The Ultimate Australian Guide to LASIK

The two best-known types of laser surgery are PRK (PhotoRefractive Keratectomy) and LASIK (Laser-Assisted In-Situ Keratomileusis).

The main difference between the two is that in PRK after the laser treatment is done, the outer layer of the cornea is not replaced. Instead, it is allowed to regrow and stabilize over a longer period of time (typically 1-2 weeks).

In the case of LASIK, the outer layer is put back in place as part of the procedure, which allows for rapid healing (patients can usually drive the next day).

In this guide, we cover LASIK specifically.

What is LASIK?

LASIK is the most widely-used method of correcting short-sightedness (myopia), far-sightedness (hyperopia) and/or astigmatism.

LASIK surgery is a pain-free procedure which takes only about 15 minutes for both eyes (the actual laser procedure takes less than a minute). The results are immediately apparent, and vision usually continues to improve and stabilize over a few days.

Currently, LASIK is the dominant and preferred option for eye surgery, as there is less discomfort experienced after surgery, and the patient’s eyes heal very quickly.

How it works

LASIK works by reshaping the cornea allowing light to focus accurately onto the retina without the use of glasses or contact lenses.

The first step in LASIK surgery is the creation of a flap on the cornea.

In the past, a blade (microkeratome) was used to create the flap, but with rapid advancement in femtosecond laser capabilities, now a laser is used to create the flap. This makes it a bladeless procedure.

The bladeless LASIK procedure is more precise and predictable than PRK, achieving less than 10-micron variability. This has reduced corneal abrasions and induced astigmatism.

The flap is then gently lifted to allow the excimer laser to reshape the cornea for perfect focus.

The excimer laser that is used in LASIK is a cool ultraviolet light beam which causes no discomfort to the patient. Current lasers fire at 500 Hz, with a 2 milliseconds latency time. The laser works together with a precise eye tracker which can move at 1050 Hz speed per second (10 times faster than the natural movement of the human eye). In other words, the laser can move quicker than the eye.

After the laser treatment is completed, the flap is then carefully repositioned over the newly-contoured cornea. The flap adheres to the underlying tissue within a matter of minutes. This is a bladeless and sutureless procedure. This mean faster recovery and visual stability, allowing most patients good, functional vision the very next day.

LASIK at a glance

Over 10 million LASIK procedures performed worldwide

10 seconds per eye for the time the laser takes to do its magic

24 hours after surgery you can drive

1.5 million LASIK procedures performed in Australia each year

What are the different types of LASIK Surgery?

There are several different forms of LASIK surgery, the main difference being how the flap is created. Your eye surgeon will advise you on which type of LASIK is best suited for your unique needs.

Also known as 'all-laser LASIK', 'Bladeless LASIK' or 'femtosecond laser technology'. The procedure eliminates the need for a microkeratome (“blade”) to create a flap before reshaping the cornea. Current-day technology makes it possible to create a customised flap of the optimum thickness, size, orientation and location for specific individuals.

This procedure analyses your eyes using wavefront analysis. It’s able to detect and automatically adjust for subtle imperfections and scattered light errors specific to each individual. This results in better-quality vision for the patient.

Q1: Is LASIK safe?

This is a commonly-asked question and for good reason. Like all surgical procedures, there are potential risks, limitations and side effects that you should be fully aware of before undergoing LASIK surgery. LASIK surgery has an excellent safety record and a very high success rate.

Since its introduction in 1991, there have been over 10 million LASIK operations performed in Australia.

It is widely agreed that LASIK has become one of the safest, quickest and most predictable procedures for vision correction.

In a recent study done by FDA on a specific LASIK technology, 98.4%* of patients who had had LASIK done said they were very satisfied with the surgery.

30% of patients had vision outperforming the current glasses and contact lenses.

Nearly 100% of all patients would have met the Australian legal driving requirements.

Choosing the right surgeon and technology is the key to successful surgery. After deciding on your specialist, the next most important step is to make sure you are suitable for the surgery itself.

Q2: How do you know if you’re suitable for LASIK?

Unfortunately, not everyone is suitable for LASIK. The first step to determine if you are a suitable candidate for LASIK is to have your eyes checked a laser vision correction clinic.

The clinic will perform multiple diagnostic scans on your eyes to determine your suitability for LASIK surgery. These scans are painless and do not involve any contact with your eye. The scans aim to determine:

• the shape and thickness of your cornea
• the number of refractive errors present
• pupil size
• how dry your eyes are

Your general wellbeing will also be considered as this will also play a big part in your healing process.

If the diagnostic findings determine that you have a cornea which is too thin or irregular, overly-large pupils, or even refractive errors which are out of the range of correction, you will not be a suitable candidate for LASIK.

Other health conditions which could disqualify you from LASIK include:

• Your age. Most eye surgeons agree that LASIK surgery is ideal for people over the age of 20 years with a stable prescription. You need to be at least 18 years of age to qualify.
• If you are pregnant. Because hormonal changes during pregnancy can affect your eyes, many surgeons recommend waiting after the baby is born and only after you have stopped breastfeeding.
• If your prescription has recently changed. You need to have had a stable prescription for the past 12 months.
• If you experience Dry Eye Syndrome. Individuals suffering from severe dry eye syndrome may have to seek treatment before LASIK, as LASIK in some cases decrease in tear production which can cause eye discomfort and blurred vision
• Other health or eye conditions. These will affect your healing after the surgery.

Q3: What if you’re not suitable for LASIK?

Even if you are not a suitable candidate for LASIK, there are several technologies which you might still be able to have, such as PRK, implantable lenses, or even lens exchange. These can all be discussed with your laser vision correction clinic.

Q4: Is LASIK painful?

In most cases, LASIK does not hurt during, or immediately after the procedure. Before your LASIK eye surgery begins, numbing eye drops are used to control any pain or discomfort to the eye during the procedure. Patients report feeling some pressure on their eyes or a scratchy sensation. Some patients experience mild discomfort for a few days after the procedure.

Q5: Can you blink, sneeze or move during LASIK?

You do not have to worry about holding your eye open during the procedure. Numbing eye drops ensure you don’t feel the urge to blink, and a small device is used to gently keep it open when necessary.

Importantly, the laser uses a sophisticated tracking system that measures the position of your eye a thousand times per second, ensuring it is only functioning when on target, so there is no danger from blinking, sneezing or moving during the procedure.

Q6: How long does LASIK take?

The whole LASIK procedure usually takes less than 10 minutes per eye. Depending on your prescription, and the amount of correction needed, the laser itself only takes 10 seconds per eye to correct your vision. However, you should plan on being in the clinic for a few hours on your day of the procedure.

Q7: Are you awake during LASIK?

Yes. LASIK surgery usually takes less than 10 minutes per eye and does not require general anaesthesia. If you fear you will be anxious during the procedure, your LASIK surgeon can give you a mild sedative or other medication prior to surgery to help you relax.

Q8: Is LASIK permanent?

Yes, in most cases, the results achieved with LASIK are indeed permanent. Laser eye surgery doesn't protect your eyes from the effects of ageing. Those entering their mid-40s may require reading glasses, irrespective of having had LASIK or not. For patients over 40, the surgeon will discuss monovision to avoid reading glasses.

Q9: Can you see immediately after LASIK?

Your eyes start healing immediately after your LASIK surgery, and the initial healing usually occurs rapidly. However, it's normal to experience some blurred vision and fluctuations in your vision for several weeks or even months after LASIK. In most cases, vision should be stable and clear at the six-month post-op visit.

Q10: What conditions can LASIK treat?

LASIK is commonly used in the treatment of Hyperopia (Long-sightedness), Myopia (Short-sightedness), and Astigmatism.

Q11: Can Laser Eye Surgery get rid of my reading glasses?

Yes. Monovision can give you independence from reading glasses. The concept of monovision involves correcting one eye so that it is focused on reading. Monovision is subject to individual adaption and may not be suitable for everyone. Suitability for monovision can be discussed and even trialled at the time of your consultation. You may also be found suitable for multifocal lens technology -­ another option for reducing dependence on reading glasses.

Q12: How soon can I drive after having LASIK eye surgery?

Most people can resume driving the next day, although generally, we would recommend not driving for a day or two after surgery.

Just like in any surgery, there are risks and possible complications when undergoing LASIK surgery. Below are the possible side effects of LASIK, which are not uncommon for patients to experience, mostly within the first few days following the procedure.

Some of these issues can be resolved with additional medical treatment.

• Dry eyes In most cases it is self-resolving. The older you are the longer it takes to resolve. The general rule is patients in their 20’s will generally take 2 months where else patients in their 60’s it takes up to 4 months to resolve this issue. There will always be a difference between individual based on their baseline dryness. The dryness is managed routinely as part of the aftercare.
• Inflammation Is a rare complication that can happen after the procedure, this has been reported in countries outside Australia and was related to inks use during surgery. personalEYES have not had a case of inflammation in the last 10 years. Despite not having had this complication for 10 years we still routinely review our patients 7-10 days post-surgery.
• Halos, glare and starbursts In low-light environments
• Under-correction There may be a case of the surgery not being able to remove enough tissues, which leads to not having clear vision as expected. Further LASIK enhancement surgery is possible after sufficient healing and rest.
• Over-correction Removing too much tissue is also possible and may be harder to fix than under-correction.
• Astigmatism Caused by uneven tissue removal. Symptoms may include double vision (diplopia) or "ghost images."
• Flap problems The process of removing the flap of the outer layer of the cornea is a delicate step, and if not handled properly may result in possible infection and other complications, like Epithelial Ingrowth (cells from the outer layer of the cornea, or epithelium, grow under the flap after surgery, which causes discomfort and/or blurred vision), and Diffuse Lamellar Keratitis (DLK), also called "Sands of the Sahara," (which is inflammation under the flap, possibly interfering with healing and causing vision loss; usually responds to therapies such as antibiotics and topical steroids).

LASIK technology continues to improve and evolve. Researchers and doctors continue to study ways to improve current methods by finding ways to increase safety, omit risk and enhance efficiency. As it is continuing to evolve, choosing a clinic with the latest software and equipment is an important part of ensuring the optimum outcome.

Software is evolving

Since your eye is as unique as a fingerprint, the precise mapping of more points allows for greater accuracy during the procedure.

Lasers are becoming increasingly precise

With the introduction of excimer lasers, the precision of laser surgeries has greatly increased.

What are Excimer Lasers?

An Excimer Laser has the characteristic to remove, or "ablate" microscopic amounts of tissue from the cornea with exceptional accuracy and efficiency. Excimer lasers are the latest and most popular gas lasers generating ultraviolet radiation composed of a gas mixture - a noble, a halogen and usually neon.

The principal advantage of excimer lasers is that they can produce high-energy pulses of ultraviolet light that can remove as little as 0.25 microns of tissue at a time at a very low (UV) wavelength without damaging adjacent tissues. Your surgeon will program the excimer laser with the desired measurements to reshape your cornea and treat your prescription.

• The exact amount and pattern of tissue removal are unique to each patient.
• An excimer laser corrects near-sightedness by flattening the cornea, and farsightedness by making the cornea steeper.
• Astigmatism can be corrected by smoothing an irregular cornea into a more symmetrical shape.
• Most modern excimer lasers have automated eye-tracking systems that enable it to monitor eye movements. This keeps the laser beam on target throughout the procedure.

Surgery Day

While all pre-surgery instructions are different, most clinics will give you a set of instructions before your surgery day. However, the following is a guide to ensure your comfort and safety:

What happens during the LASIK procedure?

What happens after the LASIK procedure?

Your eyes start healing immediately after your LASIK surgery. Normally, you may experience some blurred vision and fluctuations in your vision for several weeks after LASIK.

Your eye doctor or LASIK surgeon will typically see you the day after your surgery to check your visual acuity and make sure your eyes are healthy and healing properly. Most patients are legally able to drive (without eyeglasses or contact lenses) and can return to work the day after a LASIK procedure.

Regular follow-up visits are usually scheduled for six months, where your vision and eye health can continue to be monitored. In most cases, vision should be stable and clear at the six-month post-op visit. Also, if you experience dry eyes, halos, glare or other visual disturbances after LASIK, most of these symptoms should either disappear or be significantly reduced at your six-month visit.

In the unlikely event that there are issues with your vision more than 90 days after your LASIK surgery, your surgeon may recommend a LASIK enhancement procedure to sharpen your eyesight.

Most surgeons wait a minimum of three to six months before performing an enhancement. This is to ensure that any residual refractive error is completely stable.

After LASIK surgery, you should take precautions to protect your eyes from injuries. This is true even after your surgeon advises you that your eyes have fully recovered.

Some further points as a guide for after surgery day:

If you are contemplating laser eye surgery, preparation is just as crucial (if not more) than the actual procedure itself. It is important to be able to identify and choose the best clinic and surgeon for you in order to get the outcome you desire.

Read

Best way to prepare is to be informed. Do your research on the best procedures and technologies available in your area. This will help you have a better understanding and equip you with the right questions to discuss with your surgeon.

Ask

Ask those who have been through the same procedure about their experience. Ask your family, friends and even other doctors for referrals. This gives you a better idea, and narrows down your search based on reputation and trusted opinion.

Prepare

Be ready. Be comfortable. There is no harm in looking into different clinics and surgeons until you find one that feels right. Choose one that has your best interest in mind.

After finding a few options from your research and setting an appointment with the clinic/surgeon, be sure to take advantage of the meeting with the surgeon, and ask ALL the relevant questions you have.

You should be confident with the surgeon that you will choose. If you have any hesitation, do consult another clinic/surgeon until you find the right one. Since there are many types of eye surgery, you should consider a surgeon who is both competent and versatile in their work.

If your surgeon displays a thorough understanding of these different procedures, you can confidently choose the one that will be best to address your particular vision problems.

You may want to keep the following points and sample questions in mind:

Experience, Skill and Reputation

• How many procedures has the surgeon performed? Meet Dr Kerrie Meades and A/Prof Chandra Bala.
• What is surgeons’ outcome/complication rate, and how does this compare with national averages?

Commitment to safety

• Has the surgical centre you use ever had an outbreak of serious eye infections? If so, what caused this?
• If a complication does occur, what is the clinic’s policy regarding follow-up? Will you have 24/7 aftercare access to your surgeon? Learn more about our unwavering commitment to safety here.

Advanced and up-to-date Equipment and Software

• Does the clinic have the best equipment and software available on the market? Learn about the latest technology here.
• How up to date is the clinic in terms of new methods and technology?

Price and financing options

• What is the price range of this specific procedure? Are there any financing options available? See finance options here.
• Does the clinic charge extra if an enhancement is required? If not, what is your cut-off date for addressing problems after the initial procedure? Do they offer a satisfaction guarantee?