Before Surgery

If you are considering LASIK eye surgery, your first step is to choose a good surgeon.

Your doctor will examine your eyes to determine exactly what kind of vision correction you need, and how much laser ablation is required. A corneal topographer will be used; this device photographs your eye and creates a kind of "map" of your cornea. No one has a perfectly rounded cornea, and the topographer will display the corneal irregularities and the actual steepness or flatness that the surgeon must correct.

Patients may not use soft lenses for at least ten days or use gas permeable lenses for three weeks prior to treatment.

During Surgery

LASIK is an ambulatory procedure; you walk into the surgery center, have the procedure, and walk out again. In fact, the actual surgery usually takes less than a minute, and you're awake the whole time. Occasionally, a mild oral sedative is given beforehand.

Most people don't feel pain during LASIK surgery. Your eyes are first anesthetized with special drops ensuring that the patient feels absolutely no pain during the procedure. The doctor will have you lie down, then make sure your eye is positioned directly under the laser. (One eye is operated on at a time.) A kind of retainer is placed over your eye to keep your eyelids open -- normally, this is not uncomfortable. It has a suction ring that keeps your eye pressurized, important in LASIK for allowing the surgeon to cut the corneal flap. The surgeon will use an ink marker to mark where the flap should be placed. The cut is then made with the keratome. During the procedure you won't actually see the creation of the flap, which is very thin.

The doctor uses a computer to adjust the laser for your particular prescription. The laser ‘locks‘ onto the eye during the procedure so that the treatment ώs not disrupted, eve if the patient moves the eye. You will be asked to look at a target light for a short time while he or she watches your eye through a microscope to make sure it remains in the correct position while the laser sends pulses of light to your cornea that painlessly remove the tissue. The higher your prescription, the more time the surgery will take.

Different types of corrective eye surgery require different kinds of post-operative treatment, because each procedure has its own healing issues and potential side effects.

What is true for all surgery is that you follow your doctor's instructions to the letter! Get proper rest, don't drive if you're not supposed to, fill and use any necessary prescriptions, and call your doctor immediately if you suspect a problem. What occurs after the surgery can affect your vision just as much as the surgery itself.

What Happens Right After Laser Eye Surgery?

After resting, you can go home, where you should relax for at least a few hours. Someone else must drive you home. You may be able to go to work the next day, but many doctors advise a couple of days of rest instead. They also recommend no strenuous exercise for up to a week, since this can traumatize the eye and affect healing.

The corneal flap should re-adhere to the eye right after LASIK (Your doctor will check this.) You shouldn't rub your eye, but if you accidentally do, the chance of dislodging the flap is low. The day after surgery, patients also return to the clinic for a follow-up examination

Longer Term

If you had PRK, avoid rubbing your eye for a much longer time (your doctor will tell you how long). In fact, you will be examined just about every day to make sure the epithelium is healing properly. You will probably wear a special "bandage" contact lens, use antibiotic drops for a few days, and apply anti-inflammatory drops for several weeks.

With LASIK surgery, you will probably notice improved vision right away; some people see their vision gradually improve even more over the next few days or even months. On a rare occasion, people will experience improvement, then notice a gradual worsening of vision (called "regression"). If this happens, you'll want to discuss it with your surgeon to determine if more surgery (referred to as enhancements or "touch-ups") will be necessary.

Most people achieve 20/20 or better vision with LASIK and PRK. Some may achieve only 20/40 or not quite as good. They may still need glasses or contact lenses, though their prescription level will be much lower than before.

Post-operative complications can include infection and/or night glare (starbursts or halos that are most noticeable when you're viewing lights at night).

Even if you see perfectly after laser eye surgery, or another type of corrective eye surgery, you may still need reading glasses or bifocal contact lenses once you hit your 40s. This is because your eyes will continue to change as you age, and no one can avoid presbyopia, which occurs when the crystalline lens in your eye becomes stiffer. Your distance vision will probably remain crisp, but seeing up close will be more difficult. However, researchers are studying ways to correct presbyopia surgically, so it is possible that you could have one of those procedures later, once they are FDA-approved.

All of these are important topics to discuss with your surgeon before deciding on the surgery.