LASIK: laser eye surgery

Imagine a simple operation that could make your eyesight better than when you wore glasses or contact lenses. Well that’s what can happen following a LASIK procedure. And what’s more, it takes only a few minutes to complete. But how does it feel to have your eyes ‘lasered’? Katie Perrott, a 29-year-old Sydney-based graphic designer in the magazine industry, told myDr what it’s really like to have laser eye surgery.

For Katie Perrott, the decision to have laser surgery performed on her eyes was an easy one. She says: ‘I decided to have the LASIK procedure because I didn’t like wearing glasses. Unlike many other people, I never got used to wearing glasses because I needed them only now and then for short-sightedness. But within a short period of about 6 to 8 months my eyesight deteriorated really quickly and I started to need my glasses nearly all the time. I was really excited at the prospect of having the laser surgery so I could get rid of my glasses.’

What is LASIK?

LASIK, or Laser in-Situ Keratomileusis, uses a laser to reshape the cornea of the eye, without cutting it, to correct vision problems such as short-sightedness (myopia), far-sightedness (hyperopia) or astigmatism.

LASIK is one of 2 main types of excimer laser refractive surgery: the other main method is known as PRK (Photorefractive Keratectomy).

In PRK, the older of the 2 procedures, the laser is applied to the surface of the cornea. In this case, the laser shaves off tiny parts of the outer cornea. Unlike LASIK, no protective flap is cut in the cornea. Healing takes longer than with LASIK.

LASIK is newer than PRK and involves 2 steps: cutting a hinged flap from the cornea and folding it back and then applying the laser to the inner layer of the cornea. The flap is then replaced, covering the reshaped area of the inner cornea. The protective flap bonds securely to the eye by itself so there is no need for stitches. The advantage of LASIK over PRK is that healing is quicker and often more comfortable. However, both methods have risks and benefits and not everyone is suitable for the procedure so you should have an assessment at a clinic before deciding to go ahead.

Choosing a surgeon
Katie says: ‘My advice would be to make sure you find a surgeon who makes you feel comfortable. You feel very vulnerable while you’re in the chair so you need to trust your surgeon.

‘You can get free quotes so shop around, check out their equipment and get them to explain everything to you before you make a decision.

‘In my case, the refractive surgery specialist was recommended to me by someone who’d had the procedure done at his clinic. He had the latest, most up-to-date equipment — a tiny tracking laser that offers better precision than older lasers. This equipment follows the spot at which it’s aimed so even if you move your eye a little, it can follow and still hit the right spot.’

Preparing for LASIK
Katie says: ‘Before the procedure, I went to the eye clinic for a consultation. The refractive surgery specialist evaluated my eyes to see if my cornea was suitable for the procedure. He used a computer to plot a 3-D mapping scan of the structure of my eyes to help get a more precise result. He also checked my eyesight both with and without glasses so there would be a comparison after treatment.’

In all, it took about one-and-a-half hours for the full evaluation.

For a week before the procedure Katie had to use eyedrops for dry eyes 3 or 4 times a day to prepare her eyes. She was also warned not to drink alcohol or use mouthwash containing alcohol the night before the procedure.

The big day
Katie had both eyes ‘lasered’ on the same morning. She says: ‘I wasn’t frightened at all on the morning of the procedure. I was really very excited, though, because I just wanted to have it done. It helped that I felt very confident and comfortable with the surgeon.

The procedure takes place with the patient sitting in what looks like a dentist’s chair. Katie says: ‘I was given a pill to help me relax and my eye was washed out and then anaesthetic eyedrops were put in. These eyedrops make the eye “go to sleep”: they felt really dopey and heavy and my vision was blurry. You want to close your eyes and you have to concentrate hard on keeping them open.

‘Then I had my eyelashes taped back and a speculum was put on my eye to hold my eyelids open and stop me from blinking. A machine (known as a microkeratome) came down and my vision went black as it sucked on to my eyeball and cut the cornea to make the flap.

‘This took only about 2 or 3 seconds. The feeling was weird: it certainly wasn’t painful and the only discomfort I felt was pressure on my eyeball.

‘I had to hold my head very still during the procedure but I certainly didn’t feel that I wanted to move anyway.’

After the flap was cut, the surgeon lifted the flap to give access to the laser.

Katie says: ‘The laser comes in for 30 seconds. The whole process is computerised but the surgeon can override the computer if necessary. My job was to concentrate on 3 things: looking at the red dot of the laser; keeping my eye very still; and keeping the other eye open, even though it had a protective shield over it. The operator made it easy for me as he counted down the 30 seconds so it didn’t feel too long. I heard a crackling sound as the laser did its job but it wasn’t painful at all.

‘After using the laser, the surgeon put the flap back down. I knew he was touching my eye but, because I felt a bit sleepy, there was no anxiety and no pain. The flap heals itself within 24 hours so there was no need for him to do anything else.’

The entire procedure took only a few minutes. After putting a protective shield over the eye that had just been lasered, the surgeon repeated the process with the other eye.

Katie says: ‘After the procedure, he checked my eyes again and I was ready to go home. You have to take someone with you to take you home as both eyes have plastic guards taped over them. I could see a little, because the guards were clear, but it was like looking through Vaseline. I had to keep these on for 24 hours and I couldn’t take a shower for 24 hours.’

The first few days

Katie says: ‘The day after the procedure my vision had cleared so when I had the shields removed during my follow-up appointment at the clinic I could see amazingly well. But I was told I’d need at least a month for my eyes to get used to it.’

However, she adds: ‘I felt very tired after the procedure. You definitely need to take the day off work and do nothing at all afterwards. I was still tired the day after the surgery and I had naps throughout that day as well.

‘By day 3, I felt fine but I was still very careful with my eyes. My eyes were a bit sensitive to bright light at first. For example, I couldn’t watch TV for about 3 days. I was extra-careful because I live near the beach and I didn’t want to get sand in my eyes or expose them to anything that could irritate them, so I stayed indoors for about 3 or 4 days afterwards. You definitely have to plan the right time to have the surgery and I could see it might be quite hard if you had children to cope with!’

After effects
Because no surgical procedure can give guaranteed results, not everyone will end up with 20/20 vision after having had a LASIK procedure. On the other hand, the latest laser technology can go beyond simply correcting poor vision to improving your eyesight so that it could end up better than it was before you needed glasses.

Katie says: ‘A bad result for the surgeon is if someone has the procedure and still needs glasses to drive. If you can get your driving licence without needing glasses, that’s an average, expected, result in the surgeon’s eyes. What they like is to have your eyes better than when you started.’

No surgical procedure is free from risks and there is a small possibility of side effects such as discomfort from dry eyes (usually only temporary), and complications as a result of cutting the flap, including infection, distortion of the cornea and scarring.

Katie says: ‘The surgeon makes a big deal of telling you all about the possible side effects but, because I felt I had a good surgeon, I felt comfortable.

‘My eyes felt a bit sore after the procedure, like they’d been bruised. Even 2 weeks afterwards, if I rubbed my eyes they felt a bit “bruised” but only if I pushed on my eyes. Otherwise the only other problems I’ve had were dry eyes, like they were gritty or sandy. But using eyedrops for dry eyes offered relief immediately.

‘I put antibiotic and anti-inflammatory eyedrops in my eyes about 4 times a day for the 2 weeks following the procedure. Now, 3 or 4 weeks after the procedure, I still use eyedrops for dry eyes often, particularly because of the air-conditioning at work. My eyes feel tight and dry: I’ve been told this can be an effect of the surgery but that they’ll get better over time.’

In terms of follow-up appointments, Katie had to return to the clinic the day after the procedure and one week later and will have follow-up appointments 6 weeks later, 3 months later and 6 months later.

She says: ‘On a scale of one to 10, I’d say the surgery was only a one out of 10 for pain, but I’d give it a 5 out of 10 for inconvenience afterwards. Still it’s more convenient than wearing my glasses.’

So was it worth it?
Katie says: ‘Now, my eyesight is probably better than many people are born with: I can see more clearly than a lot of people who don’t even need glasses.

‘I would definitely recommend it to other people. I’ve since spoken to another friend who’s had it done and we agree that it’s fantastic.

‘I can see that price would be an obstacle for many people. It is expensive at about $2000 per eye but for me that means I am covered for 2 years of check-ups and follow-up appointments, as well as my supply of antibiotic eyedrops. And it’s definitely worth it. I think it’s the best thing I could have done.’