Everything You Must Know Before Getting Laser Eye Surgery

Transcription

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2 Everything You Must Know Before Getting Laser Eye Surgery Copyright 2011 by Blackshirt Publishing. All rights reserved. No part of this book may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or by any information storage and retrieval system, without written permission from the author, except for the inclusion of brief quotations in a review. Printed in the United States of America For more information, visit:

3 LEGAL NOTICES The information presented herein represents the view of the author as of the date of publication. Because of the rate with which conditions change, the author reserve the right to alter and update his opinion based on the new conditions. This book is for informational purposes only. While every attempt has been made to verify the information provided in this book, neither the authors nor their affiliates/partners assume any responsibility for errors, inaccuracies or omissions. Any slights of people or organizations are unintentional. You should be aware of any laws which govern business transactions or other business practices in your country and state. Any reference to any person or business whether living or dead is purely coincidental. Every effort has been made to accurately represent this product and its potential. Examples in these materials are not to be interpreted as a promise or guarantee of earnings. Earning potential is entirely dependent on the person using our product, ideas and techniques. We do not purport this as a get rich scheme. Your level of success in attaining the results claimed in our materials depends on the time you devote to the program, ideas and techniques mentioned your finances, knowledge and various skills. Since these factors differ according to individuals, we cannot guarantee your success or income level. Nor are we responsible for any of your actions. Any and all forward looking statements here or on any of our sales material are intended to express our opinion of earnings potential. Many factors will be important in determining your actual results and no guarantees are made that you will achieve results similar to ours or anybody else s, in fact no guarantees are made that you will achieve any results from our ideas and techniques in our material.

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5 Table of Contents LEGAL NOTICES... 2 Introduction... 7 What is LASIK Eye Surgery?... 9 The Different Types of LASIK Eye Surgery Alternatives to Laser Eye Surgery How to Find a Good Laser Eye Surgeon Questions to Ask a Laser Eye Surgeon Who s a Good Candidate for Laser Eye Surgery What Happens Before, During, and After Surgery? The Risks Associated with Laser Eye Surgery The Cost of Laser Eye Surgery Common Laser Eye Surgery Questions Checklist: Questions to Ask a Laser Eye Surgeon Conclusion Recommended Resources... 61

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7 Introduction If you wear glasses or contact lenses to correct your vision, then you may have considered laser eye surgery in the past, or have at least heard of it. Laser eye surgery used to be considered something that was quite experimental, and expensive, and something that only risk-takers and well-doers have actually gone through with. Today, just about anyone can afford laser eye surgery, and it s considered to be a very common procedure. Still, it s a person s eyes and it s surgery so, there s always bound to be some level of concern and anxiety. Even more, it s laser surgery which people may have heard about, but aren t exactly all that certain what it means or how it works. There s a lot to consider and so, there are also a lot of questions. Is there more than one kind of laser eye surgery? How much does it cost? Is it painful? Who s a good candidate? And probably most importantly: does it work? All of these are very fair questions regarding laser eye surgery and are just a few of the things that people think about when they first consider having the surgery. [7]

8 This report will go through everything regarding laser eye surgery from the different types, to who qualifies for it, how it works, how to find a good eye laser surgeon, and all those questions you have regarding the surgery. There s a lot to know and you want to make sure that no detail goes overlooked. [8]

9 What is LASIK Eye Surgery? Although LASIK eye surgery has become a popular term in the last few years, few people seem to actually know what the surgery entails or how it helps, unless they ve been through it themselves. Many people think it s a simple matter of your eye being cut with a laser in order to correct your vision. While that s true, LASIK eye surgery is a bit more complicated than that. LASIK eye surgery can correct vision in those who are nearsighted, farsighted, or suffer from astigmatism. The surgery for each condition involves the surgeon creating a small flap in the cornea by using a microkeratome blade or a femtosecond laser. The surgeon will then fold back the flap so that they can remove some of the tissue of the cornea using an excimer laser. People who are nearsighted have a cornea that is too steep and so some of the tissue will be cut to flatten the cornea out. Those who are farsighted have the opposite problem, wherein their cornea is too flat and so cuts must be made in order to make it steeper. Corneas in those who suffer from astigmatism are generally misshaped and so cutting them can make them a more regular shape. [9]

10 If you think that you might be interested in LASIK eye surgery, there are many steps that you ll need to take before any surgery is actually done. The first is to find a good LASIK eye surgeon. This doctor will be able to examine you and your eyes and tell you what kind of a prescription is needed, how much of the cornea needs to be removed, and whether or not you re a good candidate for LASIK eye surgery. Even if you re not, they may be able to recommend different types of laser eye surgery that may work for your situation. LASIK eye surgery can be done on an out-patient basis and the surgery itself usually only lasts for about five minutes. During the entire surgery, you ll be asked to stare at a target light while a laser makes the necessary incisions, which are painless. But that s really just putting it into a nutshell what LASIK eye surgery really entails. There s a lot to know and if you re considering it, it s important that you look into all aspects of the surgery fully before making your decision. [10]

11 The Different Types of LASIK Eye Surgery When you choose to go through with LASIK eye surgery, it s not a simple matter of just making the decision and getting the surgery done. You and your surgeon will need to decide what kind of surgery you re going to get. There are many different types and even if you decide that laser surgery isn t for you, there are still a number of alternative surgeries to laser eye surgery. Corneal Onlays/Inlays This type of surgery involves placing a coating over your eye to blend with the surface of your eye, and many say that it s going to be the most popular type of eye surgery, replacing several others, over the next several years. The coating that is placed over the eye is made from biocompatible materials and alters the way that light enters into the eye, which is what other types of eye laser surgery do. However, this type is thought to be better than implantable lenses because they are not placed behind the cornea; and it s also thought to have fewer risks than traditional LASIK and PRK procedures because no tissue is actually removed from the cornea. [11]

12 A Kamra corneal onlay, which used to be known as the ACI 7000, is a type of corneal inlay that focuses on near vision caused by aging, a condition that s known as presbyopia. A small incision is first made on the surface of the eye where the inlay is placed. The flap is then placed back in order to hold the inlay in place. This procedure only takes about fifteen minutes and can be done right in the surgeon s office. There are no stitches or sutures required, although treatment in the form of eye drops does need to be taken afterward. The Vue+ is another type of corneal inlay that is used in this type of procedure. This product comes out of Mexico and still has yet to be approved by the FDA, although it has shown very promising results. This inlay is also used in a thin flap, although it s also often placed in a pocket; and it focuses on treating near or intermediate vision. One of the major advantages that all cornea inlays and onlays have over other forms of eye laser surgery is that it is reversible. Custom LASIK or Wavefront LASIK A custom LASIK procedure starts with a measurement of the eye s ability to focus light rays being taken. In order to obtain [12]

13 this measurement, an eye surgeon will send a safe ray of light into the eye using a wavefront device. The light hits the retina and is reflected back through the pupil, into the device, which then gives an accurate measurement of how well the eye is able to focus light rays. From this measurement, the wavefront technology will create a 3D map that shows what problems the eye is having in processing images. From these images, the map will guide the laser into reshaping the cornea in order to correct its imperfections. Custom LASIK eye surgery is extremely precise and allows for the correction of many vision problems that eyeglasses or contact lenses would never be able to correct. Wavefront technology is not only credited for helping how well people see, but also how much they see. This means that it not only helps you achieve 20/20 vision, but also helps with things such as contract clarity, and the actual quality of your sight. Having your quality of vision is an obvious benefit, but being able to pick up these elements of vision also reduces the risk of other LASIK surgeries such as glare, the halo effect, and difficulty with night vision. One of the biggest drawbacks to custom LASIK surgery is that it s quite expensive. This isn t just because it s a custom surgery that uses the latest technology, but also because all [13]

14 eye surgeons need to pay a royalty fee to the manufacturer of the device every time they use it. Epi-LASIK Epi-LASIK is also another newer form of laser eye surgery and it was created in order to solve some of the potential problems of the initial forms of laser surgery. One of those initial, and still very popular, types is LASIK surgery. During this procedure, the surgeon cuts a small epithelial flap. Once the flap is cut, an excimer laser will be used to shape the cornea. Then, a spatula tool is used to place the epithelial flap back. Lastly, the eye surgeon will place a contact lens over the eye so that the epithelial flap can grow back normally. While this is still a fairly precise procedure, in LASIK surgery there is still the risk of the surgeon cutting the cornea too thickly, while there is not that risk with Epi-LASIK surgery. Epi- LASIK surgery also addresses some of the other issues that come with LASEK eye surgery. The first of those issues is the sharp blade that s used in traditional LASEK surgery. Epi-LASIK surgery uses a blunt, plastic blade that oscillates that not only has smaller room for error, but also gives the surgeon more flexibility with the blade. [14]

15 Epi-LASIK surgery also doesn t use alcohol to separate the thin sheet from the cornea, but a plastic blade. This is a better solution as alcohol kills the cells that are in the epithelial flap. Many surgeons today however are using alcohol even in Epi- LASIK surgery. Studies have shown that this doesn t cause any pain during the procedure or after treatment. Epi-LASIK eye surgery is most recommended for those that have corneas that are not steep enough. This is because the procedure makes it very difficult for the surgeon to get to the cornea enough in order to flatten it. About three days after the surgery, the epithelial flap has usually grown back and the contact lenses can be removed. Driving is also usually not allowed for about a week after Epi- LASIK surgery. Vision also may not be perfect as soon as the lenses come off. Many patients experience 20/40 vision after surgery, while a few even have 20/20 vision as soon as the lenses come off. However, it can take as long as three to six months to experience the full effects of the surgery. It s important to note that treatment time for traditional LASEK surgery is not as long; you can usually drive the next day; and better results are achieved more quickly. [15]

16 Bladeless LASIK The term for this surgery pretty much sums up what separates it from the other types of LASIK surgery: it doesn t use any blades. Instead lasers are used to make the necessary corrections to the cornea. First with bladeless LASIK a femtosecond laser is used to direct laser energy to create the necessary flap in the cornea. This laser energy will then reshape the cornea in the manner needed. Then a second laser, the excimer laser, is directed towards the tissue in the eye that is now freshly exposed so that the cornea can be reshaped. The biggest advantage that bladeless LASIK eye surgery has over other forms of LASEK and laser eye surgery is that it has fewer risks, such as scarring that can cause ongoing vision problems. Another huge benefit to bladeless LASIK surgery is that it opens up the world of laser eye surgery to those who once weren t considered good candidates for it, such as those with thin corneas. Because of the precision and the safety that bladeless LASIK carries with it, it makes laser eye surgery accessible to everyone. The downside to it however, is that it s usually far more costly than other types of laser surgery. [16]

17 Recovery from bladeless LASIK eye surgery is very similar to recovery from traditional LASIK surgery. Many patients report feeling eye irritation for up to two days, but this is normal with many different types of eye laser surgery. However, studies have also shown that bladeless LASIK surgery may also reduce chronic dry eyes, which is very common with any kind of laser eye surgery. LASEK LASEK surgery still makes the small flap along the cornea however it makes a much smaller cut. This type of surgery is usually used when the diameter of the cornea is too thick to have a flap made in it with LASIK surgery. Another difference between LASIK surgery and LASEK is that the former uses a laser to make the flap while LASEK uses a special cutting tool known as a trephine. A laser eye surgeon will use a local anaesthetic before cutting the epithelium, which is the surface of the cornea. They will make this incision using the trephine. Once the cut is made, it can then be soaked with alcohol which will loosen the edges of the epithelium; it only needs to be soaked with alcohol for about thirty seconds and does not cause any pain. Once the epithelium has loosened, the surgeon will then peel it back and use an excimer laser to reshape the cornea. The epithelial flap is then gently placed back with a spatula-like tool. [17]

18 It s thought that recovery time from LASEK surgery is slower than recovery time for LASIK; and the full effects of the surgery may not be felt for four to seven days after the surgery. Recovery from LASEK surgery has been said to be a bit more painful than LASIK surgery, which may account for the irritability some patients feel for the first day or two after surgery. The flap usually heals within a day after the surgery but a protective contact lens is worn for four days to keep the eye protected. PresbyLASIK PresbyLASIK surgery is an exciting type of laser surgery that hasn t yet been FDA-approved. It has however had many clinical trials performed on it, and it s been used in countries around the world for the past several years; both have shown very positive outcomes of PresbyLASIK. This procedure works by changing the way light enters the eye in many different areas along the surface of the eye. By doing this, it can change the way in which a person sees. For example, ask a person if they can see distances or things closeup and they likely won t hesitate to tell you. PresbyLASIK changes that, allowing people to see in many different light zones. This eliminates the need for things like bifocals or reading glasses. [18]

19 One of the things that is holding up FDA approval with this surgery is the fact that it hasn t yet been proven to be reversible. In addition, there do seem to be a few risks that come with this surgery. One of those is blurriness, which may not go away even several months after surgery; reduced contrast sensitivity which will cause things such as halos around light. This reduced contrast sensitivity is said to likely go away, but still not until three or six months after the surgery is performed. PRK PRK was the original laser surgery and remained the most common type until LASIK came along and provided a safer option. This surgery uses an excimer laser that emits an ultraviolet beam to remove small pieces of the cornea. Before the surgery, the surgeon will fully examine your eye to see how much of laser ablation is required. To do this, a corneal topographer will take a map of the surface of the cornea. This map will clearly outline any imperfections in the cornea and the flatness or steepness of it that the eye surgeon will need to correct. A PRK procedure is done on an out-patient basis and only takes a few minutes. Generally the patient is awake the entire time but sometimes the surgeon may choose to give a mild sedative beforehand. Drops will be used in the eyes as a local [19]

20 anaesthetic so there is no pain during the procedure. Normally the patient will need to lie down with their eye placed directly underneath the laser. A retainer may be used to keep the patient s eyelid open and prevent blinking but this doesn t cause any discomfort to the patient. Once the procedure starts, the eye surgeon will begin by using a computer to determine what kind of prescription you need. Once they ve established that, you will need to look at a target light during the entire procedure. Remember that it only takes a few minutes so this also isn t difficult. It s also important to remember that continuing to look at this target light is very important to get the best results. If you are having both eyes done on the same day, only one will be worked on at a time. After one eye is finished, the surgeon will probably ask you to rest for a few minutes before starting on the other eye. Many people choose to do only one eye one day and then do the other eye a week or so later. The results for PRK surgery and LASIK eye surgery are very similar. However, the recovery time with PRK is much longer and there is more risk with PRK surgery than there is with LASIK. [20]

21 Alternatives to Laser Eye Surgery If you research all the different kinds of laser eye surgery and still find that there s not one that seems to be suitable for you, you re not without hope. There are a few alternatives that can be used instead of laser eye surgery, and they can have many desirable results as well. Conductive Keratoplasty Conductive keratoplasty is a procedure that helps those who are aging and have developed mild hyperopia. It s designed to correct vision in those that need reading glasses and instead of a laser it uses low-energy radio waves to reshape the cornea. These low-energy radio waves are applied to the surface of the cornea in a circular pattern and with a small handheld probe that the surgeon will use. The probe is so small it s no bigger than a human hair! These radio waves will then cause the connective tissue around it to shrink. When that happens, it will then tighten the cornea to make it steeper, much like how a belt can narrow a waist. Once the cornea has been reshaped this way it will allow light to enter into the eye in different ways and places, and will restore near vision. [21]

22 Unlike laser surgery, conductive keratoplasty doesn t remove any tissue from the eye. And because there are no incisions made, there are fewer chances of complications such as infection to set in. Those who are a good candidate for conductive keratoplasty are: those who are over the age of 40; have been able to see distances well your entire life but now have trouble reading; and those who can live with slight distance blur. The procedure can be done in an ophthalmologist s office. First some anaesthetic eye drops will be placed into your eye and a speculum will be used to keep your eye open during the entire procedure. The surgeon will then begin the procedure by placing a dye in the eye that can be rinsed away. This dye will apply dots to the eye to indicate where the probe should be placed. Once the low-frequency radio probe has applied the frequency, the procedure is over. It s painless for the patient, although many have reported that they have felt slight pressure on the eye during the surgery. One of the advantages conductive keratoplasty has over some types of laser eye surgery is that both eyes can be worked on at both times. Also, there is virtually no recovery time needed and the patient is back on their feet right after the procedure. Some patients do need to wear contact lenses for a few days afterward to protect their eye, and eye drops are usually [22]

23 prescribed to reduce the risk of infection and inflammation. The feeling that there s a piece of dirt or dust trapped in the eye is also very common after conductive keratoplasty surgery. Refractive Lens Exchange This procedure focuses on the lens of the eye, rather than the cornea and it s mostly used for older people, although there are some instances where it is beneficial to younger people as well. This procedure removes the natural lens from the eye and replaces an artificial lens in the area where the natural lens once was. This type of surgery is good for people who have problems with their lenses, or who think that they will have problems in the future with their lenses. Older people are the typical patient for this type of surgery because it s often used to replace lenses that already have cataracts forming in them. While they may not be a problem currently, cataracts can develop significantly and can cause vision problems in the people who have them. Although this surgery is very common and widely performed, it s still not yet approved by the FDA. [23]

24 Implantable Lenses Implantable lenses are becoming very popular for people who suffer from nearsightedness and who want a more permanent option for vision treatment. The implants look very much like contact lenses and they are located in one of two places: between the cornea and the iris; or just behind the iris. Implantable lenses are very comfortable to wear and most patients can t even feel them and they are similar to the artificial lenses that are used in cataract surgery. Patients who have thin corneas and aren t a viable candidate for other types of laser eye surgery are good candidates for implantable lenses; and it s said that this type of surgery can often even be more effective than LASIK. Most patients feel very comfortable after the procedure, although some do feel a slight scratchiness. Usually resting at home the day of the surgery is recommended by the surgeon and a follow-up appointment is needed the next day. However, there are some risks involved with implantable lenses as well. Some of these are: a chance of the retina detaching; losing cells in the thin layer inside the cornea; as well as inflammation, infection, and cataracts. [24]

25 Another huge advantage that implantable lenses have over LASIK eye surgery is that it s reversible. If the surgery doesn t work out, the lens can simply be taken out. [25]

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27 How to Find a Good Laser Eye Surgeon A good eye laser surgeon is the most important part of any laser eye surgery. It s been proven that the rate of complications after laser eye surgery decreases when the surgeon has a lot of experience in doing these types of surgeries. And having a laser eye surgery go wrong can greatly, and negatively, affect your life. Fortunately, finding a good laser eye surgeon isn t difficult as long as you know what to look for, and you ask a lot of questions. Credentials to Look for in a Good Laser Eye Surgeon There are three main areas that you can check to make sure that any laser eye surgeon you re considering is competent, capable and qualified. These are: their licensing, they re certification, and their ACS membership. Each state will have a licensing board and when a laser eye surgeon is licensed with the state it shows that the surgeon has the knowledge and skill that they claim they do. Any surgeon you re going to use for anything must be licensed with the state! [27]

28 Second to licensing requirements are board certifications. This is a certification that extends past just a general license and shows that the surgery is qualified to specialize in their particular field. The American Board of Ophthalmology is the board certification you should look for when choosing a good laser eye surgeon. Checking to see if the laser eye surgeon is a member of The American College of Surgeons (ACS) is the final credential you should look at when you trying to choose a laser eye surgeon. The ACS upholds standards of ethics and conduct for all its members and they also require that all of their members are board-certified. If you can only look for one of the three professional credentials, this is the one that s most important. Not only is the ACS the most difficult of these three credentials to obtain, but this institution is also highly committed to developing and advancing the world of surgery eye surgery included. Who to ask about a Good Laser Eye Surgeon It s your eyes and your health, and you definitely don t want to leave choosing your surgeon up to a random Yellow Pages draw. Just as though you were trying to find a surgeon of any other kind, you ll want to start by collecting a few names and then investigating each of those names further until you find [28]

29 the surgeon you are comfortable with. There are a few places you can start your search for names. The first person you should ask for an eye surgeon referral is your regular eye doctor. They will know a lot of names that are practicing in the area, and will have some inside knowledge on which surgeons would be better for you. Another good professional to ask is an eye laser surgeon that you know is very good and very reputable in another state. Call them and ask if they know a good laser eye surgeon in your area; you might get one or two more names to add to your list. Also, if you know a good laser eye surgeon, but they don t perform the type of surgery you want or need, ask them if they have a specific surgeon who might be good for you. Of course, if you have any friends or know anyone that has had laser eye surgery, you certainly want to ask them who their surgeon was, if the surgery was effective, if they had complications afterwards, and how happy they were with their surgeon. Lastly, you can always try surgeons that you ve heard advertised on the radio, or seen on television. Many surgeons and clinics advertise their services through popular media although admittedly, it is some more than others. [29]

30 Don t pay attention to any kind of special or package they re advertising; that shouldn t be your biggest priority when looking for a good laser eye surgeon. But it might give you another name to go on if you re really having trouble finding laser eye surgeons in your area. [30]

31 Questions to Ask a Laser Eye Surgeon Once you ve compiled your list of names of laser eye surgeons, you then need to compile a separate list of questions to ask them. These questions are vital! They will give you an inside look at the surgeon, their practices, and their office policies. These questions will also give you a better idea of what surgeons are better qualified and better skilled to perform your laser eye surgery. Here is a list of questions that will get you started when you start talking to different laser eye surgeons. How many surgeries have you done? It can t be stressed enough experience is everything when it comes to laser eye surgery. Make sure any surgeon can tell you how many surgeries they ve done, and what type of surgery they ve performed the most. They should have performed at least 250 in the past twelve months. And when it comes to the type of laser eye surgery you re getting done specifically, they should have performed at least 100 within the last twelve months. [31]

32 How many people, on average, in a year do you decline for laser eye surgery? There is no real percentage or even correct answer in this case. But you should walk away from any surgeon that says they don t turn anyone away. This indicates that they re mostly interested in making money from performing surgeries, and that they re not actually looking out for the patient s best interests. Will you use wavefront technology to diagnose what corrective surgery I need? This answer should be an absolute yes but remember that this refers to the technology that is used to diagnose your vision problems, and not correct them. Therefore you shouldn t expect the surgeon to use wavefront technology when they re performing the surgery, only when they re trying to diagnose your problem. Custom laser eye surgery is the only type of surgery that will use the actual wavefront technology to reshape your cornea. It s also important to remember that not all surgeons have this technology available in their offices, even just to diagnose the problem. However, they should be willing to send you to another location, at your expense, to get the diagnosing done. [32]

33 Will you do a contrast sensitivity test before and after the procedure? Most surgeons don t perform this test because it s not required and not standard procedure. However, a good surgeon will perform this test, even if they don t have the equipment to do so right in their office. Again, it s expensive and not many surgeons have it readily available. They should be able to set up an appointment for you though, at your expense, at another location. Will you measure the thickness of my cornea before a decision about surgery is made? This is a very important question because the thickness of your cornea could ultimately determine what kind of laser eye surgery you get done. Make sure that any surgeon you re considering can answer yes to this question. How many of your patients have 20/40 vision after the procedure? This should be about 90%. If your doctor claims that their percentage is higher, ask to see something that proves that. [33]

34 How many of your patients have 20/20 vision after the procedure? In this case, about 65% is considered the average. Again, if the surgeon claims that it s higher, ask again to see proof. What is your complication rate? Is it much higher or lower than the national average? Instead of just asking the general question of how many of their surgeries are successes, specifically ask what their complication rate is any good eye surgeon should be able to tell you this. Also, they should be able to tell you what the national average is, and how their complication rate compares. As of 2011, the complication rate for laser eye surgery was 3% Do you perform the surgery right in your office, or at another location? Many eye surgeons perform laser eye surgery right in their office. But it s not a bad sign if a surgeon wants to meet you at a hospital or health clinic to have the surgery done. Many surgeons also have hospital rights at many nearby institutions and use their facilities. However, it is good to know in case the surgeon only performs procedures at a place that is too far away, or where you don t want to get your procedure done. [34]

35 Has your office (or other clinic) ever had an outbreak of eye infections? A surgeon who has seen an outbreak of eye infections in their practice could be using equipment that s not entirely clean. Therefore, the infection remains on the equipment, is then used on another patient, and the infection is passed on. Whatever caused the outbreak, it s a very good indication that the office may be unhygienic. And while there may be a good reason for it and you may not want to base your decision on this alone, it may be a good warning signal and cause you to pay closer attention to other details. What will my vision be like in the weeks following surgery? Any good eye surgeon should be able to give you a complete breakdown on what you can expect your vision to be like following surgery. They should explain any discomfort you might have, what your vision will be like immediately after the surgery, and when you can expect to see the full effects of the surgery. How long is the recovery period? It s true that laser eye surgery is a minor, common procedure that doesn t take a very long time to recover from. However, [35]

36 any surgeon who tells you that you ll be up and at em an hour after your surgery should be avoided. There is still a slight recovery time and you should make sure you rest for a day or two after having the surgery. What happens if a complication arises after my surgery? Although no one wants to think about it, there is that three percent complication rate and you might be one of them! You need to know you will be properly taken care of if there are complications after your surgery and that you won t be charged for a surgeon s mistakes. When enhancements are needed, is there an extra charge? Some eye surgeons will charge for enhancements that are needed due to complications after surgery, and some won t. Either way, you need to know if there are fees and if so, what they are. [36]

37 What is your cut-off date for enhancement done after surgery? When surgeons don t charge an additional fee for enhancements, they will typically have a cut-off date. This date may be one month, one year, or another specified time after your surgery. Any enhancements made before this date will be free; enhancements made after will not be. Will you complete a full examination of my eyes both before and after surgery? You want to make sure that you re not only getting a surgeon who will take great care with your eyes before the procedure, but afterwards too. How often will you examine my eyes after surgery? The next day is an absolute must! After that the surgeon may want to check back with you at the one week and one month mark. And if you need more treatment or further monitoring after that time, a good surgeon will also make sure that you get it. [37]

38 Can I get the names of four past patients of yours who have had the same exact surgery I m having? Can I contact them? You need references! Of course you may have already gotten your own at this point but it s important that a laser eye surgeon has a list of names at the ready that they can give you to prove that they ve performed this surgery many times in the past and most importantly, that their patients were happy with the results. [38]

39 Who s a Good Candidate for Laser Eye Surgery Even though different types of laser eye surgeries will each have their own qualifications regarding who will make a good candidate, there are a few qualifications that pertain to all different types of laser eye surgery. If you re considering having laser eye surgery of any type done, looking at these qualifications and asking yourself if you fill them, is a good place to start. Eyes must be in good general health Although laser eye surgery is being done to correct vision problems in the eye, eyes must still be in general good health before laser eye surgery can be done. If there are any conditions of the eye, such as chronic dry eye, this would rule out laser eye surgery. Cataracts and glaucoma are also two conditions that would make one an unsuitable candidate for laser eye surgery. Must be an adult Most states, hospitals, clinics, and doctor s offices require that an individual be an adult before laser eye surgery is [39]

40 performed. In some cases this is 18, and in others it s 21. Procedures are sometimes done on people younger than that but these are exceptions and are usually due to very special circumstances. Must have a steady prescription for at least one year Surgeons need to know what the problem is, and what it s going to be over the coming years. The eyes and prescription of young people and teenagers is constantly changing and so, it s hard to get an accurate diagnosis of what their prescription for laser eye surgery should be. Usually surgeons like to wait until a person has had one prescription for at least one year until they consider laser eye surgery. You should not be pregnant The hormones that are coursing through the system during pregnancy cause many physical changes in a person; one of those is a change in the shape of the cornea. Because of this, it may cause slight vision problems. However, these problems will probably go away on their own three to six months after birth, when the hormones are in balance once again. Another reason why it s not a good idea to get laser eye surgery done while you re pregnant is due to the medications that are used [40]

41 before, during and after the procedure. These medications sometimes contain chemicals that could be harmful to an unborn baby, or a newborn that s nursing. You should not have degenerative or autoimmune diseases The body does need to be able to heal itself, and do so relatively quickly after the surgery and degenerative or autoimmune diseases prohibit this from happening. Rheumatoid arthritis, AIDS, HIV, and type 1 diabetes are some of the conditions that are automatic disqualifiers for laser eye surgery. You should not have a severe prescription When people have a severe case of nearsightedness, it requires removing too much of the cornea in laser eye surgery in order for it to be effective. For this reason, people who have a very high prescription may be deemed an unsuitable candidate for laser eye surgery. [41]

42 [42]

43 What Happens Before, During, and After Laser Eye Surgery? When people first consider laser eye surgery, they re often hesitant simply because they don t know what will happen. Fear of the unknown is a given in any surgery on the eyes or anywhere else. Knowing what will happen before, during, and after your laser eye surgery can be a great help, and can help you determine whether or not laser eye surgery is for you. Before Laser Eye Surgery Before anything is done, a full examination will be done on the eyes. The eye surgeon will look to see if the eyes are healthy; how much of the cornea needs to be reshaped, and how big of a laser prescription will be needed. During this examination the surgeon will also look to see if there is any presence of chronic dry eye syndrome. If there is, this will need to be treated before laser eye surgery is performed. Getting a corneal topography of your eye is probably going to be done if the surgeon finds that your eyes are in good condition for laser eye surgery. This involves using wavefront [43]

44 technology that is used in custom LASIK. This creates a map of your cornea and shows the surgeon where exactly the corrections need to be made. Lastly, the surgeon will take to you about your general health and about any medications you re taking. Some medications may interfere with laser eye surgery and with some, you may have to wait until you ve stopped taking the medication. During Laser Eye Surgery Laser eye surgery, of pretty much any type, is an outpatient procedure. You ll show up at your appointment at the surgeon s office, have the surgery, and be on your way anywhere from five to fifteen minutes later. You should have someone take you to the appointment that can also drive you home, as you will be unable to do this yourself afterwards. Because you will be awake the entire time, the surgeon may begin by giving you a mild sedative. Drops containing a local anaesthetic will also be applied to the eye so that you don t feel any pain or discomfort during the surgery. You will then lie down flat with one eye positioned directly underneath a laser. [44]

45 A device will be placed on your eye to keep it open during the entire procedure and this isn t usually uncomfortable either. A target light will be turned on and you ll be asked to look at this light throughout the entire procedure. Depending on the type of laser eye surgery being performed, the surgeon will then make his flap, pocket, or marks along the cornea. While the laser is making its incision, you will hear a rapid clicking noise and may even smell something unpleasant. This is normal, and nothing to worry about. It s also important to remember that your surgeon has complete control over the laser during the entire procedure. If you feel uncomfortable at any point, you can tell them and they ll switch it off and make you more comfortable. After Laser Eye Surgery The surgeon may prescribe an over-the-counter medication for pain afterwards but generally no painkillers are needed. However, it s important to remember to strictly follow every post-operative instruction that your surgeon gives you. Getting plenty of rest is important after laser eye surgery and taking all medication properly and as instructed is equally important. As well, always make sure that you let your [45]

46 surgeon know immediately if you have any problems or extreme pain after eye laser surgery. Once you get home, you should rest for at least a few hours. Sometimes you may be able to go back to work the next day but often surgeons will recommend that you take one or two days off after laser eye surgery. Usually it s also recommended that no heavy lifting or excessive exercise is done for up to a week after surgery, as this can tear the delicate corneal flap and cause complications. You should also avoid rubbing your eye, as this can also cause the corneal flap to come loose. [46]

47 The Risks Associated with Laser Eye Surgery Most people respond very well to laser eye surgery but, it is still surgery and in most cases, a part of your is still being cut. Because of this, there s always a chance of complication. The very nature of laser eye surgery also lends itself to have the potential for problems after the procedure. The most serious complications that are known to happen after laser eye surgery are chronic dry eye, the flap that s made during LASIK surgery becoming loose or shifting. and infection of the area, although this is very rare. Less severe complications that arise from laser eye surgery are the halo effect and glare. The halo effect is when a person can see a reflected glow of light around another source of light, such as a street lamp. This is most likely to occur at night. Glare can also be quite bad for a person after laser eye surgery, causing them to squint and for everything to seem too bright. Both of these side effects are quite common and are likely to clear up on their own, as the surgery site heals. [47]

48 Dry Eyes Dry eyes is so common after LASIK eye surgery that it s seen in about half the patients that get it. The condition is generally pretty mild but some have been known to complain of the problem months or even years after their surgery. It s important to note too, that most people who get LASIK eye surgery already suffer from some degree of dry eyes. Dry eyes after LASIK eye surgery is caused when the nerves in the cornea become numbed and can no longer function after the procedure. Because of this, they cannot send signals that they need lubrication, so the cornea never really gets as much lubrication and moisture as it needs. Therefore, the eyes are constantly dry. Dry eyes can be itchy and are irritating to the person who suffers from them. But more dangerously, they can also cause vision problems. Because of this, surgeons usually give eye drops to their patients so that they can receive the proper amount of lubrication. Severely dry eyes will be diagnosed upon the initial consultation and evaluation. If a surgeon thinks that a person s eyes are already too dry, they may recommend other forms of eye surgery, such as PRK that don t require a thin flap being created on the cornea. [48]

49 Contact Lenses Even though laser eye surgery is successful in most people, there are sometimes small complications. However, for just about every complication there is a treatment that can correct it. This is such the case in contact lenses after laser eye surgery. Sometimes after surgery, there are small bits of tissue left on the cornea. This reshapes the cornea improperly and therefore, a followup surgery may be recommended. However, many patients have a cornea that is too thin for a follow-up surgery and in these cases contact lenses are a great solution. Other times, the initial surgery simply wasn t enough to correct the vision to an acceptable standard and so, eyeglasses or contact lenses are needed. Choosing the specific type of contact lens that s typically prescribed after laser eye surgery will allow the patient to have better patient than they would with glasses or other types of contact lenses. Contact lenses that are made for post-laser eye surgery are gas permeable and are hard. This allows them to maintain their shape on the surface of the eye, which results in better vision. [49]

50 Follow-Up Surgery after LASIK It may be the last thing any LASIK eye surgery patient wants to think about but sometimes things go wrong and a follow-up surgery is needed after LASIK eye surgery. But whether it s a small complication or just a matter of you being unhappy with the results, follow-up surgery takes only seconds and really isn t a big deal at all. It too happens right in the surgeon s office and the surgery is usually identical, or close to, the first procedure. The only difference between the first procedure and the follow-up surgery is that when the corneal flap is lifted, an excimer laser will be used to reshape the cornea. [50]

51 The Cost of Laser Eye Surgery Laser eye surgery is considered an elective surgery and as such it tends to have higher costs and less coverage than other surgeries. The cost of the surgery will vary from provider to provider but each will always provide a quote based on one eye. This is important to know, especially if you re having both eyes done on the same day. It s also important to know that when special technology is used, such as bladeless or wavefront technology, the surgeon is most likely going to charge more for this. But even though the prices will vary from surgeon to surgeon, there are some general price guidelines you can go by to understand what a surgeon is charging, and how this compares with what laser eye surgery typically costs. Generally, all-laser based procedures that only have one quote given are in the range of $2,150. Those that use wavefront technology typically cost about $2,170; while those that use non-customized LASIK or excimer lasers that do not use wavefront technology cost well below those that do, costing about $1,580. You should never go with a laser eye surgeon based solely on the fact that they offered the lowest price. This is partly [51]

52 because often, it s a matter of you get what you pay for and you may not be entirely happy with the results. Another reason however, is because some surgeons may advertise an extremely low price for laser surgery and then leave you shocked when you re charged for other parts of the surgery because that price only included one certain element of it. If a price seems too good to be true, it probably is and you should just walk away. However, if you still think that lowest is best, make sure that you get a written estimate that fully outlines what that low cost includes, and what you ll be expected to pay for after the surgery. Laser Eye Surgery Financing Options It s true that laser eye surgery does cost a small fortune but you shouldn t let that stop you from having that wonderful vision you dream of. And you shouldn t think that it s only something that s available to the very wealthy either. There are a few financing options available to you if you re considering laser eye surgery, but don t have thousands of dollars to hand over to a surgeon all at one time. Depending on the financing options you choose, the payments could cost anywhere between $127 and $140. [52]

53 The options you ll have available to you are: financing companies, financing through laser eye surgeons; or financing through flexible spending accounts (FSAs.) Financing Companies There are many health financing companies that specialize in providing loans to finance surgeries such as gastric bypass, braces, or laser eye surgery. Applying to one of these companies to cover your surgery is much like applying for any other loan, in which they ll cover the costs and then you ll make monthly payments with interest until the entire amount of the loan has been paid off. When you re using a financing company to pay for your laser eye surgery, it s important to note that not all surgeons will accept payment from all financing companies. Because of this, it s best to ask the surgeon first for a list of approved financing companies before applying for any financing for your surgery. Financing Through the Surgeon More and more surgeons are starting to offer financing options right through their office. More often than not, this comes in the form of a simple agreement between the surgeon and the patient in which the patient agrees to pay off the amount in a certain period of time, or to make monthly [53]

54 payments of a certain amount. There is usually no interest included with the payments with this type of financing, making it a much better option than using a financing company. Financing through Flexible Spending Accounts Flexible spending accounts (FSAs) are a good, tax-free option that can help you pay for your laser eye surgery, but not everyone is eligible for them. One of these accounts will take a certain portion of your salary every month and deposit it into the FSA account. When it s time for your surgery, just take the money out and don t ever worry about paying a cent in interest. Not everyone has access to an FSA however; they re only available through employer-sponsored benefits that include both eye care and flexible spending accounts. [54]