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The newest and latest surgery to be approved by the FDA for
ophthalmology is LASIK. This is an acronym for
Laser Assisted in-situ Keratomileusis,
which can be more simply described as "Flap and Zap".
Before we start let's take a brief look as to how LASIK came about.
It began with the invention of the Excimer laser. This is an ablation
laser that vaporizes specific tissue without damaging the surrounding tissue.
At first the excimer laser was used to reshape the cornea after the
surgeon removed the top layer of tissue - or the epithelium.
This was called PRK. This was a successful surgery but it was extremely painful,
like a very large scratch, for about 2 weeks because the
epithelium, which protects the eye, was removed.
The idea for LASIK grew from the machines used to create skin grafts.
By using a much smaller version of this machine a layer of tissue is lifted
from the front surface of the eye. This protects the valuable epithelium.
This flap of tissue is inverted on a hinge, and then the excimer laser is used to
reshape the underlying cornea, just as it is in PRK. The flap is returned to
its original position and within 24 hours the small scratch - or incision -
which was created to remove the epithelium
is healed and the "new" vision is achieved.
The whole procedure takes about 5-10 minutes for each eye and is so safe
and successful that in most cases it can be preformed on both eyes in the same day.
LASIK is a safe and successful surgery with 20/20 results over 95% of the time,
however, LASIK is not a panacea - it is not meant for everyone. The FDA says that
LASIK can be performed to correct MYOPIA (nearsightedness) as well as HYPEROPIA
(farsightedness) and even ASTIGMATISM (corneal warpage). However, there are some
combinations of hyperopia and astigmatism that the FDA has not approved for
correction. There are also upper limits to the amount of myopia and hyperopia
that can be corrected.
Now, more realistically, who should have LASIK surgery?
Not the person who expects perfection. Laser corrective surgery cannot
bring back vision that has been lost by a medical condition. It cannot bring
back your near vision if you are over 40. It will not allow you to focus at
multiple distances if you are over 40. It will not correct vision lost from
cataracts. LASIK is a fantastic and safe surgery to alleviate dependence
on glasses but it cannot solve all problems.
This is a tried and true surgical laser
procedure that can alleviate your dependence on glasses. The procedure
can be as accurate as 99.9% in the hands of a good, well trained surgeon.
The surgery is fast and safe enough to allow both eyes to be treated on
the same day, expecting a return in as little as 24 hours. Some surgeons
believe that this procedure is safer than contact lenses. If you are the
kind of person prone to sleeping in your contacts or have difficulty with
insertion or removal, I believe this is true.
Well, as was mentioned above this surgery can be 99.9% successful. However,
it is major surgery on healthy eyes and should not be taken lightly. Problems
could occur throughout the surgery leading to a prolonged recovery, however
in the hands of a good surgeon these can be easily corrected. This is the
primary reason why you would want your surgeon available after the surgery.
Some eye doctors associate themselves
with a surgeon that will fly in from another state or country to offer this procedure
to their patients at a "discounted" rate. This can cause obvious problems if
something in the surgery or post-operative course were to go wrong and the
surgeon was not due back in town for a week or a month.
Remember as you "shop" for this surgery the famous cliché, "you get what you pay for".
Often the best price doesn't mean the best deal for your surgery.
Another common problem is over or under-correction. This means that the measurements
that are taken to evaluate how to reshape your eye or more likely the healing
process your eye goes thru are not estimated correctly. After several months your
doctor and you may decide you need to have a "retreatment". What this means is
that your vision is not 20/20 without glasses and that more reshaping needs to be done.
This is the most common reason for "bad" results. However, this is not a bad result,
it is merely an incomplete result.
Cost is a very variable
aspect of LASIK surgery around the country. It is based primarily on the market in
which you live. You should expect your fee to include the cost of the surgeon,
which should include all pre and post-operative examinations, as well as the surgery
itself. It should also include the cost of the laser fee, as these Excimer lasers
are usually rented and not purchased by medical practices. It should also include
the "card" fee, which is a royalty to the people who invented the lasers - yes
these people make about $150 on every eye that is treated. The surgeon or the laser
center has to purchase a card to run the laser for every eye treated and this is a
direct royalty fee back to the laser inventors. That is where the cost, if any,
occurs when a retreatment is necessary.
If you have any further questions about LASIK surgery, you are welcome to call the
office and shedule an appointment with me to discuss the procedure.
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