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LASIK: Is It Right for You?

BY JOANNA GRAY, SOUTHERN HEALTH CONTRIBUTOR

Imagine being so dependent on eyeglasses for clear vision that you would start to take a shower and suddenly realize that you still had your glasses on.

That's exactly what Dr. Ukeme Umana, a refractive surgery specialist and director of the Laser Refractive Institute of the Marion Eye Centers, used to do before having his severe myopia corrected with what was then the new LASIK refractive eye surgery in 1998.

"I wore glasses most of the time," said Umana. "I tried contact lenses, but it was a hassle to take care of them."

"While I was in training for LASIK, I saw that the patients were so ecstatic about the results," said Umana. "I was very impressed with the results, too, so I decided that I wanted LASIK. Plus the fact that if I was going to do this procedure on patients, it would be more credible for me to have had LASIK myself."

Umana is just one of the millions of persons with myopia (nearsightedness), or hyperopia (farsightedness), or astigmatism (having trouble focusing on both near and far objects) who have had their vision problems corrected with Laser-Assisted In Situ Keratomileusis (LASIK) refractive surgery.

Like a modern-day Michelangelo, the LASIK surgeon uses advanced computer-controlled excimer laser technology to reshape the cornea and sculpt it precisely to correct the patient's specific vision problem.

After the patient's eyes are numbed with eye drops, the procedure involves cutting a flap through the epithelium, into the second layer of the cornea, called the stroma, with either a microsurgical instrument or "blade," or with a femtosecond laser in what is called "bladeless" LASIK, depending on which type of procedure the surgeon performs.

The flap is then folded back to expose the inner tissue of the cornea to the computer-guided pulses of the excimer laser, which removes minute portions of the tissue that are thinner than a human hair.

After the laser has reshaped the cornea, the LASIK surgeon puts the flap back into place. No stitches are necessary since the corneal tissue adheres to itself and heals naturally.

Time elapsed: about 30 to 60 seconds per eye for laser time alone. The creation of and repositioning the flap may take several minutes beyond the laser time. The total procedure lasts from between 15 to 20 minutes for both eyes; or 7 to 10 minutes per eye.

The mildly sedated patient feels no pain, but perhaps only a light pressure sensation while the surgeon creates the corneal flap.

"Since you have your own natural tissue as a bandage, there is no pain and vision recovery is almost instantaneous," said Dr. Eric Jones, refractive coordinator at The Eye Surgery Center, Belleville, IL. "That's why LASIK has become so popular."

"Amazing" Results

Introduced in the late 1990s, LASIK was developed primarily as an painless alternative to another refractive surgery called photo refractive keratectomy (PRK), which has an uncomfortable and usually painful post-operative recovery period lasting several days. While PRK and several other types of refractive eye surgeries are still viable alternatives for certain patients, LASIK has emerged as one of the most popular elective surgeries in the United States today.

"Compared to even five or six years ago, LASIK is dramatically different and I think the results are better and more predictable," said Dr. Richard L. Kies of The Kies Eye Center, in Cape Girardeau, MO and Marion, IL. "Consequently, people who have had a 'wait and see' attitude about LASIK over the past few years are now interested."

Two years ago, Carbondale psychotherapist and web design business owner Annette Vaillancourt rekindled her interest in LASIK after a friend raved about the results of her recent procedure over lunch one afternoon.

But Vaillancourt had always believed that her astigmatism, which was corrected by eyeglasses, would disqualify her as a candidate for LASIK. Coincidentally, Vaillancourt had an appointment the next day with her eye doctor, who referred her to Umana at Marion Eye Center for a LASIK screening.

During the screening, Umana thoroughly examined the cornea and measured its thickness using ultrasound images. A topography image or "map" of Vaillancourt's cornea was also taken and printed out to reveal exactly where the excimer laser would remove tissue to correct the astigmatism and myopia.

To her surprise and delight, Vaillancourt was indeed a candidate for LASIK, and she scheduled the surgery for the following week. "The fact that Dr. Umana had LASIK himself increased my confidence in him and the procedure," Vaillancourt said. "That was the biggest selling point for me."

"It was over in just a couple of minutes," Vaillancourt added. "There was no physical pain, but it was a bit uncomfortable for me to not be able to blink, while the beam of the laser was flashing in my eyes."

Immediately after the procedure, Umana asked Vaillancourt to sit up and read the time on the clock across the room. "I could see the clock clearly, which I normally wouldn't have been able to do without my glasses," Vaillancourt said. "It was amazing."

The next day, Vaillancourt continued to marvel at her new 20/20 vision as she drove her car to her post-op follow-up appointment for the first time without wearing glasses.

Vaillancourt continued her post-operative care with another visit to Umana within a week of the surgery, then three months later, and six months later. Now she checks in with Umana once a year.

"The next-day visit is very critical to make sure that the flap is well aligned and free of wrinkles," said Umana.

"In later visits we make sure that no infection has developed beneath the flap, and at some point we dilate the eyes to check the retina because nearsighted persons in particular are naturally prone to retinal detachment, but it's not caused by LASIK. The bottom line is that LASIK patients must follow up on a regular basis after the surgery."

Understanding Risks and Expectations

Prospective patients should also be aware that LASIK is a surgery and despite its successful track record is not 100 percent risk-free.

"LASIK has become a much more routine and predictable procedure, but it's still surgery and there are some risks," said Kies. "Some complications might involve post-operative misalignment of the flap perhaps due to the patient accidentally poking the eye, or inflammation under the flap which can lead to infection."

"But if all of those things are managed, which they generally are with post-op care, then the results of LASIK are usually permanent, stable, and don't change much over the ensuing years."

Kies also noted that a common misconception about LASIK is that the procedure will completely eliminate the need for glasses in all situations. Vaillancourt, 52, for example, still needs reading glasses, as many patients over 40 usually do.

Also, some patients may require a second refractive procedure to enhance the results, as Vaillancourt did to further correct the astigmatism. Lastly, not everyone can expect to achieve 20/20 vision since each individual situation is different.

"Not everyone gets the same results," said Glen Hagele, executive director and founder of the Council for Refractive Surgery Quality Assurance and its patient-information web site, www.USAeyes.org.

"You wouldn't put in a friend's contacts and be able to see well, so neither should you expect to get the same results, good or bad, as a friend did when he or she had LASIK," said Hagele. "Everyone is unique, not only in the physiology of their eyes, but also in what they can expect from refractive surgery. What would be appropriate for one personality, or one particular set of needs, might be inappropriate for another."

Other Refractive Surgery Options

LASIK is not right for everyone, but there are several other refractive surgeries available as options for patients who do not pass the LASIK screening.

According to Dr. Eric Jones of The Eye Surgery Center, PRK and LASEK (laser epithelial keratomileusis) are two of the better-known refractive surgery options for people whose eyes cannot tolerate LASIK.

Pronounced "Lay-SEEK," LASEK offers patients a more comfortable and shorter post-op recovery time than PRK, although Jones noted that the two procedures are fairly equivalent in terms of preserving corneal tissue and accomplishing the desired vision correction.

Patients are referred to Jones for LASIK screenings and surgeries from The Eye Clinic in Mt. Vernon, IL, and other Eye Clinic locations in Centralia, Carlyle, and Breese.

"One of the most common reasons that LASIK cannot be done is that the corneal tissue is too thin," said Jones. "If the laser is removing tissue, we have to be sure that we can maintain the structural integrity of the cornea."

"Another reason is that the cornea might be irregularly shaped and therefore cannot accommodate the suction ring that's placed on it during the LASIK procedure. That might disqualify you for LASIK, but your eye doctor might recommend one of the other refractive procedures as the right fit."

Tips for Choosing a LASIK Surgeon

Choosing the right LASIK surgeon is a critically important decision, according to Glen Hagele, executive director and founder of the Council for Refractive Surgery Quality Assurance.

The organization's web site at www.USAeyes.org has a list of 50 of what Hagele calls "tough" questions to ask a LASIK surgeon and what answers to expect. For example:

o How long have you been performing refractive surgery procedures? (Should be no less than three years.)

o How many total procedures have you done? (No fewer than 500.)

o What percentage achieved 20/20 or better? (Around 50% is normal.)

Hagele also suggests asking if the surgeon has ever been convicted of a felony or has ever had his or her license revoked. "Some people might consider the questions to be a bit invasive, but the doctor is going to be rather invasive on your cornea, so it seems reasonable to ask," Hagele said.

"Another key point is to look for a surgeon who is focusing in on what you as a patient expect of LASIK in relation to your personal lifestyle," Hagele added. "People don't want LASIK because they want their corneas reshaped. They just want to feel better, look better, and reduce the need for corrective lenses."

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