Lasik Eye Surgery In Review

Lasik Eye Surgery in Review

Lasik is the acronym used to describe Laser in Situ Keratomileusis. It is a special type of refractive laser eye surgery that can only be performed by ophthalmologists. The surgery is intended to help correct poor vision.

Development

Dr. Jose Barraquer created a procedure that was the first step toward the development of Lasik in 1970. At this time, he created a microkeratome, which was used to change the shape of the cornea and to cut the thin corneal flaps. This procedure was called keratomileusis.

In 1990, Dr. Lucio Buratto of Italy and Dr. Ioannis Pallikaris of Greece developed Lasik surgery as it is known today. This was accomplished by combining Dr. Barraquer's technique with photorefractive keratectomy, or PRK. PRK is a form of laser eye surgery that permanently changes the shape of the anterior central cornea by burning off a small amount of eye tissue from the corneal stroma. Today, this procedure alone is not preferred because it takes longer for patients to recover from surgery and is more painful than Lasik.

The combination approach, however, was shown to have a lower number of complications and to be more precise in correcting vision. Dr. Stephen Slade and Dr. Stephen Brint first performed the procedure in the United States in 1991. That same year, German doctors Thomas Neuhann and Tobias Nuehann completed the first automated Lasik surgery in Munich.

Pre-Surgery

Before beginning Lasik surgery, the surface of the corneas must first be examined using a computer controlled scanning device. This serves to determine the exact shape of the cornea. Low power lasers are then used to create a topographic map of the surface of the cornea. This allows the surgeon to also determine the degree of astigmatism, if any, as well as other irregularities that might be present in the cornea's shape.

This information helps the surgeon determine how much corneal tissue needs to be removed, and from where. Generally, the patient is also prescribed antibiotics beforehand. This helps to minimize the risk of developing an infection after the procedure is completed.

In addition, Lasik patients who wear contact lenses are encouraged to stop wearing the contacts for days, or even weeks, prior to the surgery. This is because the cornea needs to absorb oxygen in order to fully function. Low-oxygen permeable contact lenses reduce the ability of the cornea to absorb oxygen. This can result in blood vessels growing into the cornea in a process called corneal neovascularization. This condition can cause an increase in the inflammation of the area and lead to a longer healing time. It can also cause additional discomfort during surgery.

The Procedure

The patient remains awake and fully functional throughout the entire procedure. Usually, a mild sedative is used, along with anesthetic eye drops. The surgeon will then use lasers to make all of the necessary incisions. As this takes place, the computer system keeps track of the patient's eye position at a rate of 4,000 times per second. In this way, it can redirect laser pulses to maintain precise placement of the laser.

Using a blade or a femtosecond laser, the surgeon cuts a flap in the cornea, but leaves a “hinge� on one end. The flap of corneal lining is pulled back to uncover the stroma, which is the middle portion of the cornea. Using an excimer laser, the surgeon reconfigures the corneal stroma by effectively vaporizing tissue. This procedure does not, however, damage the adjacent stroma.

Post Surgery

Lasik surgery does have potential complications, though these are fairly uncommon. Some potential complications include: dry eyes, halos or starbursts around light sources, over or under correction, sensitivity to light, double vision, wrinkles in the “flap,� debris under the “flap,� induced astigmatism, and epithelium erosion.

Many of the potential complications occur as a result of the flap detaching from the rest of the cornea. For this reason, most doctors recommend going home to sleep after the surgery, as this will decrease the likelihood that it will become detached completely. In addition, it is possible to develop an infection under the corneal flap.

Lasik eye surgery is an innovative procedure that utilizes cutting edge technology. But, care should be taken to learn all of the potential risks, both short term and long term, associated with the procedure before having it done.