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Everything You Need to Know About LASIK Eye Surgery

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Photo: Paper Boat Creative / Getty Images

It's been nearly two decades since the Food and Drug Administration (FDA) approved LASIK eye surgery. Since then, almost 10 million people have taken advantage of the vision-sharpening surgery. Still, many others fear going under the knife—and the potential side effects of the outpatient procedure.

"LASIK is a fairly straightforward surgery. I had it done myself almost 20 years ago, and I have operated on many family members, including my brother," says Karl Stonecipher, M.D., clinical associate of ophthalmology at the University of North Carolina and medical director for TLC Laser Eye Centers in Greensboro, NC.

It might seem like a godsend, but before you put your peepers through the process, study this eye-opening guide to LASIK.

What is LASIK eye surgery?

Tired of relying on glasses or contacts to see sharply? (Or don't want to worry about getting a contact stuck in your eye for 28 years?)

"LASIK, or 'laser-assisted in situ keratomileusis,' is the most commonly performed laser eye surgery to treat nearsightedness, farsightedness, and astigmatism," says Samuel D. Pierce, O.D., current president of the American Optometric Association (AOA) and a practicing doctor of optometry in Trussville, AL. Post-surgery, the vast majority of people who have received LASIK eye surgery settle into 20/40 vision (the level many states require for driving without corrective lenses) or better, he says.

LASIK eye surgery is a two-part process, Dr. Stonecipher explains.

  1. The surgeon slices a small flap off the top layer of the cornea (the clear covering on the front of the eye that bends light as it enters the eye).

  2. The surgeon reshapes the cornea with a laser (so that light entering the eye is accurately focused onto the retina for more precise vision).

While you might be at the operating facility for an hour or so, you'll only be on the operating table for 15 minutes, says Dr. Pierce. "LASIK is done with a topical anesthetic and many surgeons will give an oral agent to relax the patient too." (Meaning, yes, you're awake, but you won't feel any of this slicing and lasering.)

The lasers used in LASIK are remarkably sophisticated, and use the same tracking technology NASA uses to dock shuttles at the International Space Station, says Eric Donnenfeld, M.D., clinical professor of ophthalmology at New York University and founding partner of Ophthalmic Consultants of Long Island in Garden City, NY.

"The advanced technology protects patients from harm and ensures the procedure goes according to plan," says Dr. Donnenfeld. No surgery is 100 percent effective, but estimates show that 95 percent to 98.8 percent of patients are pleased with the results.

"Six to 10 percent of patients may require an additional procedure, often called an enhancement. Patients expecting perfect vision without glasses or contacts may be disappointed," says Dr. Pierce. (P.S. Did you know you can also eat for better eye health?)

What's the history of LASIK eye surgery?

"Radial keratotomy, a procedure that involves making small radial incisions in the cornea, became popularized in the 1980s as a way to correct nearsightedness," says Inna Ozerov, M.D., an ophthalmologist at Miami Eye Institute in Hollywood, FL.

Once the Kremer Excimer Laser was introduced in 1988 as a tool for biological purposes (not just computers), eye surgery progress ramped up quickly. The first LASIK patent was granted in 1989. And by 1994, many surgeons were performing LASIK as an "off-label procedure," according to Dr. Stonecipher, or performing the procedure prior to official approval.

"In 2001, 'bladeless' LASIK or IntraLase was approved. In this procedure, a lightning-quick laser is used in place of the microblade to create a flap," says Dr. Ozerov. While traditional LASIK is slightly quicker, bladeless LASIK generally produces more consistent corneal flaps. There are pros and cons to both, and doctors choose the best option on a patient-by-patient basis.

How do you prepare for LASIK?

First, get your wallet ready: The average cost for LASIK in the U.S. in 2017 was $2,088 per eye, according to a report by All About Vision. Then, get social and get screened.

"Talk to your eye doctor and talk to your friends. Millions of people have had LASIK, so you can hear their personal experiences," says Louis Probst, M.D., the national medical director and a surgeon for TLC Laser Eye Centers across the Midwest. "Don't just go to the cheapest laser center. You only have one set of eyes, so do your research about the best centers with the best doctors."

Dr. Pierce echoes those sentiments: "Patients should beware of those who promise or guarantee a perfect result or who offer bargain prices with little or no discussion of follow-up care or potential side effects."

If you land on a doctor and decide to move forward, screening is crucial to see if you have any medical reason to skip LASIK, says Dr. Stonecipher.

"We're now using deep learning technology and artificial intelligence in ophthalmology to better screen for ocular issues that could produce poorer quality outcomes with laser vision correction—and have seen incredible results," he continues.

The evening before surgery, aim to get a good night of sleep and avoid alcohol or any medications that might dry your eyes. Your doctor should explain if and how you need to tweak any medications and contact lens use leading up to LASIK. (Related: What You Need to Know About Digital Eye Strain)

Who qualifies for LASIK (and who doesn't)?

"LASIK candidates need to have a healthy eye and normal corneal thickness and scans," says Dr. Probst. The surgery is a great option for many with myopia [nearsightedness], astigmatism [an abnormal curve in the eye], and hyperopia [farsightedness], he says. "About 80 percent of people are good candidates."

If you've had to get stronger contacts or glasses each year, you may have to wait: Your prescription needs to remain fairly steady for at least two years prior to LASIK, adds Dr. Donnenfeld.

You may want to avoid LASIK eye surgery if you have a history of any of these conditions, according to Drs. Ozerov and Donnenfeld:

"The AOA recommends that candidates for LASIK be 18 years old or older, in good general health, with stable vision, and no abnormalities of the cornea or the external eye," says Dr. Pierce. "Patients who are interested in any corneal modifications should first have a comprehensive eye examination by a doctor of optometry to evaluate their eye health and determine their vision needs." (Yo, did you know you need to exercise your eyes too?)

What is recovery like after LASIK eye surgery?

"LASIK recovery is surprisingly fast," says Dr. Probst. "You're comfortable and seeing well just four hours after the procedure. You need to be careful with your eyes for one week so they heal well."

While some discomfort is normal during the first 24 hours (mainly during the first five post-LASIK), it can often be managed with over the counter pain-relievers, says Dr. Donnenfeld. Plus, prescribed lubricating eye drops can help keep your eyes comfortable, prevent infection, and promote healing. Plan to take off for the day of your surgery and the day after to rest.

The surgery typically requires a follow-up with your doctor about 24 hours after the procedure. Then, you'll likely get the green light to return to normal daily activities. He or she will likely schedule follow-up visits one week, one month, three months, six months, and one year after surgery.

"After the first day or so, patients may have some temporary side effects as part of the healing process, including halos around your eyes at night, tearing eyes, puffy eyelids, and sensitivity to light. These should all diminish within a week, but the healing period can last three to six months, during which patients have a few follow-up appointments so their doctor can monitor their progress," says Dr. Donnenfeld.

You may also have heard about a more rare and scary side effect of LASIK eye surgery, such as when 35-year-old Detroit meteorologist Jessica Starr died by suicide while recovering from the procedure. She'd had LASIK a few months earlier and had admitted she was "struggling a little bit" afterward. Starr's suicide isn't the only one that's been questioned as a possible repercussion of LASIK; however, it's not entirely clear why or if LASIK played a role in any of these deaths. Struggling with pain or vision problems after the procedure (or any invasive procedure, for that matter) could certainly be unnerving. Most doctors point to the huge number of successful procedures as a reason not to worry about any of these isolated and mysterious cases.

"Suicide is a complex mental health issue, and for the news media to directly link LASIK to suicide is irresponsible, and frankly dangerous," says Dr. Ozerov. "Patients should feel comfortable returning to their surgeon if they are experiencing difficulty with their recovery. The good news is that most patients will recover and will have a successful outcome." 

 

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