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Cover Focus | June 2017

Let’s Talk About LASIK

Education and cooperation are key to achieving good results.

LASIK has become one of the most popular and safest elective procedures performed today.1 Nevertheless, we should never forget that, in general, LASIK patients have very high expectations of their postoperative visual outcomes. It is essential, therefore, to devote time to ensuring that each patient understands the aims of the surgery, its limitations, and its possible complications.

The point I make when talking to patients about LASIK is that we will attempt to help them stop depending on the glasses or contact lenses they have needed for so many years. However, I never state that patients will no longer wear glasses after surgery. It is also important to emphasize that, during surgery, the patient’s collaboration is key to the success of the procedure. He or she must remain calm and follow my instructions, among them being “Look at the light,” and “Avoid moving your eye.” Once the patient is aware of this responsibility, and of the steps involved in the surgery and the sensations he or she will experience, everything becomes simpler in the operating room.

During surgery, doctor-patient communication is again a key factor. Informing the patient that he or she will now feel the suction ring or hear the noise of the laser as the flap is created eliminates surprises and leads to the maximum cooperation of the patient—and, ultimately, to successful surgery. In addition to preparing patients for the intraoperative experience, I also clearly explain the intra- and postoperative complications that may occur. Patients are also instructed in how to take care of their operated eye after LASIK.

USING VISUAL AIDS

I usually show patients 3-D images and videos specially designed for patient education about LASIK and other topics. We started out by using animations created by Amerral Medical that were available on YouTube; however, we have since developed and now use our own animations. These visual aids, which I can display on my tablet or desktop computer, are useful, detailed, and patient-friendly.

As I said earlier, it is essential that patients understand the procedure before surgery is planned; however, I never show patients footage from an actual surgical procedure, and I even recommend that they not watch such videos on the internet. Instead of going online to get answers to their questions, I insist that they bring any doubts or questions to me or my team. I emphasize that we will be sure to answer their questions accurately, whereas the accuracy of information on the internet is never assured. This can be gleaned from the accompanying sidebar, in which I answer the five most common questions I receive from patients regarding LASIK, followed by answers pulled from the first page of a Google search of that question.

INFORMED CONSENT

Informed consent for an elective procedure such as LASIK must be as complete as possible, offering even more detail than what we describe in face-to-face meetings with patients. A good informed consent reiterates the aim of the surgery and the steps to be followed. It also details all possible complications, along with their incidence rates and the solutions we can use to address them if they occur.

Informed consent also must explain the possibility that retreatment may be necessary. It is fundamental for patients to understand the conditions under which additional treatment or enhancement may be necessary and when and how it will be carried out. It is also important to indicate whether there would be additional charges associated with retreatments.

Our surgical department is in charge of providing patients with all the information they need about LASIK. Our staff gives each patient enough time to read any printed information and raise questions. The staff members can answer most patient queries because they have been carefully trained for this purpose, and they know the LASIK protocol in depth.

Question No. 1: Will I be awake?

Dr. Benatti: Yes, you will be awake and conscious all through surgery. As I mentioned, I need you to be calm and to pay attention to the instructions I give you during the procedure. For example, I will tell you when not to move your eye and when to look fixedly at the green light. This will help us carry out the surgery effectively and safely, reducing the possibility of intraoperative complications to a minimum.

Google hit No. 2: Perhaps the most common LASIK fear is the fear of being awake during surgery. But LASIK begins with numbing eye drops, and sometimes a mild sedative, to help you relax. Still, some patients notice mild discomfort, such as pressure, vibration, or dimmed vision, during the procedure. You don’t have to worry about blinking, though, because a specially designed instrument holds your eye open. And a computer in the laser tracks your eye movement more than 4,000 times per second, ensuring precision. In 15 minutes or less, both eyes can be done with little discomfort. If you can stare straight ahead for 45 seconds—about as long as it takes to watch a traffic light—you can do this.1

1. www.lasik.com/articles/common-lasik-fears/

Question No. 2: Will LASIK surgery or the laser beam be painful?

Dr. Benatti: No, it will not. The procedure is done under topical anesthesia: that is to say, with numbing eyedrops. You will not feel pain. You will feel the device that keeps your eye open (called a blepharostat) and the pressure exerted by the suction ring, and then you will hear the sound of the laser when it performs the cut. None of that will be painful.

Google hit No. 5: While Improve Eyesight HQ does not advocate laser eye surgery (such as LASIK), we understand that some [individuals] feel that getting their eyesight fixed quickly is a necessity. … Most people would imagine the whole process to be painful and scary and potentially life debilitating (going blind) if a burning hot laser beam goes off tangent. Fortunately, that’s just a myth because the laser beam is actually cold. The short answer is that laser eye surgeries are generally not painful (no stitches involved), but one may expect to experience a certain degree of discomfort, often mild, during surgery and recovery. It is also important to note how your perception of the process can affect the level of discomfort experienced. For example, if you go into the procedure feeling extremely anxious, your heightened sense of awareness may make you more sensitive towards discomfort and pain. Likewise, if you are relaxed and feeling confident about the whole process and outcome, your experience of the surgery would most likely be more positive.1

1.http://www.improveeyesighthq.com/does-laser-eye-surgery-hurt.html

Question No. 3: If there is a complication, can I become blind because of the laser?

Dr. Benatti: Definitely not. Right before the flap cut is initiated, you might notice temporary blindness, but this is normal during the procedure. Should there be an intraoperative complication, we may need to reschedule the procedure for a couple of months later, at which time we will decide whether to repeat LASIK or perform PRK instead. Postoperative complications such as dry eye, night halos, and undercorrection will be reduced to a minimum thanks to the detailed preoperative screening process we have performed before choosing you as candidate for surgery.

Google hit No. 1: No poll needed, this is every LASIK patient’s greatest fear. You go in with blurry vision, come out with none. Dr. Chynn [Emil William Chynn, MD, FACS, MBA] states that this is very rare, but references a case where an Italian woman with atherosclerosis had laser eye surgery and the blood didn’t return in her eye after the LASIK suction ring was removed. Temporary blindness, [Dr.] Chynn explains, may occur because during LASIK surgery “you have to pump the pressure up in the eye to about 6x normal in order to cut a good flap, as you can’t cut an accurate flap in a floppy eye. The pressure is actually higher than your blood pressure, so the eye stops perfusing with blood, and you go temporarily blind.”1

1. https://www.realself.com/blog/terrible-lasik-surgery-complications#.WSWirTOZOV4

Question No. 4: Will I need glasses after surgery?

Dr. Benatti: LASIK is a very safe surgery, and its aim is to help you avoid wearing glasses. Most patients do not need them after LASIK, but, in a few cases, patients find that very low-power glasses may be necessary, perhaps only for certain specific purposes or special activities. Let me point out here that, despite your LASIK, after the age of 45 years presbyopia begins to develop. After that, you will need glasses for reading or computer use.

Google hit No. 2: By choosing LASIK with the right doctor and advanced technology, the typical person age 18 to 45 will not need prescription glasses at all. Between age 40 and 50, a person will likely need reading glasses whether they have had LASIK or not, due to the reduced flexibility of their eyes’ lenses. This condition is called presbyopia and can be effectively handled through a special LASIK technique known as monovision, which has given thousands the ability to see both close up and far away. If you are considering LASIK and are using reading glasses, you should ask your LASIK doctor if monovision will work for you.1

1. https://eyecareinstitute.com/8-questions-about-lasik/

Question No. 5: How long does recovery take?

Dr. Benatti: Recovery time is quite short. After surgery, you should go back home to relax and rest. The following day, 24 hours after surgery, you must come back for the first postoperative follow-up visit. Usually by that time all discomfort is over, and your vision, although not definitively stabilized, is very good. From then on you may resume most of your activities, except those we have previously indicated to you.

Google hit No. 1: Most patients who have LASIK are happy about their LASIK recovery time, with the vast majority reporting that their eyes felt fairly normal the day after having surgery. Many patients also experience improved vision immediately following LASIK, but it is important to understand that patients with higher prescriptions will notice an improvement quicker than patients who have lower prescriptions. In these cases, the patient may not see an improvement in their vision until 6 to 8 hours into their LASIK recovery.1

1. https://www.qualsight.com/lasik-recovery-time

CONCLUSION

Once patients are well educated on the aims and execution of the procedure, and once all their questions have been answered to their satisfaction and to my own, we can proceed to schedule surgery. With their concerns out of the way, their expectations set properly, and their intraoperative and postoperative cooperation assured, we have the best chance of achieving satisfactory outcomes for our LASIK patients.

1. Solomon KD, Fernández de Castro LE, Sandoval HP, et al. LASIK world literature review. Ophthalmology. 2009;116(4):691-701.

C. Andres Benatti, MD
  • Cornea and Refractive Surgeon, Associate Professor, and Director of Teaching and Research at Clinica de Ojos Córdoba, Argentina
  • International Professor, Cornea and Refractive Surgery Department, Asociacion Para Evitar la Ceguera en Mexico (APEC), Mexico
  • andresbenatti@gmail.com
  • Financial disclosure: None acknowledged

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