Surgery

Both LASIK and PRK procedures are performed under the use of anaesthetic eye drops.

• There is no use of injections and no pain should be experienced during either surgical procedure.
• An eye speculum is used to prevent blinking and a flashing light in the laser acts as a target for you to fix on.

LASIK involves the creation of a thin flap of cornea using a microkeratome. A suction ring is used to steady the eye during the flap creation and consequently, a light pressure sensation during the surgical procedure is experienced. Laser correction is applied to the bed of the cornea exposed by the flap and takes about 20-40 seconds. The laser will track any eye movements and adjust the position of each spot to compensate. The flap is then repositioned and re-adheres by the natural suction of the eye within 2 minutes and without the use of stitches.

PRK does not require the creation of the flap of cornea but instead, the surgeon gently removes the surface epithelium and the laser is applied directly to the cornea. A temporary contact lens (3 – 4 days) protects the regenerating epithelium. The procedure is performed in Adelaide Eye & Laser Centre's day surgery facility by surgeons who have specific training in excimer laser surgery. Your visit may take up to 2 hours to allow for the application of pre-operative drops and sedatives, the procedure and post-operative checks by the surgeon. It is important not to wear eye make-up, to wear comfortable clothes and to arrange a lift home on the day of surgery. You are not permitted to drive immediately following the procedure.

Generally surgery may be performed on both eyes on the same day. This can be discussed further with our clinical staff.

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Recovery guidelines for LASIK

• The rate of visual recovery varies for each individual. Initially vision may be blurred for a few days with steady improvement over a few weeks to months.
• You should be able to return to most activities within 2 to 5 days with stable vision being restored between 1 to 3 months.
• Results can vary according to the severity of the refractive error corrected. They are best explained together with the alternatives and possible complications during the pre-operative assessment.
• Patients 40 years or over may still require reading glasses as would normally be the case at that age (see presbyopia).
• It is necessary to return to the Adelaide Eye & Laser Centre the day following surgery for a post-operative consultation and then again between 1 and 4 weeks after the initial surgery as directed by the surgeon.

A thorough visual examination will be needed between 3 and 4 months to assess the final result. These consultations are important, and failure to attend may jeopardise results.

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Possible Complications and Side Effects

As with any surgical procedure, there are risks involved with the LASIK procedure. Fortunately, as technology has improved along with surgical skills and techniques, the possible complications associated with laser vision correction have been greatly reduced.

• The most common complications arise from the creation of the corneal flap. An incomplete flap can result in a deferral of the procedure for a period of 4-6 months before re-continuing and occurs in approximately 1 in 1000 procedures.
  
• The corneal flap must be repositioned carefully after the laser is applied and should the flap slip, folds will result in a reduction of vision. The incidence of flap slippage is 1 in 1000 and immediate repositioning results in excellent outcomes.
  
• Epithelial Ingrowth is rare and occurs in 1 in 2000 cases when these cells grow and multiply under the flap. The most common way to treat this is to lift the flap, remove the bothersome cells and reposition the flap.
  
• Rates of infection after LASIK vary between 1 in 5000 to 1 in 20,000 cases depending on the country at question. At the Adelaide Eye & Laser Centre there have been no cases of severe infection over the last 12 years and 7,000 procedures.
  
• Occasionally your eye will overreact to the procedure resulting in inflammation. Clinically bothersome inflammation is rare occurring in 1 in 2000 cases. Treatment allows rapid resolution.
  
• An important complication after LASIK is the development of an unstable cornea (keratoectasia). When there is insufficient corneal tissue to maintain the new shape then the cornea may progressively steepen allowing myopia and astigmatism to recur. A number of risk factors for this complication are assessed pre-operatively. When present, LASIK is not a safe option and alternative measures are considered. Despite the absence of these risk factors keratoectasia may rarely develop. The rate is about 1:10,000 or lower. Currently there is no treatment for this problem other than glasses or contact lenses.”

The most important thing to remember is to attend all of your post-operative consultations so that we are able to monitor your recovery closely and also to strictly adhere to all post-operative guidelines, minimising the possibility of post-operative complications.

Of paramount importance is a comprehensive pre-operative assessment to determine your suitability to laser surgery and possible risks associated with your specific case so that you are well educated and can make a well-informed decision regarding laser vision correction for your eyes.

Our Clinical Adviser would be happy to discuss any further questions you may have or to arrange a pre-operative assessment for you to see the clinical optometrist and surgeon.