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Laser vision correction: The future is now

Dr. Janet Carter

Several million people have opted for laser vision correction over the past few years.

Although the number of procedures performed in the United States has leveled off with the current economic slowdown, it seems likely that these procedures will continue to be an excellent option for qualified candidates who wish to reduce their dependency on glasses or contacts.

The excimer laser corrects vision by breaking chemical bonds in the cornea (the clear front surface of the eye) and reshaping its surface.

The cornea acts as a lens that refracts (bends) light, and the laser thus reshapes the lens to correct the vision problem, be it myopia (nearsightedness), hyperopia (farsightedness) or astigmatism.

There are several laser vision correction procedures currently in use today.

The most popular by far is LASIK, or Laser Assisted In Situ Keratomileusis.

In this procedure a special instrument called a microkeratome cuts a thin flap on the cornea.

The flap is gently folded back by the surgeon and the laser energy applied.

The very top layer of corneal cells (called the epithelium) cannot be lasered, as they will grow back exactly as they were prior to treatment.

The LASIK procedure thus allows the surgeon to treat the proper layer of the cornea without disrupting this top layer.

This allows for minimal discomfort and a rapid healing process.

Some patients (particularly those with thinner corneas) may opt for an older procedure called PRK (Photo Refractive Keratectomy) in which the corneal epithelium is totally removed so that the laser can be applied (the epithelium grows back, but this procedure does require a longer and less comfortable healing process).

Laser vision correction has been proven to be safe and effective for those who are good candidates.

However, many patients are still afraid to undergo the procedure.

This is a natural enough reaction, as vision is perhaps the most precious sense.

Some of the most common patient questions regarding the procedure (and their answers) include: Can I go blind from laser vision correction? There have been no reported cases of total blindness from any of the laser vision correction procedures.

A very small percentage of patients (around 1 percent) have a loss of best-corrected vision following the procedure.

In other words, they see worse with glasses or contacts than they did when corrected with these devices prior to the procedure.

However, most of these people still see better with no glasses than they previously did.

Is laser vision correction permanent? Yes.

A few individuals may have some under- or over-correction of their vision from the procedure as they heal.

This can usually be treated by a second procedure.

The higher the original correction, the more likely this is to occur.

In general, if the vision remains good three to six months following the procedure it will remain so.

There are patients who had laser vision correction 10 or more years ago who still enjoy clear, comfortable vision.

What are the potential risks? The most common “risk” of laser vision correction is an over- or undercorrection of the vision problem.

As I stated earlier, this is more common with the higher prescriptions, and can be corrected with a second procedure (often called an “enhancement”).

Dry eyes are also a common result of LASIK.

The corneal nerves that stimulate the tears are cut when the LASIK flap is created.

These nerves regenerate, but can take a few months to do so.

Most LASIK patients will require artificial tear eye drops following surgery for several months.

Those patients most at risk for dry eye (such as allergy sufferers, those who take certain medications, and menopausal women) may be most affected.

Many people have heard of complaints of halos, glare and night driving problems following laser vision correction.

Although these problems were more common in the early days of laser vision correction, they are much less likely to occur today.

The excimer lasers being used today combine a wider treatment area with a smoother beam profile to greatly reduce the risk of glare and halo.

Most patients will experience some glare and/or night vision difficulty for a brief period following laser vision correction, but in almost all cases it goes away as the healing process completes in several months.

As with any surgical procedure, there are risks involved in laser vision correction.

You can increase your chances of an optimal procedure by doing your homework and taking your time in preparing for surgery.

You should visit ahead of time any laser center where you are considering having the procedure.

The staff should be competent and friendly, and be able to answer all of your questions or refer you to someone who can.

You should be allowed adequate time to meet with the surgeon and have any questions answered.

All patients considering laser vision correction should have a test of their corneal shape and thickness to insure that the procedure is safe for them.

If you are wearing contact lenses, you will have to be out of them for a certain period of time.

(Follow your doctor’s advice on this!) You should have the corneal tests repeated after you are out of contacts.

A little time invested now will help insure a lifetime of good vision! There are many exciting recent developments in the field of laser vision correction.

The Food and Drug Administration recently approved the procedure known as wave front correction for laser vision correction.

This procedure uses a special scanner to test how the eye affects the light entering it.

This information can be programmed into the laser and used to correct what are known as higher-level aberrations (These are aberrations caused by the shape and/or composition of the eye that aren’t corrected by ordinary glasses or contact lenses).

This exciting new procedure has the potential to correct many individuals to better than 20/20 vision! If you are considering laser vision correction, the best place to start is with your own eye doctor.

He or she can best answer your questions as to whether you are a candidate for laser vision correction, and which procedure is best for you.

You too can enjoy a lifetime of clear vision thanks to this exciting technology! Dr.

Janet Carter is an optometrist who has been in private practice in the Truckee Meadows for over 20 years.

She is also the director of clinical services for Pacific Laser Eye Center of Northern Nevada.

She is a 1979 graduate of the University of California, Berkeley School of Optometry.

Dr.

Carter has lectured and written extensively on the fields of vision correction and eyecare.



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