this time, the eyes are prone to getting dry.
Long-term dryness can occur if an underlying problem has not been diagnosed and treated adequately before surgery.
Symptoms: Grittiness, burning, fluctuating vision, pain
Make sure the operating center performs dry eye tests, including
a) Schirmer’s test for tear production and
b) Tear Break-Up Time (TBUT).
Make sure your operating surgeon is also experienced and knowledgeable about dry eye.
1. Ask your surgeon if you have Meibomian Gland Disease. Meibomian glands are located in the eyelids and produce vital oils, which helps to prevent tears from evaporating too quickly.
2. In advance of your laser eye surgery, consider taking re-esterified Omega 3 supplements to improve your Meibomian gland function.
3. Take preservative-free eye drops frequently after your procedure
4. Take breaks from computer monitors every 20 mins, close your eyes for 20 seconds and look out of the window for 20 seconds – then get back to work.
2. Halos and Glare
For some days to a few weeks following LASIK eye surgery (both Lasik and surface ablation), ALL patients experience halos. This is because fluid within the recently treated cornea causes light to scatter.
Once the fluid clears, the halos disappear. Some patients, however, develop permanent halos following surgery and find their symptoms are worse at night (left-hand image). This problem is caused by induced aberrations from lasers that have delivered small diameter zones of correction or older forms of treatments not Aspheric in profile.
The good news is this problem does not occur very often as long as patients are selected correctly and the correct treatment customized for each eye is delivered correctly. This problem can also happen if the treatment has not been centered perfectly.
1. Ensure your pupil size is measured in dim/dark light
2. Ensure your surgeon is experienced in Laser eye surgery and understands the significance of high order aberrations.
3. Ask your surgeon if you will be receiving an ASPHERIC treatment profile on your cornea. Good cameras and spectacles have “Aspheric” lenses to provide good quality vision. You want to be sure your surgeon plans on making your cornea aspheric. Click here to read about 5 Early Signs You Need Laser Eye Surgery.
4. Ensure the treating center has laser eye surgery technology that is up to date and well maintained.
Like all surgical procedures, there is a risk of infection. Fortunately, the risk of disease in laser eye surgery is minimal. The risk of infection from highest to lowest is LASEK, PRK, blade -LASIK, and IntraLASIK with a femtosecond Laser carrying the lowest risk of all. The overall risk of infection after IntraLASIK in excellent eye centers is 1 in 10,000 cases.
1. Go to a reputable center that has an excellent Care Quality Commission (CQC) rating
2. Ask about the environment in which laser eye surgery is being carried out. Is the air HEPA filtered, and the exchange rate per hour? 10 per hour is the minimum required; many use 15 per hour.
3. Ask what antibiotics are used in preoperative preparation and during surgery. Ideally, a 4th generation fluoroquinolone such as Moxifloxacin or Gatifloxacin. These antibiotics are powerful and eliminate a wide variety of bacteria.
This is a condition where the cornea is more elastic than usual and can become unstable following laser eye surgery; the cornea becomes “ecstatic,” in other words, it bulges and thins over time. This results in a change in vision with the requirement to initially wear glasses. Astigmatism increases and causes continuing problems. Ectasia can occur in both Lasik and PRK/LASEK surgery. There are tell-tale signs on the cornea that can be picked up using sophisticated corneal mapping, biomechanic checks, and corneal epithelial thickness mapping. Click here to learn more about the symptoms you need to know before going for Eye Surgery.
1. The best person to determine whether you are at risk or not is a surgeon who has specialized in the Cornea. Specialized corneal surgeons are trained and experienced with Keratoconus, a condition where the cornea is elastic and bulges. They are very familiar with the type of tests used to check for this condition and subtle signs of the disease.
2. Ask if three-dimensional tomography devices like the Pentacam are being used to evaluate the cornea.
3. Does the center use biomechanical checks to determine corneal elasticity.
5. Flap complications
Flap complications such as buttonholes, partial flaps, irregular fragmented flaps have been reported in Lasik laser eye surgery, where a bladed microkeratome is used to create the flap.
Following the introduction of the IntraLase femtosecond laser for flap creation (introduced by Centre for Sight in 2004), flap complications are now thankfully rare. Use of the femtosecond laser is the gold standard, and blade microkeratomes that in the past were responsible for flap complications should no longer be used.
- Ask the treating center if the IntraLase laser will be used for creating the corneal flap in the LASIK procedure
- Ask your surgeon how long they have performed LASIK and for how long they have used IntraLASE.
Laser eye surgery is a fantastic procedure that is liberating. You must make a good choice. Becoming well educated is a good first start. Next, find a good surgeon and eye center who can deliver exceptional care. A good tip is to go where other eye surgeons go for their care.