Background Information:

What are the other Names for the Procedure?

• Laser Vision Correction
• Laser-Assisted In Situ Keratomileusis (Lasik)
• Lasik (Laser In-Situ Keratomileusis)

What is Laser In-Situ Keratomileusis (Lasik) surgical procedure?

• The human eye functions like a camera, to help us see objects clearly. Light coming from an object is refracted or bent and focused on the retina (the light-sensitive screen at the back of the eye). This is carried out by the cornea (a clear transparent membrane that covers the colored part of the eyeball) and the lens, inside the eyeball
• Discrepancy between the eyeball length and the refractory system of the eye, lead to visual disturbances, called refractory errors. Such refractory errors include shortsightedness, farsightedness, and astigmatism (an error where the cornea is not curved smoothly)
• Laser In-Situ Keratomileusis (Lasik) is a procedure to improve vision by reshaping the cornea, using excimer (ultraviolet) laser

What part of the Body does the Procedure involve?

The Laser In-Situ Keratomileusis procedure involves the cornea of the eye.

Why is the Laser In-Situ Keratomileusis (Lasik) surgical procedure Performed?

A Lasik surgery is performed to improve the vision of individuals, who are:

• Nearsighted
• Farsighted
• Affected by astigmatism

What are some Alternative Choices for the Procedure?

A few alternatives to the Laser In-Situ Keratomileusis procedure include:

• Use of contact lenses/eye glasses, to improve vision
• Other vision correcting surgical procedures, such as:
• Photorefractive keratectomy (PRK)
• Conductive keratoplasty for mild to moderate farsightedness
• Radial keratotomy for mild to moderate shortsightedness
• Astigmatic keratotomy for astigmatism
• Laser thermal keratoplasty (LTK) for farsightedness

What are the Recent Advances in the Procedure?

A more individualized treatment option tailored for each individual’s eye, known as a ‘Custom LASIK’ has been developed.

What is the Cost of performing the Laser In-Situ Keratomileusis (Lasik) surgical procedure?

The cost of a Lasik procedure depends on a variety of factors, such as the type of your health insurance, annual deductibles, co-pay requirements, out-of-network and in-network of your healthcare providers and healthcare facilities.

In many cases, an estimate may be provided before the procedure. The final amount depends upon the findings during the surgery/procedure and post-operative care that is necessary.

When do you need a Second Opinion, prior to the Procedure?

• It is normal for a patient to feel uncomfortable and confused with a sudden inflow of information regarding Laser In-Situ Keratomileusis (Lasik) procedure and what needs to be done
• If the patient needs further reassurance or a second opinion, a physician will almost always assist in recommending another physician
• Also, if the procedure involves multiple surgeries or has many alternatives, the patient may take a second opinion to understand and choose the best one. They can also choose to approach another physician independently

What are some Helpful Resources?

http://www.surgery.com/procedure/laser-insitu-keratomileusis-lasik (accessed on 08/02/2014)

http://www.nlm.nih.gov/medlineplus/ency/article/007018.htm (accessed on 08/02/2014)

Complete Guide to Symptoms, Illness & Surgery; Written by H Winter Griffith, M.D.; Revised and updated by Stephen Moore, M.D. and Kenneth Yoder, M.D.; The Berkley Publishing Group, 5^th Edition, New York, 2006

Prior to Laser In-Situ Keratomileusis (Lasik) surgical procedure:

How is the Laser In-Situ Keratomileusis (Lasik) surgical procedure Performed?

• The Laser In-Situ Keratomileusis procedure is performed by an ophthalmic surgeon under mild sedation, after instilling anesthetic eye drops in the eye
• The eyelids are held open using an instrument, called the speculum. The surgeon peels back a flap of superficial corneal tissue (the cornea is the transparent membrane covering the colored part of the eye) to expose the inner corneal layers
• Using an excimer laser, the surgeon then reshapes the corneal tissue depending on the indications for performing Lasik
  • The cornea is flattened for treating shortsightedness
  • It is steepened for treating farsightedness      
  • Its shape corrected for astigmatism
• The corneal flap is then put back in place and the eye gently washed with saline drops, to remove any debris
• The flap is held secure with a shield; no sutures are necessary. Eye drops to prevent infection and control inflammation after the procedure is then, instilled in the eye
• The procedure may be repeated in the other eye, if required

Where is the Procedure Performed?

A Laser In-Situ Keratomileusis is usually performed in an out-patient surgery center facility.

Who Performs the Procedure?

An ophthalmologist, who has experience performing Laser In-Situ Keratomileusis procedures, performs the same.

How long will the Procedure take?

A Laser In-Situ Keratomileusis procedure takes about 10-15 minutes.

What do you need to tell your Physician before the Procedure?

It is very important to provide the following information to your healthcare provider. This enables your healthcare provider in assessing the risks for the Laser In-Situ Keratomileusis procedure and helps avoid unnecessary complications.

• Provide a complete list of medications you are currently, taking to your physician. This information is useful for a variety of reasons. For example, it can help your healthcare provider prevent complications due to a drug interaction
• If you are allergic to any specific medication or food items
• If you are taking blood thinners, such as aspirin, warfarin, herbal supplements, or any other such medications
• If you or your family members, have a history of bleeding disorders, or if there is a tendency to bleed more than normal
• If you have diabetes, high blood pressure, chest pains, or have previously suffered from a heart attack
• If you have ever been diagnosed with blood clots in your leg (deep vein thrombosis) or lung (embolism of lung)
• If you have a history of frequent bone fractures (this may affect bone-healing, if bones are involved as part of your procedure)
• A list of all previous surgical procedures you have undergone, like for example: Removal of appendix, gallbladder, or any other part, of your body; surgical repair of any body part, such as hernia repair, perforation of bowel wall, etc.

What Preparations are needed, prior to the Procedure?

• A complete eye exam is needed prior to the Laser In-Situ Keratomileusis procedure. Individuals wearing contact lenses should discontinue using their lenses for some time, prior to the initial examination. This duration depends on the type of lens being used
• The physician may evaluate the individual’s medical history to gain a comprehensive knowledge of the overall health status of the patient including information related to the medications that are being currently taken.
• Avoid using any make-up/lotion/creams a few days, prior to the procedure
• It may be necessary to scrub the eye lashes clean, prior to the procedure

What is the Consent Process before the Procedure?

A physician will request your consent for Laser In-Situ Keratomileusis procedure using an Informed Consent Form.

Consent for the Procedure: A “consent” is your approval to undergo a procedure. A consent form is signed after the risks and benefits of the procedure, and alternative treatment options, are discussed. This process is called informed consent.

You must sign the forms only after you are totally satisfied by the answers to your questions. In case of minors and individuals unable to personally give their consent, the individual’s legal guardian or next of kin, shall give their consent for the procedure.

What Tests are needed, before the Laser In-Situ Keratomileusis (Lasik) surgical procedure?

A complete eye examination is required before the Laser In-Situ Keratomileusis procedure. The tests performed may include:

• Test to check visual acuity
• Refraction testing
• Slit lamp examination of the eye, to check the cornea and lens
• Fundus exam to check the status of the retina
• Tests to find the curvature and thickness of the cornea

What are some Questions for your Physician?

Some of the basic questions that you might ask your physician are as follows:

• What is a Laser In-Situ Keratomileusis (Lasik) procedure?
• Why is this procedure necessary?  How will it help?
• How soon should I get it done? Is it an emergency?
• Who are the medical personnel involved in this procedure?
• Where is the procedure performed? 
• What are the risks while performing the procedure?
• What are the complications that might take place, during recovery?
• How long will it take to recover? When can I resume normal work?
• How many such procedures have you (the physician) performed?
• Are there any follow-up tests, periodic visits to the healthcare facility required, after the procedure?
• What are the costs involved?

During the Laser In-Situ Keratomileusis (Lasik) surgical procedure:

What kind of Anesthesia is given, during the Procedure?

Topical anesthesia is administered prior to the Laser In-Situ Keratomileusis procedure.

How much Blood will you lose, during the Procedure?

There is no blood loss involved during a Lasik procedure.

What are the possible Risks and Complications during the Laser In-Situ Keratomileusis (Lasik) surgical procedure?

There are general factors that increase the risk of getting complications during surgery and they include:

• Obesity: Generally greater the degree of obesity, greater is the surgical risk
• Smoking: Longer the smoking history (in pack years smoked), greater the surgical risk
• Advancing age
• Poorly controlled diabetes, as evidenced by a high hemoglobin A1c and a high fasting glucose
• Poorly functioning kidney, as evidenced by increased BUN (blood urea nitrogen) and blood creatinine
• Poorly functioning liver, as evidenced by increased blood liver function tests
• Hypertension (increased blood pressure), especially if it is poorly controlled
• Poor nutritional status (malnutrition with mineral and vitamin deficiencies)
• Poor lung function, as evidenced by abnormal lung function tests
• History of bleeding disorders
• Longstanding illness, such as autoimmune disorders, chronic infections
• Poor immune system due to a variety of causes
• The possible risks or complications that may arise during the Laser In-Situ Keratomileusis surgery are:
• Perforation of the cornea can occur, in very rare cases
• Vision abnormalities, arising due to incorrect laser positioning

What Post-Operative Care is needed at the Healthcare Facility after the Laser In-Situ Keratomileusis (Lasik) surgical procedure?

At the healthcare facility, usually there is no requirement for any post-procedure care, unless any complications arise.

After the Laser In-Situ Keratomileusis (Lasik) surgical procedure:

What are the possible Risks and Complications after the Laser In-Situ Keratomileusis (Lasik) surgical procedure?

The possible risks and complications that may arise after a Lasik procedure are:

• Inappropriate vision correction
• Dry eyes
• Vision glare/halos/double vision/blurry vision
• Noticeable difference in vision of both eyes
• Haziness of the cornea
• Increased or decreased light-sensitivity
• Eye infection

What is the Prognosis after the Surgery?

A complete recovery from the Lasik procedure is normally achieved. The prognosis is usually excellent, without any serious complications being noted.

When do you need to call your Physician?

Do contact your physician, if you notice any of the following symptoms:

• Pain that worsens and fluid drainage from the eye
• Complete or temporary loss of vision
• Signs of an infection
• Dizziness
• Muscle aches, headache
• Fever, feeling sick
• Complications associated with prescription medications used in treatment

What Post-Operative Care is needed at Home after the Laser In-Situ Keratomileusis (Lasik) surgical procedure?

At home, the following post-operative care is recommended, after a Laser In-Situ Keratomileusis procedure:

• Individuals should wear an eye patch at night while sleeping, to protect the eye
• Individuals are advised to avoid rubbing the eye
• Avoid washing the face with non-sterile water from the bathtub or faucet, in order to help prevent infection
• Use protective eye wear, while participating in sports or any activity, which may increase the risk of eye injury
• Complete the course of prescribed medication, as advised by your physician
• Use anti-inflammatory and moisturizing eye drops
• Schedule regular follow-up with an ophthalmologist, following the procedure
• Resume driving only after appropriate vision has returned, or when advised by your physician

How long does it normally take to fully recover, from the Procedure?

• In most individuals, the vision becomes normal in a few days’ time, after the procedure
• However, in some cases, it may take as long as 3-6 months
• Some individuals may still need additional vision correction, with low-powered eye glasses or lenses

Additional Information:

What happens to tissue (if any), taken out during the Procedure?

The Lasik procedure does not involve the surgical removal of any tissue.

When should you expect results from the pathologist regarding tissue taken out, during the Procedure?

Since no tissue is removed during the procedure, a pathologist does not get involved in the care of the patient.

Who will you receive a Bill from, after the Laser In-Situ Keratomileusis (Lasik) surgical procedure?

It is important to note that the number of bills that the patient may receive depends on the arrangement the healthcare facility has with the physician and other healthcare providers.

Sometimes, the patient may get a single bill that includes the healthcare facility and the consultant physician charges. Sometimes, the patient might get multiple bills depending on the healthcare provider involved. For instance, the patient may get a bill from:

• The outpatient facility or a hospital
• An anesthesiologist (if anesthesia was administered)
• An ophthalmologist

The patient is advised to inquire and confirm the type of billing, before the Laser In-Situ Keratomileusis (Lasik) procedure is performed.

Thanks and Gratitude:

We sincerely acknowledge and thank Dr. Douglas J. Jones for reviewing the article. His valuable input and feedback has helped enrich the contents of this article.

Douglas J. Jones, MD FACS
Board Certified General Surgeon and Faculty Member
University of Illinois, College of Medicine at Urbana-Champaign
506 S. Mathews Ave., Urbana, IL 61801, USA