Things You Should Know Before LASIK Eye Surgery
15 Things You
Should Know Before You Have
The following information is provided by The San Diego LASIK
Institute as a service to patients considering LASIK and other types of refractive surgery. It is intended
to encourage patients to examine issues about LASIK that are not commonly considered or discussed. If you
have any questions about LASIK or would like to schedule an appointment for a no cost, no obligation
consultation to see if you are a candidate for LASIK please call The San Diego LASIK Institute.
Is your surgeon American Board Certified?
Physicians and surgeons go through a process call Board
Certification as part of their total educational and credentialing process. In the United States, The American
Board of Ophthalmology certifies eye surgeons. This is a rigorous examination process that can only be completed
after the surgeon has successfully finished their residency and gained additional clinical experience. It also
demonstrates that the surgeon meets or exceeds certain standards of practice and competency. It is important
that any ophthalmologist you consider for LASIK have this credential.
Is your surgeon experienced in all aspects of refractive
surgery including LASIK?
Dr. Pham is experienced in all types of refractive surgery
including all laser IntraLASIK, photo-refractive keratectomy, (PRK), refractive lens exchange, multifocal
lenses, limbal relaxing incisions (LRI), and the Staar Implantable contact lens.
The surgeon also needs to have performed enough LASIK and
refractive surgery procedures to have this type of surgery down to a science. Although there is no generally
accepted minimum number of surgeries that a surgeon needs to have performed to establish consistently good
results, your choice of a surgeon should be someone who has performed at least 1,000 refractive procedures and
be able to provide you with long term (at least two years) data on their results.
Dr. Pham has dedicated his career to refractive surgery and
IntraLASIK. He believes that the key to success in any field is to concentrate on one area of expertise.
Does the surgeon live locally and is he/she
available for emergencies?
Dr. Pham lives locally and is always immediately available for
his patients. Although LASIK patients rarely have significant complications, there are times after surgery when
immediate availability of the surgeon is imperative. Most commonly this is when there is a problem with the
corneal flap. There are many offices and LASIK centers where the surgeon is only present part time and actually
lives more than a hundred miles away. Always check to see how accessible your surgeon is and how their office
manages after hour emergency calls.
What type of laser does the facility
The excimer laser market is very competitive with many newcomers
that have varying levels of approval by the U.S. Food and Drug Administration (FDA). The VISX S4 with Iris
RegistrationTM laser is approved to correct a range of myopia, hyperopia, and
astigmatism prescriptions. It is also one of the most widely used laser by ophthalmologists in the United
States and has a long track record of reliability and excellent outcomes. VISX’s hardware and
software support are second to none. As a company, VISX is dedicated to research and development
to stay at the leading edge of refractive surgery. However, not all practices upgrade to the newest
advancements. Just like a person can have an iPhone, it is important to see which version of the phone it is.
This principle is the same with the Visx and CustomVue. Our practice uses iDesign 2.0 which is the newest
upgrade from Johnson and Johnson (Visx parent) in 2019.
Is a blade used for LASIK? Does the center offer all laser
One of the most critical steps for successful LASIK is the
creation of a good corneal flap. This can be done with a device called a micro-keratome which is a precise
surgical instrument specifically designed for LASIK. In the past, a microkeratome has been used to perform this
step. Although most people who undergo traditional LASIK with a microkeratome and blade do well, there are a
small but significant number of possible complications associated with the use of a blade. These include but are
not limited to corneal abrasions, irregular flaps, flap striae or slippage and buttonholes.
One of the most important breakthroughs in laser vision
correction is the IntralaseTM method of flap creation. Dr. Pham believes in
using this revolutionary technology to decrease the risk of flap complications. The Intralase laser also allows
him to control how your flaps are made.
What is the enhancement rate of the surgeon?
Although most patients are successful with only one treatment, a
significant percentage of patients will need to have one or both eyes “enhanced”. This is a second laser
procedure to “touch up” the original treatment. It is important to make sure that the eye has stabilized before
doing an enhancement. Therefore, they are usually not performed before three months after the initial surgery.
Nationwide, the average enhancement rate is about 10% - 15%. Enhancement rates greater than 20% should be
view with suspicion. High enhancement rates obviously indicate a problem. Dr. Pham strives to keep his
enhancement rate below 1-3%.
Repeated enhancements can make the cornea too thin and
create poor vision. Therefore, one or two enhancements are often the maximum number that can safely be
performed. The determination of whether and enhancement is necessary will occur within three – six months from
the original surgery. Enhancements beyond a year are rarely needed or practical.
Will your surgeon work with your family eye
Your family eye doctor knows your eyes and personality best. He
or she can be an excellent resource in helping you make this important decision. In addition, they can perform
your pre-operative examination and post-operative care. In most instances this care does not add to the cost of
the overall procedure and in fact may be less expensive. It is important to clarify all fees with your eye
doctor and operating surgeon prior to surgery.
Will I still need to wear reading
glasses after LASIK?
If you are over 40 and you are already in bifocals the answer is
“Yes”. Over time, the internal lens of the eye loses a certain amount of flexibility and is unable to focus
properly at close distances. This condition is called presbyopia. There are no approved refractive surgery
procedures available at this time that correct presbyopia including LASIK. There is a procedure called LTK that
is being advertised in very misleading manner that implies that LTK cures presbyopia. It does not. Therefore, if both eyes are corrected for clear
distance vision by LASIK and you are over 40, it is highly likely that you will need glasses for reading small
print such as a newspaper or magazine.
In order to “get around” presbyopia, some patients over 40
can have one eye corrected for distance and the other eye corrected for reading at near. This is called
monovision and can be successful if there is a history of successful monovision with contact lenses. We would
recommend that you consult with your family doctor of optometry to see if you can adapt to monovision with
contacts. If so, you may be a candidate to have the contact lens correction duplicated with LASIK.
How soon can I return to work after LASIK?
Unless you work outdoors all day or work in an extremely dusty
or dirty environment, most patients can return to work the following day. If you have your surgery on a Friday,
you should easily be ready to go back to work Monday. Your vision may be a little blurry during the first few
days after surgery with some mild variability. However, you most likely will feel comfortable driving the next
After surgery you will need to be examined at one day, one week,
one month, and three months. These office visits are typically quite short but important. Unless you need an
enhancement, you will be released to normal follow-up for routine examinations after the three-month
examination. If you are borderline for needing an enhancement, you would be re-examined at six months
post-surgery. It is important to have routine eye examinations every one to two years after surgery to be
evaluated for eye diseases such as glaucoma. LASIK does not increase or decrease your risk of eye disease so
regular examinations with your family optometrist are important.
Who should not have LASIK?
Patients with a history of recurring eye infections or
inflammations such as herpes simplex, herpes zoster, and Sjogren’s syndrome are probably not candidates for
LASIK. Certain systemic conditions such as diabetes and autoimmune disease may be contraindications. A good
pre-operative examination for LASIK should include a careful medical and ocular history to make sure there are
no conditions that could compromise the outcome of your surgery. The corneas of pregnant women and nursing
mothers can vary significantly from their baseline state and therefore these patients should put off LASIK for
at least 8 weeks post pregnancy and/or nursing.
Is LASIK affordable?
Considering the cost of glasses and/or contact lenses over the
years, LASIK is very competitive. Financing is available for LASIK that usually allows the procedure to fit into
most people’s budget. For the reasons mentioned in this pamphlet,
patients should be very careful about “shopping for the best price”. LASIK is surgery and it is
permanent. Saving a few dollars here or there should not be the determining factor. Making an informed decision
about this life changing surgery is essential.
At the San Diego LASIK
Institute, we offer several financing offers. We have been able to offer financing to virtually all of our
patients. We strive to make this procedure affordable for everyone!
How can I find out if I am a candidate for LASIK?
At the San Diego LASIK
Institute, we offer no cost, no obligation consultations with convenient appointment times. During this
consultation one of our doctors will review your expectations for LASIK, determine whether your refractive
error can be corrected by LASIK, and rule out any ocular disease problems which might be a problem for a
successful refractive surgery outcome. If you are a candidate and want to proceed with surgery, we would
need to dilate your pupils in order to more thoroughly examine your eyes and re-check your prescription
under dilated conditions (cycloplegic refraction). For further information or to schedule an appointment
call The San Diego LASIK Institute at (888) 453 - 6884
Step 5 - What to Expect During
LASIK San Diego
Comparison Guide for LASIK Surgeons and
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