On the day of surgery do not wear any eye makeup, perfume or cologne.
Please do not eat two hours prior to your arrival time at the laser center.
The sedative will have less of an effect on a full stomach. Please arrive
on time. If you are delayed please call the laser center or our office.
You will need someone to drive for you since you will not be able to drive
after the procedure that day. Parking validation will be provided by the
center. There will be some paper work to sign. Plan to stay at the center
for approximately two hours.
Patients for LADARVision® 4000 and traditional LASIK or PRK/LASEK will
have a picture of your eyes taken to center the pupil prior to dilation.
Allegretto Wave ™ and VISX STAR S4 patients do not require a picture or dilation of the pupils.
Then you will be given a sedative to help relax you and LADARVision® 4000
patients will have their eyes dilated for the tracker. After you are
relaxed with the sedative in about 20 to 30 minutes, your eyes will be
given numbing drops and marked for astigmatism alignment. The area
around your eyes will be cleaned and you will be brought into the laser
suite. An eyelid retainer will prevent you from blinking during the
procedure. You be asked to look at the blinking red light. For LASIK,
the cornea will be marked for alignment of the flap and a suction ring
will be placed on your eye. Your vision will fade or black out for a
few seconds when the proper suction level is achieved. Then the flap
is created with the microkeratome followed by the laser treatment and
replacement of the flap. For PRK/LASEK the suction ring and
microkeratome are not used and the epithelium is removed or moved to the
side after softening with an alcohol solution. After the laser treatment
a bandage contact lens is placed on the eye for PRK. For LASEK, the
epithelium is replaced and a bandage contact lens is place on the eye.
CustomCornea® patients will be marked for registration and have a LADARWave™
measurement after dilation. CustomVue™ patients will have a Wavescan™
measurement before treatment and marked for astigmatism alignment.
LADARVision® 4000 patients will have a picture of their eyes taken to center
the pupil then dilated. Allegretto Wave ™ and VISX STAR S4 patients do not require this step. Then
you will be given a sedative to help you relax. After 20 to 30 minutes you
will be taken into the IntraLase® suite and placed under the IntraLase®
FS laser. The area around the eyes will be cleaned, then a suction ring will
be place on the eye and you vision will dim. The IntraLase® flap will be
created in about 70 seconds. At this point your vision will be blurred due
to the micro bubbles in your cornea. After 20 to 30 minutes, you will be
brought into the Allegretto Wave ™ or LADARVision®4000 or VISX STAR S4 suite and your flap is
lifted for excimer laser treatment and replaced.
Antibiotics and steroids are place on the eye and then
you will be taken to an examination room. Dr. Oyakawa will exam your corneas
with a slit lamp and place eye shields over your eyes to protect them. You
will also be given dark glasses. You may take your second sedative at this
time or wait until you get home. There will be some burning and a sandy
sensation for a few hours. Most patients sleep through this with the help
of the sedative. Keep the eye shields on until you see Dr. Oyakawa the next
day. You may lift up the eye shields to put in your drops. After you see
Dr. Oyakawa, you will need to use the eyes shields only when you sleep or
nap for the next three days and continue the antibiotic and steroid drops
for five days. Use tears frequently. The nerves to the cornea are severed
during the flap creation. As a result the cornea is less sensitive and
there is a decrease in tearing and blinking. They are more prone to dryness
until the nerves regenerate in a few months.
Most patients see well enough to drive to their appointment
the next day. However, use good judgment and have some drive you if you
vision is still blurry. The next appointment is in one to two weeks, then
at one month, three months, at six months and later if necessary.
During the healing period you may have fluctuating vision.
The vision may be better in one eye then the other. The vision improves as
the eye heals. You may also experience glare and haloes around light especially
at night. The vision fluctuations, glare and haloes decrease over a few weeks.
Exercise caution in tasks requiring good vision and in driving. They tend to
take longer to resolve in eyes requiring a larger correction. The amount of
correction and your healing rate will determine your ultimate outcome. An
enhancement will be performed three to six months or later after the original
surgery if you are left with a residual refractive error. There is a greater
probability of needing an enhancement with higher or more complicated the laser
corrections. The enhancement involves re-lifting the flap and treating the
residual refractive error. There is small fee for enhancements.
LASIK surgery has a learning curve and complications decrease with experience.
The chance of a serious vision threatening complication is less than 1%. Most
of these are related to the creation of the flap.
Epithelial abrasions: Can occur and are treated with bandage contact lenses. Epithelial abrasions are more common in patients with diabetes and anterior membrane corneal dystrophies (superficial corneal problems).
Free cap: Originally, the flap was completely detached from the cornea and replaced after the laser correction. Now, a small attachment is left on one side, a hinge, to allow easier replacement and alignment of the flap. A free cap requires the extra step of replacing and realigning the flap.
Partial flaps and Buttonhole flaps: These complications are extremely rare. When they occur, it is best to replace the flap and let the cornea heal. In 3 to 6 months, recut the flap.
Flap incorrectly positioned-not centered or of incorrect diameter: Usually not a problem unless a large ablation zone is required. This may require replacement of the flap and returning in 3 to 6 months to recut the flap.
Flap too thick or too thin: A flap that is too thick may result in termination of the surgery for an eye needing a large amount of ablation. There is a recommended amount of corneal tissue that needs to remain after the flap and laser treatment. Leaving less than this amount may lead to long-term corneal problems such as ectasia (abnormal bulging). It may not be possible to recut the flap in the future. Replacement of the flap usually maintains vision.
Ectasia may be treated with gas permeable contact lenses; if severe a corneal transplant surgery may be required. A flap too thin may be more difficult to smooth out and may result in striae (wrinkles) that can reduce vision.
Corneal perforation: This is the most serious complication and occurred with early microkeratomes.
Bleeding from peripheral corneal vessels: This is usually treated with drops that constrict the blood vessels. The bleeding stops when the flap is replaced.
Decentered ablations and central islands were seen with earlier
broad beam lasers. These complications have been largely prevented with advances
in excimer laser technology.
Diffuse lamellar keratitis (DLK): Is a rare condition and it usually occurs one to three days after surgery. Patients usually report blurred vision, pain and sensitivity to light. Some patients may not have any symptoms. It is treated with steroid drops and rarely with irrigation under the flap. This condition can be treated without significant visual loss when it is detected and treated early. It is important to attend all scheduled postoperative visits
Flap wrinkles: They usually do not affect the patient’s vision. If they reduce the acuity or quality of the vision, the flap can be lifted and wrinkles removed.
Flap slippage: Repositioning of the flap treats this. It usually occurs on the same day or night of surgery by rubbing your eye. It is important to use the protective eye shield after surgery for a few days.
Epithelial ingrowth: The eye doctor detects this. A small amount of epithelial ingrowth is seen in a few percent of microkeratome cases. It should be removed if it progresses and affects vision, or creates other problems. It is important to attend all scheduled postoperative visits.
Infection: Extremely rare. It is important to use the antibiotic drops as directed and not to get unclean water or other substances into your eyes during the healing period. Avoid the ocean, pools, hot tubs, etc. If infection is left untreated, it can result in permanent loss of vision. It is important to attend all scheduled postoperative visits and report any problems to your surgeon.
Dry eyes: Your eyes may feel scratchy and burning. This tends to return to normal after a few months. It is important to use artificial non-preserved tears frequently. If severe, punctual plugs can be used to temporarily plug the tear drainage site to keep your natural tears in the eye.
Glare and haloes are seen especially at night around light. They usually decrease over one to two months. They are more common in patients with large pupils and large refractive errors. They were more common with first generation lasers using a small optical zone.
Overcorrection, undercorrection, and regression: The desired correction was not achieved. This is due to many factors and each person’s eye heals differently. The surgical plan is based on an average response to treatment. Some patients have an increased or decreased healing response. In addition to the state of corneal hydration, the humidity and other unknown factors contribute to the response to excimer laser surgery. These conditions can usually be enhanced (retreatment by lifting up the previously created flap and treating with the excimer laser) when stable. Enhancements are done three to six months after surgery when the eye is stable. It may take longer in eyes with larger corrections to become stable.
Persistent glare, haloes, starbursts, or ghosting: Very uncommon with larger ablation zones. These may be corrected by wavefront-guided custom ablation such as CustomCornea®. Eye drops that constrict the pupil may be of benefit.
Dry eyes: Most cases of dry eyes resolve in a few months. For the few who have persistent dry eyes, temporary or permanent punctal plugs and or drops may offer relief.
Loss of best-corrected visual acuity: Some patients may not see as well with glasses after surgery as before surgery with glasses. Enhancement may help some of these patients.
Aggravation of muscle imbalance: This can occur in patients who have had eye muscle surgery or have an imbalance corrected by glasses.
Caution about glaucoma: After LASIK surgery your cornea
will be thinner and the intraocular pressure will measure falsely low.
