Things You Should Know Before LASIK Eye Surgery

15 Things You Should Know Before You Have

LASIK Eye Surgery

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.

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 available for his patients. Although LASIK patients rarely have significant complications, there are times after surgery when availability of the surgeon is important. 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 use?

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 Registration^TM 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 Intralase technology?

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 Intralase^TM 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 doctor? 

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 some 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 day.

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

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