LASIK – Dr Vish

What is the right age to get LASIK?

Patients must be older than 18 years of age to have LASIK. In addition, they must have a stable refraction (the number that is used to measure the power of glasses or contacts). If both of these criteria are met, there is no “wrong” age to have Lasik. Reports have indicated that a growing number of people age 45 and older are having Lasik and other refractive procedures to reduce the need for reading glasses.

What causes Cataracts?

Most cataracts are simply due to age-related changes in the Lens of an eye. However, there are a number of other conditions/factors that contribute to the development of cataracts.

Diabetes– Unfortunately, individuals with diabetes develop cataracts more frequently and earlier in life.

Medications– Certain medications are known to cause cataracts. One of the biggest culprits here is corticosteroids. While many of us have never taken corticosteroids, they are used heavily in patients with Chronic Obstructive Pulmonary Disease (COPD), Rheumatoid arthritis, and various other inflammatory and infectious conditions.
Other medications that lead to the formation of cataracts include chlorpromazine and other phenothiazine medications.

Ultraviolet (UV) radiation– Unprotected exposure to UV radiation can lead to cataracts. It’s a good idea to always keep those eyes protected!

Trauma– Sharp trauma (entry into the eye) and blunt trauma can both lead to cataracts. Even something as seemingly harmless as “eye rubbing” has been shown to cause the early development of certain cataracts.

Smoking– There is a significant association between smoking and the development of cataracts. Just more reason to quit.

Alcohol– Studies have shown that patients with higher alcohol consumption have an increase in cataract formation compared with patients with lower or no alcohol consumption.

What will happen if I don’t get my Cataracts removed?

It is important to understand that every Cataract is different. Some cataracts are very severe and lead to blindness if they are left alone. Other cataracts may simply cause permanently blurred vision but never significantly impair the functions of daily living. Still others can cause increased glare, double vision, or lead to forms of Glaucoma. With this in mind, it is important to see a trusted eye-care provider who can counsel you on the best decision to make regarding cataract removal.

Do I need to discontinue blood thinners or anticoagulants (example: Coumadin, Plavix, Aspirin) for Cataract surgery?

Standard Cataract surgery does NOT require the patient to discontinue anticoagulants (blood thinners). You may continue taking these as prescribed by your primary care doctor. However, it is important to note that sometimes Cataract surgery is combined with Glaucoma surgery (or less frequently with Retina surgery). In these cases, it may be beneficial to temporarily discontinue blood thinners for the surgery. Please consult with your doctor before the procedure to find out.

When will I know if I need glasses after Cataract surgery/When can I get them?

1 month. Although recovery from Cataract surgery is incredibly fast and patients often see an improvement within days, it takes a month for the lens implant to settle into position and the eye to heal. All of this impacts the power of glasses. Therefore, it is important to check patients for glasses at 1 month to avoid giving a premature prescription.

Most surgeons also check patients at 1 day and 1 week after surgery to make sure the eye is healing well.

LASIK has been around for decades. Thankfully, like some of the other procedures we’ll discuss, the technique has been improved thanks to advancements in technology and our understanding of the eye.

Now, the key steps of the procedure can be performed entirely by laser. This allows for a degree of accuracy and precision that was never possible before.

How it works

To fully understand how LASIK works, it helps to first understand Myopia (nearsightedness) and Hyperopia (farsightedness) as well as Astigmatism and Presbyopia.

In a “Normal” eye, a beam of light is focused by the Cornea (front part of the eye) and Lens to a single point on the Retina (back part of the eye). This allows clear vision. However, if a patient has Myopia, Hyperopia, or Astigmatism, light is not focused onto the Retina.

Here is a diagram from eyeglassguide.com illustrating this concept. Here we’ll use Myopia as an example.

As you can see from the diagram, a light beam is focused to a single point in front of the Retina in Myopia. This causes blurred vision in patients with Myopia.

I won’t include diagrams for Hyperopia and Astigmatism here, but you can read more about these conditions and view helpful diagrams in their respective sections.

The take home message here is that all of these conditions interfere with the ideal condition of light being focused to a single point on the Retina instead of in front or behind it.

LASIK (and a few other refractive procedures) fix this problem by re-shaping the cornea so that light can be focused onto the Retina, as it should in a “Normal” eye. Thus, LASIK returns the eye to full functionality and eliminates the need for glasses or contact lenses!

Process

The key steps in LASIK can now be performed exclusively by laser. This allows for improved precision and even better results.

Before it begins, patients are counselled on exactly what to expect so there are no surprises. First, a femtosecond laser is used to create the LASIK flap. Afterwards, an excimer laser re-shapes the cornea based on precise calculations. Both of these lasers were developed specifically for LASIK and help us achieve the best results.

Pro’s and Con’s

Pros: Patients notice improved vision immediately after having LASIK. This effect only gets better as the eye heals. Many people describe LASIK as “life-altering” once they are able to see the world in perfect clarity without assistance for the very first time.

Patients may then say good-bye to the negative aspects of wearing eyeglasses. These include blocked or distorted peripheral vision, scratched lenses, and difficult bifocal/progressive segments.

Contacts provide better peripheral vision, but come with their own set of problems. Contact lenses decrease the amount of oxygen that reaches the surface of the eye. On top of that, they interfere with the ability of our own tears to naturally remove toxins, allergens, and bacteria from the eye. Partly because of this, contact lenses cause higher rates of potentially blinding eye infections, allergic reactions, and dry eye.

Refractive procedures (such as LASIK and PRK) help decrease if not eliminate the need for glasses and contacts, which can mean a major difference in satisfaction

Cons: Every procedure has risks. While LASIK is very safe, it should not be performed in patients with specific eye diseases. Therefore, it is very important to see an Ophthalmologist who will do a thorough examination and various screening tests to ensure a patient’s eyes are healthy enough to have LASIK.

Once the examination and tests are complete, it is also important for patients to listen to the risks and details of the procedure so they can make an informed decision.

Cost analysis

While there are many reasons why patients want LASIK, the most common reason for holding off is cost. I recently attended a lecture which talked about the cost savings from refractive surgery and thought it would be helpful to share.

Cost of refractive surgery

Varies by provider but is approximately $2000 per eye or $4000 for both eyes.

Cost of contacts (with backup set of glasses)

Initial eye exam with lenses: $225
Contact Lenses: $200 every year
Annual eye exam to check prescription: $75 every year
Contact Lens solution: $150 every year
Glasses Frames: $190 every 2 years
Over the course of 15 yrs this adds up to $7875

Cost of glasses alone

Eye exams to check prescription: $150 every 2 years
Glasses Frames: $250 every two years
Over the course of 15 years this adds up to $3000. Over the course of 25 yrs, the cost has already exceeded the price of LASIK.

With this incredibly basic cost analysis, it is obvious that LASIK may actually save money in the long run. With that said, no decision that could potentially affect your eye health (or any health for that matter) should be made on the basis of cost. While LASIK is a wonderful procedure, it is imperative that you have a thorough eye examination with a trusted Ophthalmologist to ensure that you are a good candidate.