Answers To Your Top LASIK Questions
LASIK is something that provides an almost immediate lifestyle change that frees you from the hassles of wearing glasses or contacts, yet many people jump right into it without asking questions.
But like with any other life-changing decision, we at LASIK of Nevada feel it’s important to be well informed. There’s no doubt that laser eye surgery is an amazing technology that has revolutionized eye care and provided glasses-free living for millions of people, but there are still things every person considering LASIK should know.
Different Refractive Errors
1. What is nearsightedness?
Over 60 million Americans suffer from nearsightedness, or myopia. A person is considered nearsighted when the eye has too much focusing power. This occurs when the eye is either too long or the cornea is too steep to allow light to focus directly on the retina (the film of the eye). Instead, light focuses in front of the retina causing distant images to appear blurry. A minus power lens in the form of eyeglasses or contact lens is needed to subtract focusing power from the eye.
2. What is farsightedness (hyperopia)?
Hyperopia (or farsightedness) is a condition where light rays entering the eye are focused behind the retina instead of directly on it, as in the normal eye. It may be present in childhood but does not usually become apparent until people are in their late 20s or 30s when they can no longer see up close. When these patients get into their 40s or 50s, they begin having difficulty seeing distant objects as well.
3. What is Astigmatism?
Astigmatism is a condition that occurs when the cornea or lens is steeper in one axis than another, similar to a football or the back of a spoon instead of completely spherical or round like a basketball. Light entering the cornea focuses on more than one point within the eye resulting in blurred vision. Astigmatism is either regular when steep and flat axes are 90 degrees apart or irregular when they are not separated by 90 degrees.
4. What is Presbyopia?
5. What is a Diopter?
6. How can These Visual Problems be Corrected?
7. Are There other Non-surgical Means of Improving Your Vision?
series of progressively flatter gas permeable hard contact lenses are used to flatten the cornea. When the cornea has reached its desired correction, a retainer contact must be worn for several hours per day to prevent the cornea from returning to its original shape. Therefore, it does not cause a permanent correction.
History of Refractive Procedures
8. What is a Refractive Procedure?
9. What is Laser Vision Correction (LVC)?
10. What is the History of the Excimer Laser?
11. What Procedures are Performed with the Excimer Laser?
Refractive Procedures and How They Work
12. How do LASIK and PRK work?
In both procedures, a specially trained ophthalmologist uses the computer-guided excimer to gently reshape the cornea to achieve a desired correction. Prior to the procedures, drops are placed in the eye to numb it (like the ones your eye doctor uses to check your eye pressure for a glaucoma test) and an instrument called a speculum is placed in the eye to prevent you from blinking. There are no needles and no pain.
In PRK, the surgeon first removes the surface cells of the cornea using a laser or other technique, and then sculpts the underlying tissue with the laser. In LASIK, an instrument called a microkeratome or a femtosecond laser is used to gently create a “flap” – which is simply a superficial, thin layer of corneal tissue. This flap remains attached to the eye by a “hinge” which improves stability, safety, and the accuracy of repositioning of this flap after the laser treatment. The laser is used to sculpt tissue from the layer of the cornea just beneath the flap, and the flap is then gently placed back into its original position where it instantly reattaches without the need for sutures.
During the LASIK procedure, there is no pain. Instead, there is a sensation of firm pressure for 8 to 10 seconds while the corneal flap is being created (this pressure sensation does not occur during the PRK procedure). Following the procedure, LASIK patients are often more comfortable then patients who have PRK. LASIK patients will usually experience the sensation of having an eyelash or two floating on the surface of the eye for several hours, whereas PRK patients may have a greater degree of discomfort for a somewhat longer period of time. However, with the unique and powerful combination of numbing drops that we have utilized for the past several years, the discomfort level after PRK has been significantly reduced. In fact, most patients tell us that their level of discomfort after PRK is equivalent to the excellent level of comfort experienced by patients after LASIK.
13. How Long do the Procedures Actually Take?
14. Why is LASIK the Procedure of Choice for Most Patients and Surgeons?
15. How is Astigmatism Corrected?
16. What other Alternatives are There to PRK and LASIK?
17. Are there Other Alternatives for Astigmatic Correction?
18. What About Farsightedness?
In the past ALK was used. In this procedure a thicker layer of the cornea was folded back with the microkeratome. Pressure inside the eye causes the corneal bed to steepen, the opposite of what occurs in LVC. The cap was placed back into position without the removal of additional tissue. Although it has been shown to effectively reduce or eliminate farsightedness in the +1.00 to +5.00 range, enough cases of corneal instability have been reported nationwide that this procedure has fallen out of favor. Now LASIK for hyperopia is considered by most to be the best option.
Conductive Keratoplasty (CK) uses a fine tipped probe to deliver radio-frequency energy to the corneal collagen in a ring of individually placed spots to steepen the cornea. Farsighted patients with a prescription between +0.75 to +3.25 and no more than 0.75 diopters of astigmatism are the best candidates for this procedure. Because of mild regression and a lack of long-term results, the procedure has been labeled as temporary.
19. How does LVC for Hyperopia Work?
20. What are the Results/Will my Vision be 20/20 after LVC?
21. Are these Procedures FDA Approved?
22. How do I know if I’m a Good Candidate for Laser Vision Correction?
The great majority of all nearsighted Americans are potential candidates for the laser treatment. Patients must be at least 18 years of age, have mild to moderate near sightedness with a stable prescription, and have no ocular or health issues. The best candidates tend to be people who are dissatisfied with their glasses or contact lenses and are motivated to make a change, whether it’s due to occupational or lifestyle reasons.
Although a patient’s prescription may make him or her a suitable candidate for laser vision correction procedure, it is very important that the patient have the appropriate level of expectations regarding the outcome of the procedure. Although uncorrected post-op vision (after healing) is usually excellent, no one can promise you 20/20 vision.
A person is a good candidate for laser vision correction if he or she expresses the following sentiments in discussing whether or not to undergo the procedure:
- I dislike being dependent on glasses for clear vision.
- I was never a good contact lens candidate/wearer.
- Wearing corrective lenses restricts my participation in sports and other activities.
- My overall appearance is improved without glasses.
- I worry about losing my corrective lenses (or breaking my glasses). Without them I fear that I would be totally disabled.
- Having good vision without corrective lenses is more important than having great vision with corrective lenses.
- I would be happy if my vision was greatly improved, even if I still had to wear corrective lenses some of the time.
- I usually adjust well to change.
- I am a fairly easy-going person.
- Not wearing corrective lenses would open new career opportunities for me.
- I have often wished I did not have to wear corrective lenses.
A person is probably not a good candidate for Laser vision correction if he or she expresses the following sentiments in discussing whether or not to undergo the procedure:
- I like wearing glasses and would feel uncomfortable without them.
- I don’t mind wearing contact lenses.
- Glasses give me excellent vision for all activities.
- I don’t accept changes easily.
- I get upset or stressed out easily when things don’t seem to happen in just the way I had planned or expected.
- I am a perfectionist and little irregularities bother me.
- I would be very upset if I did not end up with perfect vision after my procedure and would probably consider the entire experience a failure.
- If I needed more correction after my procedure, I would be devastated.
A patient is also not a good candidate for laser vision correction, if any of the following conditions are present:
- Less than 18 years of age
- Progressive myopia/unstable refractive error (>0.25-0.50/yr)
- Keratoconus – an abnormal progressive weakening of the cornea that your doctor can detect with a sophisticated computerized machine called a corneal topographer as well as other tests
- Pupil size greater than 8 mm in diameter (in dim illumination) are only candidates for Wavefront Optimized or Optimized Aspheric treatment.
- Cataracts – Early, small, or mild cataracts often do not disqualify someone from having LASIK. A complete dilated eye exam is required to determine whether or not a patient with a cataract would be a good candidate for LASIK or would do better with a procedure to remove the cataract
- Unwilling to commit to post-procedure and follow-up care instructions
- Ocular herpes
- Uncontrolled diabetes
- Uncontrolled inflammatory diseases
23. Is there a Limit to How Much Nearsightedness LVC can Correct?
24. If I have had a Previous Corneal Injury, can I have a Refractive Procedure Done?
What to Expect During the Procedure
25. Will I be in any Pain?
During the LASIK procedure, there is no pain. Instead, there is a sensation of firm pressure for just 8 to 10 seconds while the corneal flap is being created. Following the procedure, patients may experience some mild scratchiness (usually described as the sensation of having an eyelash or two floating on the surface of the eye) that is relieved by the use of artificial tears and several hours of rest.
There is no discomfort at all during the PRK procedure. Following the procedure, you may experience a gritty sensation with some mild to moderate discomfort which we alleviate by putting in a contact lens and giving you anesthetic drops and pain medication to use during the first 24 hours in the event of severe discomfort. All discomfort should be completely resolved within 2-3 days as the surface layer fills in to cover the exposed area. All discomfort should be completely resolved within 2-3 days except in the rarest of cases.
26. Can I have Both Eyes Done at the Same Time?
27. Will I be Awake as the Procedure is Being Performed?
28. What if My Eye Moves During the Procedure?
LASIK Recovery Time
29. When Can I go Back to Work?
30. Will I Require Eye Drops After my Procedure?
In PRK, because the laser removes tissue from the surface of the eye, the body will attempt to fill in the defect much like if you had a cut on your hand. Since corneal tissue has different healing properties, the process can normally be regulated with the use of topical steroid drops which patients may be required to use over a five-week period.
In LASIK, these drops are only used for a week. These drops will rarely cause any problems. However, eyes must be monitored to fine tune the drop dosage and check for any unwanted side effects such as delayed or too rapid healing and elevation in eye pressure (glaucoma). Antibiotic drops are also used for about a week with both procedures. Please see – Post Operative Instructions.
31. How Many Times will I be Seen Following my Procedure? And how Important are These Appointments?
32. How Long do I Have to Wait Before I can Take a Bath or Shower After my Procedure?
33. When can I Wear Eye Makeup After Procedure?
34. How Soon After My Procedure Can I Drive?
35. When Can I Exercise After my Procedure?
What to Expect After My Procedure
36-a. If I have LASIK, What Kind of Vision can be Expected the Following Day?
36-b. If I have PRK, What Kind of Vision can be Expected the Following Day?
37. Will I Need Glasses or Contacts After Procedure?
38. Will I Need Reading Glasses After Procedure?
As people enter their 40s, they start to develop presbyopia (see #4). Regardless of whether or not you’ve had laser vision correction, this process will happen to you. Your surgeon can create an effect known as monovision. This means that one eye will be left slightly nearsighted, thus allowing you to focus on print such as labels and menus without reading glasses, and perhaps allowing you to read into your 50s. As one gets older, it will be necessary to wear reading glasses. Furthermore, if you are over the age of 40 and are used to removing your glasses to read, you must realize that this will no longer be an option following a full correction of your nearsightedness with the procedure.
Shortly after you have had the procedure, it is possible that you may require a temporary pair of reading glasses if you are approaching your 40th birthday since the laser, by design, causes an early overcorrection that normally goes away with time.
39. Can I Wear Contact Lenses after Laser Procedure?
40. Will the Effects of the Treatment be Permanent?
Safety and Laser Vision Correction
41. What are the Risks and How Can I find the Right Doctor for Me?
Most patients are very pleased with the results of their refractive surgery. However, like any other medical procedure, there are risks involved. That’s why it is important for you to understand the limitations and possible complications of refractive surgery.
Before undergoing a refractive procedure, you should carefully weigh the risks and benefits based on your own personal value system, and try to avoid being influenced by friends that have had the procedure or doctors encouraging you to do so.
- Some patients lose vision. Some patients lose lines of vision on the vision chart that cannot be corrected with glasses, contact lenses, or surgery as a result of treatment.
- Some patients develop debilitating visual symptoms. Some patients develop glare, halos, and/or double vision that can seriously affect nighttime vision. Even with good vision on the vision chart, some patients do not see as well in situations of low contrast, such as at night or in fog, after treatment as compared to before treatment.
- You may be under treated or over treated. Only a certain percent of patients achieve 20/20 vision without glasses or contacts. You may require additional treatment, but additional treatment may not be possible. You may still need glasses or contact lenses after surgery. This may be true even if you only required a very weak prescription before surgery. If you used reading glasses before surgery, you may still need reading glasses after surgery.
- Some patients may develop severe dry eye syndrome. As a result of surgery, your eye may not be able to produce enough tears to keep the eye moist and comfortable. Dry eye not only causes discomfort, but can reduce visual quality due to intermittent blurring and other visual symptoms. This condition may be permanent. Intensive drop therapy and use of plugs or other procedures may be required.
- Results are generally not as good in patients with very large refractive errors of any type. You should discuss your expectations with your doctor and realize that you may still require glasses or contacts after the surgery.
- For some farsighted patients, results may diminish with age. If you are farsighted, the level of improved vision you experience after surgery may decrease with age. This can occur if your manifest refraction (a vision exam with lenses before dilating drops) is very different from your cycloplegic refraction (a vision exam with lenses after dilating drops).
- Long-term data are not available. LASIK is a relatively new technology. The first laser was approved for LASIK eye surgery in 1998. Therefore, the long-term safety and effectiveness of LASIK surgery is not known.
Additional Risks if you are Considering the Following:
Monovision is one clinical technique used to deal with the correction of presbyopia, the gradual loss of the ability of the eye to change focus for close-up tasks that progresses with age. The intent of monovision is for the presbyopic patient to use one eye for distance viewing and one eye for near viewing. This practice was first applied to fit contact lens wearers and more recently to LASIK and other refractive surgeries. With contact lenses, a presbyopic patient has one eye fit with a contact lens to correct distance vision, and the other eye fit with a contact lens to correct near vision. In the same way, with LASIK, a presbyopic patient has one eye operated on to correct the distance vision, and the other operated on to correct the near vision. In other words, the goal of the surgery is for one eye to have vision worse than 20/20, the commonly referred to goal for LASIK surgical correction of distance vision. Since one eye is corrected for distance viewing and the other eye is corrected for near viewing, the two eyes no longer work together. This results in poorer quality vision and a decrease in depth perception. These effects of monovision are most noticeable in low lighting conditions and when performing tasks requiring very sharp vision. Therefore, you may need to wear glasses or contact lenses to fully correct both eyes for distance or near when performing visually demanding tasks, such as driving at night, operating dangerous equipment, or performing occupational tasks requiring very sharp close vision (e.g., reading small print for long periods of time).
Many patients cannot get used to having one eye blurred at all times. Therefore, if you are considering monovision with LASIK, make sure you go through a trial period with contact lenses to see if you can tolerate monovision, before having the surgery performed on your eyes. Find out if you pass your state’s driver’s license requirements with monovision.
In addition, you should consider how much your presbyopia is expected to increase in the future. Ask your doctor when you should expect the results of your monovision surgery to no longer be enough for you to see near-by objects clearly without the aid of glasses or contacts, or when a second surgery might be required to further correct your near vision.
Bilateral Simultaneous Treatment
You may choose to have LASIK surgery on both eyes at the same time or to have surgery on one eye at a time. Although the convenience of having surgery on both eyes on the same day is attractive, this practice is riskier than having two separate surgeries.
If you decide to have one eye done at a time, you and your doctor will decide how long to wait before having surgery on the other eye. If both eyes are treated at the same time or before one eye has a chance to fully heal, you and your doctor do not have the advantage of being able to see how the first eye responds to surgery before the second eye is treated.
Another disadvantage to having surgery on both eyes at the same time is that the vision in both eyes may be blurred after surgery until the initial healing process is over, rather than being able to rely on clear vision in at least one eye at all times.
Finding the Right Doctor
If you are considering refractive surgery, make sure you:
- Compare. The levels of risk and benefit vary slightly not only from procedure to procedure, but from device to device depending on the manufacturer, and from surgeon to surgeon depending on their level of experience with a particular procedure.
- Don’t base your decision simply on cost and don’t settle for the first eye center, doctor, or procedure you investigate. Remember that the decisions you make about your eyes and refractive surgery will affect you for the rest of your life.
- Be wary of eye centers that advertise, “20/20 vision or your money back” or “package deals.” There are never any guarantees in medicine.
- Read. It is important for you to read the patient handbook provided to your doctor by the manufacturer of the device used to perform the refractive procedure. Your doctor should provide you with this handbook and be willing to discuss his/her outcomes (successes as well as complications) compared to the results of studies outlined in the handbook.
Even the best screened patients under the care of most skilled surgeons can experience serious complications.
- During surgery. Malfunction of a device or other error, such as cutting a flap of cornea through and through instead of making a hinge during LASIK surgery, may lead to discontinuation of the procedure or irreversible damage to the eye.
- After surgery. Some complications, such as migration of the flap, inflammation or infection, may require another procedure and/or intensive treatment with drops. Even with aggressive therapy, such complications may lead to temporary loss of vision or even irreversible blindness.
Under the care of an experienced doctor, carefully screened candidates with reasonable expectations and a clear understanding of the risks and alternatives are likely to be happy with the results of their refractive procedure.
Be cautious about “slick” advertising and/or deals that sound “too good to be true.” Remember, they usually are. There is a lot of competition resulting in a great deal of advertising and bidding for your business. Do your homework.
42. Is it Possible to Become Blind with The Procedure?
43. What are the Drawbacks of LASIK?
44. How do I know Laser Vision Correction is Safe?
45. Being so Prevalent in NEVADA, How Do You Protect Against Power Surges and Outages?
Many of our patients have expressed understandable concern by asking, “What happens if there is a power outage during my laser treatment?” The answer is that we have a very sophisticated uninterruptible power supply (UPS) that will take over and supply needed power to the laser to complete any treatment started.
The laser will run for more than 20 minutes following a power outage, more than enough to complete any procedure. Our UPS unit provides pure sine wave technology for perfect mains voltage reproduction and regulation. This means that no matter what happens to the mains voltage, including current sags, or “brown outs,” all of our 3 lasers are provided with continuous alternating current power, exactly the same power that operates them under normal conditions.
I Would Like to Have Laser Vision Correction
46. Premium vs. Discount Laser Vision Correction – What is the LASIK of NEVADA DIFFERENCE?
Understandably, patients are often confused as to why LASIK pricing may differ from one office or laser eye center to another. Below are the principal factors that distinguish premium LASIK centers such as LASIK of NEVADA from the discount centers:
- Surgeon Experience and the Patient Experience
Because Dr. Rothman has dedicated his entire professional career as an eye surgeon to just performing refractive prodecure procedures, he has successfully performed over 50,000 LASIK procedures. This is all that he does, and as such, is not distracted throughout the day or week with glaucoma patients one day and cataract procedure patients the next as so many of his colleagues are. Dr. Rothman has carefully hand-picked and brought to LASIK of NEVADA an incomparable, highly skilled professional team with over 50 years of collective experience in the refractive procedure field. With this team, Dr. Rothman believes that the patient experience is optimized with personalized education and a detailed, no cost consultation to best determine which laser technology is most beneficial to you. We are singularly focused to meet and even exceed your expectations, as this is all that we do at LASIK of NEVADA. Dr. Rothman stands behind your results by several post-procedure plans for your enhancements. We encourage patients to visit the center and even observe Dr. Rothman perform a live LASIK procedure, if they wish. For your convenience, we also offer Saturday morning laser vision correction consultations..please call for Saturday appointments.
- Dr. Rothman is the team LASIK surgeon for Check It Out Advertising and ReMax Platinum.
If members of these companies trust their precious eyes and professional careers to Dr. Rothman, so can you – the LASIK of NEVADA Difference.
- The Latest Technology
Not limited to just one laser, Dr.Rothman is able to choose which technology will provide the very best results for each patient, personalizing each treatment plan every step of the way – another LASIK of NEVADA difference.
- The LASIK of NEVADA Premium Practice – A Center of Excellence
By having our own dedicated laser centers we have control over the entire process, each step of which actually allows us to achieve the very best possible results for each of our valued patients. The state-of-the-art Ziemer Femtosecond laser allows for unprecedented accuracy and results. Together with this most advanced laser technology and dedicated expertise and uniquely personalized treatment planning, we are able to provide you with a premium laser vision correction experience.Premium LASIK at LASIK of NEVADA can certainly be an exciting alternative to the more traditional annoyance of glasses and contact lenses for most people.
47. Why is LASIK of NEVADA Recognized as the LEADER in NEVADA?
Dr. Richard Rothman and the professional team at LASIK of NEVADA are recognized as the leader in LASIK laser vision correction in Nevada. Here’s why:
- 15 years of exclusively dedicated LASIK refractive eye procedure – it is all that we do.
- Extensive training and expertise of our eye surgeon – Dr. Rothman.
- Entire staff boasts over 50 years of collective experience in the refractive procedure field.
- Dr. Rothman has performed over 50,000 procedures.
- Dr. Rothman is the official team laser eye surgeon for “Phantom of the Opera” and numerous radio personalities and celebrities.
- First in Nevada with the newest FDA approved laser, the Alcon Allegretto Excimer laser.
- Nevada’s most experienced Alcon Allegretto Excimer laser provider.
- Nevada’s exclusive Alcon Allegretto Excimer laser provider for over three years.
- Dr. Rothman is a Certified National Trainer for the Alcon Allegretto Excimer laser and has trained military surgeons across the United States in this technology.
- We have the advanced Orbscan corneal mapping technology for more definitive diagnosis and treatment planning.
- Only center in Nevada with the newest FDA approved laser for flap creation, the Ziemer Z6 laser.
48. How do I Proceed? What is My Next Step?
LASIK of NEVADA is committed to preserving your absolute trust and confidence in us. LASIK of NEVADA will not sell, rent, trade or share your personal information at the center or from this website with anyone except where legally required.
LASIK of NEVADA will not disclose your personal information without consent unless required to do so by applicable law or requires us to: 1) conform to legal requirements; 2) protect and defend the rights or property of LASIK of NEVADA; or 3) directly enforce its agreements with you.