Moreover the state-of-the art technology to achieve this end is economical and easily available. We are talking about Lasik, which was till yesterday a dream, a dream come true and in the years to come will become a dream revisited. Lasik is considered by virtually all refractive surgeon and worldwide to be the safe procedure of choice today. Lasik or LASer In-situ Keratomileusis or laser assisted In-situ Keratomileusis -means laser treatment inside the tissue of the cornea to give it a desired shape . It is hot topic so naturally we see lot of information and misinformation in the media some reporting it as miracle tool to correct any kind of refractive error and some reporting it as horrible monster. Some reports depict this as unsuitable for Indian eyes and some explain it better suited for Indian eyes. There are mix of facts and fictions. Patients are confused and naturally they seek some clarification from a doctor. Refractive errors : If the image in the eye is formed in front of retina - {myopia or near sightedness} minus power; behind the Retina {hypermetropia or far sightedness} plus power or image is stretched between two locations {Astigmatism} cylindrical power with axis :,then to see clearly we need correction of refractive error. Commonly specs or contact lenses are used. Surgical correction- What is done in surgery : anterior curvature of cornea is either flattened to correct myopia or steepened to correct hypermetropia.To achieve this we have big list of options LASIK, LASEK, PRK, R.K.{Radial Keratotomy} , A.K.{Astigmatic Keratotomy} , Clear Lens Extraction , Phakic IOL , Specs , Contact Lens , INTACS{Corneal Rings},LTK {Laser Thermo Keratoplasty}, CK {Conductive Keratoplasty} , ALK{Automated Lamellar Keratoplasty}. Laser assisted correction: LASIK, LASEK, PRK safety is proportional to corneal thickness / pupil size This ratio is better for Indian eyes. Suitability for Indian is further increased by the better illumantion for most of the time except few weeks of foggy days . It is a fact that Laser assisted vision correction is better suited for Indian eyes. But it is also a fact that every person with refractive error is not fit for surgical correction Then who is fit:- Good stable vision with specs, low to medium refractive error; in the healthy eye of an adult more than 18 years of age, willing to get rid of specs by surgery understanding the possibility of complication attached with any surgery. It is good only for low to medium refractive error –12.0 is the limit in most of cases of myopia In some cases it may be – 2.0 and in some cases –15.0. In hypermetropia +5.0 is limit in most of the cases.If the vision with specs are not good then there must be some o ther associated problem in cornea, lens, retina or optic nerve, which cannot be corrected by lasik. It does not correct or stop presbyopia [near vision defect after 42 yr of age Eye should not be suffering from recurrent redness, watering etc. One year before & after delivery it should be avoided, that means pregnancy should be avoided for next three months after surgery. Final evaluation is made by considering pupilometry, refractive correction , keratometry Intraocular pressure measurement ,pachymetry, topography and retinal assessment. The goal of vision correction – It is to achieve working vision or decreased dependence on specs. It does not guarantee the total correction in all cases but 95% correction in 95% cases. In 5% cases specs of very small power may be required if patient has a job requiring very precise vision. SURGICAL PROCEDURES - PRK- [ photo refractive keratotomy]It is good up to –7.00D .In this case epithelium is removed, some times epithelium grows too much or grow abnormally ,particularly in high correction more than –8D which may result in haze or regression. LASEK- [laser assisted sub epithelial keratomileusis] is good up to –9.00D.Epithelial flap is raised with the help of alcohol. Here the part of Bowmens membrane and epithelium are preserved , so problem related with overgrowth or abnormal growth of epithelium is very minimal. There is no use of microkeratome or blade .After surgery ,even laser expert can not easily detect ,recovery is slow like PRK. it is safer, easier but slower than Lasik & suitable only for mild to moderate myopia. It is recommended for all less than -9.00 D myopic keeping in mind that is slower & safer than myopic. LASIK- It[laser assisted in situ keratomileusis] is good upto –12D myopia & + 5.00 D hyp. Superficial 1\3 rd of cornea is raised with the help of micro keratome to treat the stromal bed by laser most popular because fast recovery within four hours. One day after surgery one can attend out door works & after 4 days one can attend table work, after 2 months one can start driving . SAFETY & COMPLICATION-It is very safe & painless procedures; complication rate is very low which may require medical or surgical treatment. Excimer laser surgery was first performed in 1988. LASIK is a more accurate variation from ALK, which has been performed for over 25 years, and has been proven safe in long-term studies. Extensive testing has been performed around the world by many different sources and it is now firmly entrenched within the medical arena that there are no long-term health problems to the eye from these procedures. Earlier one dreaded intra-operative complication was perforation of eye by microkeratotome head requiring corneal grafting & Iol implantation. It is no more now a days because all microkeratotome head are manufactured today with base plate incorporated, no chance of mistake in assembly. Chance of infection is very rare because bacteria & virus cannot sustain the laser energy, even it has occurred post operative it is easily cured with medicines. It is extremely rare that infection not cured then it may require corneal grafting. In modern surgery every body know that incidence of infection are very low & management is very effective. Few patients will experience optical aberrations during the initial healing phases including glare & haloes. CONCLUSION-It is very safe & useful but not for all. It is very good procedures to remove corneal opacity occupying less than 20% of total thickness. Earlier these patients had to go for corneal grafting. CAST OF THE PROCEDURES- It is the high tech procedure requiring very costly equipments, costly consumables like blade & gas and very high maintenance cost of the laser. Price war and low cost will certainly be at the cost of quality, so one must control the temptation to look into low cost. FREQUENTLY ASKED QUESTIONS : 1. Why are specs needed? If the image in the eye is formed in front {myopia or near sightedness}; behind the Retina {hypermetropia or far sightedness} or image is stretched between two locations {Astigmatism} then to see clearly we need correction of refractive error. Commonly spects are used. 2. What are the alternatives for correction of refractive errors? Lasik ,lasek,PRK, R.K.{Radial Keratotomy} , A.K.{Astigmatic Keratotomy} , Clear Lens Extraction , Phakic IOL , Spects , Contact Lens , INTACS{Corneal Rings},LTK {Laser Thermo Keratoplasty}, CK {Conductive Keratoplasty} , ALK{Automated Lamellar Keratoplasty}.In some people, contact lens can cause frequent redness and itching. Removal of this problem requires changing them from time to time. 3. What is R.K.? R.K.-Radial Keratotomy- To correct myopia, radial cuts are made in cornea around the pupil. This flattens the cornea, thereby nullifying the myopic effect. 4. What is P.R.K.? P.R.K.-Photo Refractive Keratotomy-It uses excimer laser to flatten the cornea. However it works best only for small power less than -4.00 D. It also has the attendant lacuna of eliminating some protective layers of the cornea permanently. So sometimes there is scar and sometimes power reverses back {regression}. Painful post operative days with scaring and reversal are a troubling impediment. 5. What is LASIK? LASIK-Laser Assisted In-site Keratomileusis-Laser ablation in the middle of the tissue of cornea. This makes it superior, safer and predictable compared to P.R.K. Superficial protective layers are not eliminated. There is no pain after procedure. Correction is stable without scaring. If you decide to go ahead with LASIK, you will first be assessed for suitability. If you wear contact lenses, it is a good idea to stop wearing them before your baseline evaluation and switch to wearing your glasses full-time. Contact lenses may change the shape of your cornea for up to several weeks after you have stopped using them depending on the type of contact lenses you wear. Not leaving your contact lenses out long enough for your cornea to assume its natural shape before surgery can have negative consequences. These consequences include inaccurate measurements and a poor surgical plan, resulting in poor vision after surgery. These measurements, which determine how much corneal tissue to remove, may need to be repeated at least a week after your initial evaluation and before surgery to make sure they have not changed, especially if you wear RGP or hard lenses. 6. How is LASIK done? Superficial 1/3rd of corneal flap is raised {not removed} with the help of microkeratome to give laser treatment on the middle of cornea. Amount of treatment is fully guided and calculated by computer. 7. What are the benefits of lasik? See the advantages of LASIK above. Quick procedure – 8 seconds per Diopter , Brief recovery time , No pain during or after procedure , All corneal layers remain preserved , widest range of correction . 8. Who all must go for LASIK? If you decide to go ahead with LASIK, you will first be assessed for suitability. Good stable vision with specs in the healthy eye of an adult is a pre-requisite. If the vision with spects is not good then there must be some other associated problems in lens or retina nerves etc. This can not be corrected by lasik. So improvement after lasik will not be perfect. Moreover eyes should not be suffering from recurrent redness & watering due to infection or recurrent inflammation. Certain auto immune disease like Rheumatoid Arthritis is Contraindicated Glaucoma, Herpese and Diabetese render LASIK impossible for your eye. One year before and after the delivery date should be avoided for lasik surgery. However, the final evaluation is the forte of the doctor alone and it includes complete history and examination with the help of automated refraction, keratometry, intra ocular pressure measurement, pachymetry, topography and retinal assessments. 9. What is the cost of the procedure? It is the high tech procedure, requiring very costly equipments and costly consumables like blade and gas, apart from huge maintenance cost of the laser room. However despite the pecuniary pressures and bearing in mind the economy, procedure fee has been kept 5 to 10 % of the fee as in U.S. if it is done with the same equipments and same consumables. It varies from center to center, which can be asked. There has always been trade-offs between price war and the cost of quality. So one must resist the predisposition towards the latter and go for the best for a healthy eye is the window to the soul and let not the latter affect it detrimentally. 10. Where one should go for Lasik? Now it is very popular and available at many places. One should check good well equipped laser center. Equipments should be approved by international standard and F.D.A. Fee should be the last attraction. Since the choice to go for it is not mandatory but entirely optional, one should not choose simply any center attracted by the lure of low fee. 11. What one should expect from Lasik? The primary objective behind Lasik is to achieve working vision with decreased dependence on specs. Refractive error keeps a changing for whole life but distance vision remains almost stable (almost) between the 18th year and 50th year of age. Therefore once corrected with lasik 12. What are the precautions before surgery? -No creams, makeup and perfumes. -Clean face and eye lashes well. -Someone must assist you during the surgery. 13. How must the candidate co-operate during surgery? It is a comfortable and brief procedure. Eye drops are placed in your eye to clean it and make it painless. Lid speculum is used to keep open the eye lids. During the procedure you have to look into red blinking light. A suction ring is placed over cornea. When it becomes full, light will be very faintly visible until released. Within one to two minutes time interval the job will be done. No bandage, no injection and no stay is required. 14. What is the long term result? Excimer laser surgery was first performed in 1988. LASIK is a more accurate variation from ALK, which has been performed for over 25 years, and has been proven safe in long-term studies. Extensive testing has been performed around the world by many different sources and it is now firmly entrenched within the medical arena that there are no long-term health problems to the eye from these procedures. 15. What if I move during the procedure? Patients usually worry about their head or eye movements. It will be ideal if you can fix them to the blinking light but even if you move them the eye tracker will track you. Blinking will not be problem ergo because of lid speculum. Note: However, some patients will have to wear a contact lens overnight to promote healing. 16. If I don't get full correction, will I be able to repeat operation? Yes, re-operation can be done for any significant under or over correction. "Touch-up" procedures are extremely quick and easy, and there are no additional charges. 17. How safe is the procedure? When performed at the right centre, LASIK treatments are extremely safe. Like any laser or surgical procedure, these treatments are subject to complications, but the complication rate is very low. Most complications can be corrected through eye drops or surgical procedure. Note- Complications may occur as rarely as one in a million or billion cases on papers of study report, but beware that one may be you! In order to decrease the risk of complication, we at the Raj Eye Hospital walk the extra mile and take many steps that go far beyond the minimum standards of most laser centers. Our laser is calibrated before every single procedure to ensure the most accurate results, whereas many laser centers only calibrate the laser every six patients, or even just once per day. We monitor and control the temperature and humidity in our laser room, which improves the accuracy of our results. One of the more important steps to avoid complication is in the rigorous testing of our patients. After the brief initial screening exam and prior to undergoing a procedure at the LASIK Center, we will perform a most thorough evaluation; some important measurements will be performed two or more times, and will be further repeated if necessary. Few patients will experience optical aberrations during the initial healing phases, including glare, halos at night, or ghost images. In 99% of cases, this will disappear in few weeks. |
Small wonders why many of us find life with glasses less exciting! And why not? Nature is so beautiful and bountiful and it is only natural to view it with plain eyes and not with glasses or contact lenses. While the latter sends a vague sense of awkwardness, nothing beats the former. Here's to this discomfort. We aim at providing a non-glassy touch and a 'non-glassy cut above the rest'. 
