Many people don’t fully understand the details of LASIK eye surgery, even those who are undergoing or about to undergo the procedure. Don’t be someone who waits until afterwards to discover the things you should have known beforehand. Be an informed consumer, especially with something as important as your vision.

Many people wonder if they may need "Laser surgery" after they have had cataract surgery. In fact, many people actually confuse cataract surgery for "Laser surgery." Actually, modern cataract surgery does not usually involve lasers at all. Instead, a microscopic ultrasound instrument (phacoemulsification probe) is used to break-up and remove a cloudy lens in a patient's eye. After the cloudy lens is removed, an artificial intraocular lens implant (IOL) is placed within the eye. In the vast majority of cases, however, no laser is involved in this process.

There are a couple of instances where lasers may be some benefit following cataract surgery. The most common is the development of a posterior capsular opacity (PCO) which is a thin, hazy film which can grow across the remnant lens structures behind the IOL. This hazy PCO can partially block the path of light through the IOL and obscure the patient's vision causing blurred haziness or glare. PCO is actually the most common complication after routine cataract surgery. If it becomes significant enough to limit a patient's functional vision, then it is generally treated using an instrument called an Nd:YAG laser.

This type of laser has been available for several decades and is extremely accurate and successful in clearing a PCO with little to no discomfort and with minimal recovery time. The Nd:YAG laser can be very carefully aimed behind the IOL to cut away an area of the PCO creating a new clear path for light to pass through. The procedure usually takes less than five minutes.

From the patient's perspective it is actually quite easy. The doctor places a plastic "contact lens" onto your eye which holds your eye open and also allows him to focus the laser beam. He then carefully aims the laser so that it cuts a small clear circular area in the PCO. Although there are bright lights involved, the patient typically feels little to nothing. The Nd:YAG procedure has a very high rate of success for restoring vision to a high level.

Another situation that can arise is the occurrence of residual refractive error (glasses prescription) even after cataract surgery with IOL implantation. In the case of a cataract patient, the IOL can be selected to match the characteristics of the eye thus minimizing the patient's glasses. If there is any residual refractive error, the patient may choose to wear glasses or it may also be possible to use the Excimer laser to correct it. For these cataract surgery patients, there are a number of things to consider.

First, they should understand that the standard IOL cannot change its focus so it is always set to either far or near distance only, but not both. Because of that fact, standard IOL patients require reading glasses if their distance vision is made perfect or they require distance glasses if their up close vision is good. These patients should consider carefully what distances are most important to them in their daily function before undergoing any Lasik vision correction. Also, there are now newer advanced technology IOLs (AT-IOLs) which are able to restore some ability of the eye to focus at different distances. These AT-IOLs are capable of reducing the need for glasses or bifocals to a greater degree than their older standard IOL predecessors. Prior to having cataract surgery, patients should ask their surgeons if they might benefit from the implantation of an AT-IOL.

Second, there are a couple of different ways to use the excimer Laser to correct a refractive error and surgeons have different approaches and philosophies. The two basic methods are called PRK and Lasik. Lasik is the most common vision correction procedure in younger patients that have not had cataract surgery, but many surgeons favor PRK for their cataract surgery patients. I personally prefer Lasik using blade-free Lasik technology. The major difference between PRK and Lasik is the creation of a corneal flap off the front of the eye in Lasik.

You can visualize the corneal "flap" as a wall calendar where one page can be flipped up to reveal the underlying page. Similarly, the hinged flap is created on the cornea and lifted up to reveal the underlying corneal tissue. The advantage of Lasik over PRK is the significantly faster healing and visual recovery. Some surgeons prefer the ease of PRK in post-cataract surgery patients because it avoids the need to surgically create the flap. However, the most advanced blade-free Lasik technology can very easily create the flap on post cataract surgery patients. These newer instruments place much less pressure on the eye than the older bladed flap-makers and can cut a corneal flap with far greater precision and accuracy as well. So the quick healing of Lasik can easily be applied to post cataract surgery patients and avoid the slow visual recoveries that can occur in PRK.

Modern cataract surgery is a very highly successful surgery whether laser surgery is required afterward or not and, in fact, the majority of cataract surgery patients never need laser treatment of any kind. Nevertheless, patients should be aware of the possibility that they may benefit in some cases from Nd:YAG or excimer laser (PRK, Lasik). Typically, these lasers will give added visual benefit after cataract surgery but are not absolute necessities. Your surgeon should explain the reasons and potential benefits as well as risks prior to having these additional laser procedures.

Pursuing a Career in Ophthalmology

The following are the pros and cons behind two of the most common misconceptions about LASIK.

1. “After the procedure, I’ll never need glasses or contacts again!”

Depending on your age at the time of the procedure and the issues with your vision that you’re trying to correct, you may or may not continue to need glasses or contacts, either immediately after surgery or possibly later on, as you age.

This is not to say that the procedure can’t be both effective and life-changing. It can be, and it generally is. The vast majority of patients who undergo the procedure report significant improvement in their vision.

It allows California drivers to drive without glasses within days of their surgery. A small percentage require “enhancement” surgery, which is a second procedure, conducted to fix any over- or under-correction of your vision resulting from the first procedure.

Also, many people, as they age (generally between the ages of 40 and 50), develop poor vision for reading (called presbyopia). If you had LASIK surgery in California prior to developing presbyopia, you could still need reading glasses as you get older. Presbyopia is sometimes treated with Monovision LASIK, which corrects one eye for distance vision and the other eye for close vision.

How to choose a LASIK Eye surgeon in California

Dry eye has been long recognized as a postoperative side effect of Lasik surgery. Studies have concluded that clinically detectable dry eye is present nearly universally following Lasik surgery, even when patients do not normally experience dry eye symptoms. There are a couple of causes of dry eye problems. First, when the corneal flap is created during the Lasik procedure, either a steel blade or a laser must cut through the corneal tissue and corneal nerves are disrupted in the process. The deeper this cut, the more likely the disruption to nerve tissue. The laser reshaping of the cornea further disrupts the nerve tissue. During the time while the nerve tissue heals and regenerates, the reflex to tear and blink is significantly diminished; thus creating the dry eye problem.

The quality and smoothness of the corneal surface and tear layer is important for quick recovery of good visual acuity. The tear layer is actually the first optical surface that light hits when it enters the eye during the Lasik procedure. If that tear layer is irregular or deficient, it can create a poorer visual image, with heightened "ghosting" or "fuzziness."

To maximize my patients' vision postoperative, I suggest approaching the problem of dry eye with a basic regimen that includes the following:

1) A good preoperative evaluation for preexisting dry eye problems and maximizing the surface condition prior to performing Lasik.

2) The usage of the Intralase FS lasers for making the initial Lasik flap rather than the steel razor blade microkeratome.

3) The good use of artificial tears and gel lubricants postoperative, even if the patient does not complain of dry eye symptoms.

I also suggest that patients use cyclosporine 0.05% eye drops (Restasis) twice per day for one month postoperative. Studies have shown that this regimen can improve visual outcomes and reduce the need for enhancements after Lasik surgery. It appears that the improved quality of the tear layer can actually improve a patients vision, so that they are less likely to feel the need for additional or touch up surgery. This not only improves the patients overall experience but decreases the possibility of any secondary side effects or complications that could occur with a second procedure, however rare that would be.

Ultimately, attention to detail with every aspect of surgery enhances the outcomes as well as patient satisfaction in the long run. That's why surgeons need to pay so much attention to new and innovative technologies and medications on every level as they are developed.

LASIK Eye Surgery - The Truth Behind the Misconceptions

lasik in boston

If you have decided to go ahead and have laser eye surgery then you are likely to have been offered the option of having Intralase. Intralase is the latest development in laser eye surgery and is a type of Lasik and is so called Intralase Lasik. Intralase Lasik is considered the gold standard in laser eye surgery and this is because of the many benefits it has over standard Lasik. Intralase is different to standard Lasik in the way in which the flap is created. During standard Lasik the flap (outer layer of cornea) is created using a microkeratome (surgical blade) whereas with Intralase it is created using a laser. The creation of the flap is required so that the surgeon can access the inner layers of your cornea which are to be lasered during the procedure. Intralase is so called a bladeless procedure and is becoming increasing popular. Let's look at its advantages and see if it is worth the additional cost:

Risks/complications: There are fewer complications when compared with standard Lasik as the flap that is created is much more precise and cleaner. The vast majority of complications with Lasik are flap related.

Dry Eyes: There is less of a chance of getting dry eyes if you have Intralase.

Recovery Time: Recovery time is quicker than compared with standard Lasik and vision stabilises sooner as well.

Results: Having Intralase gives you a greater chance of achieving 20:20 vision following surgery. It not only improves the quantity of your vision (how far you can see down the test chart) but it also improves the quality of your vision, meaning you are less likely to have night vision problems following surgery.

Laser enhancement: Fewer people having Intralase need a re-treatment down the line meaning there is a higher chance your laser vision correction will last for life.

Thinner Flap: This means the people with thin corneas could be able to have Intralase Lasik, where they were unsuitable for standard Lasik.

As you can see there are a lot of advantages of Intralase and it is definitely worth having it if you can afford the additional cost. You are more likely to achieve 20:20 vision with a lower risk of complications.

If you are interesed in laser eye surgery then visit to find out everything you need to know about the procedure. You can ask questions in the laser eye surgery forum if there is anything you are unsure about.

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