All About the Lasik Procedure

Best Candidates for Lasik Surgery

Before getting into any of the criteria for being a good candidate for LASIK surgery, we want to state right up front that the only way to absolutely know if LASIK surgery is right for you is to have a comprehensive eye exam from a qualified eye doctor. Ideally, that doctor will have considerable experience with actually performing LASIK, or other types of eye surgeries.

That said, LASIK has been around long enough and has a high degree of success with much data available to give guidance as to who are good candidates. This will give you a good idea as to if you are within the surgical parameters of LASIK, so you can decide whether or not it’s worthwhile to see an eye doctor for a final decision.

LASIK can address four types of refractive errors:

People with other types of vision problems will need to look at alternatives to LASIK. The American Refractive Surgery Council on their website says that 15-20 percent of people who consider LASIK are judged to be not eligible by their doctor or surgeon.

According to the FDA, you may not be a good candidate for LASIK, or any other type of refractive surgery, if:

You may be a good candidate for LASIK if you meet the following criteria (most of which are the opposite of the criteria above that identify a poor candidate!):

Eye Conditions That Lasik Can Handle

Any type of surgery that changes the shape of the cornea in order to improve vision or correct other types of problems is called refractive surgery. While there are many different types of eye conditions that can be addressed with refractive surgery, this discussion focuses on the conditions treated by LASIK.

There are four types of common vision problems that can be addressed with LASIK:

Nearsightedness – the inability to see distant objects clearly.
Farsightedness – the inability to see up close objects clearly.
Astigmatism – a common condition that can cause you to see all object blurry.
Presbyopia – An age related condition – usually starting at age 40 – that gradually causes you to lose the ability to see up close objects clearly.

These four conditions make us the majority of vision problems and can all be successfully corrected by LASIK, so long as you are in the right age category and your prescription hasn’t changed in the last year.

For a list of other conditions that may prevent LASIK from being an option, see the section on “Candidates”.

What to Expect With Lasik Surgery

Based on information from the Federal Trade Commission, the U.S. Food and Drug Administration, and interviews with various experts (see our Resources page for a detailed list of research), this is what you can expect both before and during your Laser surgery procedure.

What to Expect Before Your LASIK Surgery

Initial Evaluation and eye examination

Before agreeing to any laser surgery procedure, you should have an evaluation meeting with the doctor, along with an eye examination.

During the evaluation, the eye doctor should ask about your medical history, including any surgeries you’ve had. You should also discuss your goals and expectations for the procedure.

One important point that is often missed is that if you wear contact lenses, be sure to stop wearing them and only wear your glasses for at least two weeks before your initial evaluation. The reason for this is that contacts change the shape of your cornea and it can take two to four weeks after you stop wearing them for your eyes to 100% return to their normal shape.

This can cause inaccuracy in the measurements used to determine the amount of corneal tissue to remove. This can lead to poor results from your surgery. So be sure to ask up front how far in advance you should stop wearing your contact lenses.

For the eye examination, be sure to bring your vision prescription records and a summary of any eye conditions along with any other medical history that has involved your eyes. In addition, bring an up-to-date list of any medications you are currently taking, both prescription and over the counter.

After your initial evaluation, your eye doctor should perform a thorough vision and dye exam. This includes dilating your pupils and examining the health of your eyes. This should include:

A glaucoma test
A retinal exam
Testing the thickness of your corneas
Measuring the curvature of your corneas
Assessing any dry eye condition
Testing your pupils
Testing for astigmatism
Evaluation of any cornea irregularities (such as a cone shaped cornea)
Testing for high eye pressure

All of these tests are necessary for the eye doctor to determine if laser surgery for you will be safe and effective. They also allow your doctor to assess which areas of your corneas need reshaping and the precise amount of tissue that should be removed. This us determined using a scanner that creates a very detailed “topographic map” of our eyes.

After all this is done, your eye doctor should discuss with you:

The risks and benefits of LASIK surgery to correct your vision.
If you are a good candidate for LASIK and why or why not.
If so, what procedure is most appropriate for your unique situation.
A review of what’s involved before, at the time of, and after your LASIK.
What you need to do to prepare for the procedure and after the procedure is performed.
Your expectations and a realistic answer as to if the results are likely to meet them.
Discuss alternatives to surgery that may be appropriate for you.
Any other questions you have.

Here are some specific questions you may want to ask, if they aren’t already covered during the discussion:

How long will it take for your vision to improve?
Will your vision fluctuate during your recovery and if so how?
Will you have any preoperative antibiotics, eye drops or other medications and if so how to use them.
Will any follow-up surgery (often called “enhancements”) be required?
If so, are they covered by your contract?
Does your contract cover any complications that may arise as a result of the surgery?

After all this, if you are not completely comfortable with the answers you receive or with the doctor which whom you’ve consulted, get a second opinion. This is very common and your doctor should not be offended. If you’re pressured by anyone at that facility to sign a consent form then and there, that’s a red flag that you need to look elsewhere.

What to Expect During Your LASIK Surgery

The day before your surgery, you should stop using all makeup, creams, lotions and perfumes, as they can increase the risk of infection. You may also be asked to scrub your eyelashes thoroughly to remove any debris or residue.

Be sure to wear comfortable clothes on your surgery day. You’ll also need to arrange for someone to drive you home, as your vision will be too blurry to drive safely.

The Surgery Itself

Bear in mind that laser surgery is surprisingly brief – both eyes are done in less than 30 minutes total.

In the surgery room, where the laser system is located, you will lie in a reclining chair on your back.

The area around your eyes will be cleaned and numbing drops are placed in your eyes. Your eyelids will be held open with an instrument called a “lid speculum”. None of this will be painful.

If needed, you can be given some medication to help you relax during the procedure.

Next, a special ink marker is used to mark your cornea before cutting the flap that is necessary for the laser to subsequently do its work.

Either a blade device (called a “microkeratome”) or a laser device (called a laser keratome) will then be used to cut a flap in your cornea. You may feel some pressure and experience some blurred or dim vision at this point, with perhaps some slight discomfort. The flap is then lifted and folded back and the exposed tissue is dried.

The “excimer laser” (a different laser than the one used to cut the flap) is then adjusted by computer for your specific prescription and positioned over your eye. You’ll then be asked to stare at a light to keep your eye fixed on one spot while the laser is turned on.

The laser then sends pulses of light directly to your cornea to painlessly reshape it. You may feel a bit of pressure on your eye and will hear a steady clicking sound from the laser. When done, the flap is put back in place. Each eye only takes about five minutes.

Since no stitches are required, a shield will be placed over your eye as protection. This shield is then worn while you sleep to keep you from rubbing or putting pressure on your eyes until the flap heals.

Immediately After Your Surgery

After surgery, you’ll rest for a bit and may experience some temporary itching, buring, or sensation that something is in your eye. You’ll likely have some blurred or hazy vision but this should improve by the next morning. For a few days, some people have some light sensitivity or see starbursts or halos around lights. Your eyes may also look a little bloodshot.

There will be a brief post-operative exam and someone can then drive you home. Some people are able to return to work the very next day. However, most doctors will advise you to have at least one full day of rest instead. In almost all cases, you will come back the next day after surgery for a check-up.

You must be very careful to not rub your eyes, no matter how great the urge to do so. This could dislodge the flap, requiring additional surgery.

As far as driving a car is concerned, you should not attempt this until you see your eye doctor the next day and it’s confirmed that you now meet the legal standard for driving without the need for glasses or contacts.

For many patients, vision improves immediately, though it may take a few days for your eyesight to stabilize. It’s also recommended that you avoid strenuous exercise for at least a week.

Recovery and Post-Op

Your chances for a successful recovery are quite good. More than 80 percent of patients who’ve had LASIK surgery will no longer need glasses or contacts for most activities.

The most successful results are for people who have a low level of nearsightedness. People with farsightedness or a high level of nearsightedness have less predictable success rates. In some instances, surgery may result in an undercorrection, which may require a second surgery to correct. If this is required, the FDA recommends that you wait until your vision and eye measurements are consistent for two consecutive visits that are separated by at least three months.

In rare cases, a patient’s eyes may slowly revert back to the vision level they had prior to surgery. Certain conditions can cause this: hormone imbalances, irregular wound healing, cataracts, or even pregnancy. This means it’s important to speak with your eye doctor if you experience any vision changes.

Generally speaking, it can from three to as much as six months for your vision to completely stabilize. During this time, you may experience glare from halos and glare from lights, as well as some difficulty driving at night.

Post Op and Short Term Recovery

Although LASIK surgery takes mere minutes to complete, there are several things you will need to do to speed up your immediate recovery.

After surgery, when you first open your eyes for the first time, you will probably feel that your eyes are “foggy”. You also might experience some burning and itching as the local anesthesia wears off, but this usually will wear off after a few hours.

The most common post op symptom, which is experienced by almost all patients, is dry eyes. You’ll be given special eye drops by your doctor and it’s critical to avoid scratching or rubbing your eyes and use the eye drops instead. Otherwise, you might dislodge the flap created during surgery, which can lead to pain, other complications, and even further surgery.

It’s also common to have blurred vision immediately after surgery, which will fade over time.

You will likely be sent home with your eyes covered by shields. It’s important to keep these in place until told by your doctor to remove them. They are designed to protect your eyes from rubbing on sheets or pillows.

Any pain or discomfort from your surgery shouldn’t last longer than about four days and your doctor can give you pain medication to help. If pain lasts longer than that or becomes severe, you should see your doctor right away to make sure there’s not a problem with your surgery.

It’s okay to take a shower the day after your surgery, so long as you keep soap and other chemicals out of your eyes. In fact, you should avoid all lotions and makeup for at least the first week after surgery. They can contain bacteria which can interfere with healing.

For this same reason, Makeup, lotions, and creams should also be eliminated from your routine for the first week or so after surgery. There’s a possibility that products such as these may contain bacteria that could get into your eyes while they heal.

For this same reason, the American Refractive Surgery Council recommends that you avoid any water sources that could be contaminated, such as the ocean, rivers, lakes, swimming pools and hot tubs.

Other things to avoid or limit during the first week or two include:

Strenuous exercise
Reading (only for long periods)
Contact sports (e.g. boxing, football, karate, basketball, soccer, wrestling)
Wait at least 24 hours before watching television or staring at computer/tablet screens
Don’t rub your eyes for at least four weeks
Don’t go outside in the sun without sunglasses for at least four weeks

Essentially, you want to avoid any activity that could result in a blow to your eyes.

Since computer use is now a universal need, for the first two weeks after your surgery, try to use what’s called the “20/20/20” rule. This rule says that for every 20 minutes looking at a computer screen, take a 20 second break and focus on something 20 feet away (and use your eye drops at this time). This will minimize your eye strain during this critical healing time period.

Intermediate Recovery

The intermediate stage of healing begins after about your first month after surgery. Although you probably will no longer have pain or discomfort, you’re still in active recovery as your body heals from the surgery.

It’s still important to protect your eyes, which means you should still be avoiding activities such as contact sports. Even goggles will not provide enough protection, as a blow to your head could still disrupt healing of the flap.

At this point, you can probably once again use eye creams and makeup, so long as you don’t experience any signs of irritation or redness.

During this intermediate stage of recovery, you should still be meeting with your doctor to determine if any mediations or eye drops are still needed. You should also ask for advice about the various activities you perform and if they will impact your eyes or your recovery. An example of this is if your job involves constant work on a computer, which can lead to eye strain and a prolonged recovery.

Long Term Recovery and Results

According to the American Refractive Surgery Council, complete recovery and healing may take up to six months.

You’ll have fewer doctor appointments during this period of time. However, it’s still be important to follow any instructions you may be given, such as continuing to use eye drops to prevent dry eyes or continuing to wear goggles to protect the cornea flap.

According to research done by International Journal of Ophthalmology, stable vision is achieved by most people within the first month after surgery, but the complete healing process takes several more months.

Once healing is complete, if your vision is still not where you want it to be, talk to your doctor about touch-up surgery, which may be able to bring your vision into sharper focus.

Will Blurred Vision be a Long Term Problem?

Although LASIK surgery will provide sharp and clear vision almost immediately, it’s important to remember that it is a surgery that involves an incision. The body needs time to heal and that healing process can include inflammation, which can affect clear vision.

The American Academy of Ophthalmology advises that it’s fairly common for to experience some blurring in your vision for several weeks or even several months. This is simply part of the normal healing process and there is really nothing to be done about it. It will fade with time, though that amount of time will vary by individual.

Blurring can be caused by a couple of different situations. According to the journal Ocular Surgery News, an unusual reaction to LASIC can affect some people. What happens is that very small particles in the cornea get somehow overstimulated by the laser, causing them to swell up and block light from entering the eye. This causes blurring and indistinct images. This will frequently go away on it’s own as healing progresses and inflammation goes down. It can also be treated by medication to speed up this process.

A second cause of long term blurring is infections, particularly when they involve bacterial colonies growing on the eye’s surface. Medications can also address this, as well as surgery and irrigation to flush out the bacterial infection.

Finally, blurring can return many years later as your eyes change with age. Over time, your lenses stiffin and the eye muscles weaken, causing what is called age-related blurring. This is a natural result of aging and can’t be considered a LASIK complication. As a result, it can’t be corrected by further laser surgery.

Risks, Complications, Long Term Effects

As with any medical procedure, there are both pros and cons associated with LASIK. Generally speaking, and as the Mayo Clinic explains on its website, Lasik provides the smallest risk and the largest reward when it is used to correct nearsightedness that is relatively mild.

In fact, LASIK has one of the highest rates of safety of any medical procedure. There is a gigantic amount of scientific evidence documented by hundreds of medical experts, making the clinical data on LASIIK one of the most extensive of any medical procedure. It is because of this mountain of data that the medical community considers LASIK to be both safe and effective.

That said, for more severe cases of nearsightedness, farsightedness, or asigmatism, the rate of complications is higher, along with a correspondingly lower chance of complete success. You should always consult with your ophthalmologist to discuss if you are a good candidate for LASIK and have them review the pros and cons for your particular situation.

The following discussion will give you a good overall picture of the risks, complications and side effects associated with LASIK. This will help you be better prepared for a discussion with your eye doctor as to if LASIK is a good choice for you, given your tolerance for risk.

RISKS

Most LASIK eye surgery side effects are mild and temporary, although they are fairly common. These include things such as dry eyes and short term vision blurring and usually go away after a few weeks or months. It’s extremely rare that a loss of vision can result from complications.

LASIK surgery risks, complications and side effects include the following items:

Double vision, halos and glare. You may have trouble seeing at night and may notice halos and glare around bright lights, or in some cases double vision. However, these are usually short term effects that last only a few days or a few weeks.
Dry eyes. A temporary decrease in tear production can result from LASIK As your eyes heal for the first six months, they may feel unusually dry and scratchy. Ask your ophthalmologist to recommend eyedrops to solve this issue. In the rare case of severe dry eyes, a procedure can be performed that inserts special plugs into your tear ducts to allow the surface of your eyes to retain your tears instead of drain them off.
Undercorrection. It’s possible that too little tissue is removed from your eye by the laser, resulting in a less than perfect vision correction. This is more common in surgeries to correct nearsightedness and may require another procedure to remove more tissue, usually within the first year.
Overcorrection. On the other hand, if the laser removes too much tissue from your eye, you also won’t have perfect vision and this is more difficult to fix.
Problems with flap removal. The flap in front of our eye is removed or folded back during surgery, which can create complications such as excel tears or infection. Or, during the healing process the outer cornea tissue layer may experience abnormal growth, which can cause complications.
Vision changes or loss of vision. While rare, it is possible that surgical complications can result in a partial loss of vision, or perhaps the inability to see as sharp or clear as before surgery.
Astigmatism. Uneven tissue removal can result in astigmatism, which can require glasses, additional surgery, or contacts.
Moderate pain. There may be some nominal pain for the first day after your LASIK surgery, which usually goes away after 24 hours.
Healing takes time. It only takes a few days for superficial healing of the cornea to take place and that should be complete within a few weeks. Complete healing, which includes regrowth and the reshaping of the cornea, can take months but is not painful. Gradual vision clarity will take place over this time.

LONG TERM EFFECTS

While 20/20 vision or better is achieved by most people who receive LASIK, results can vary. The result may be only 20/40 or less for some patients.
Some people may still have to wear glasses, or contact lenses, following LASIK surgery. On the up side, the prescription will be much lower than before LASIK.
You may develop some sensitivity to sunlight, which can be helped with eyeglasses containing photochromic lenses.
If you end up with a mild refractive error following LASIK, you may find eyeglasses with an anti-reflective coating to be especially helpful for night driving.
Once you reach the age of 40, you may experience some normal age-related loss of your near vision. This can be easily corrected with reading glasses.
In order for an acceptable level of vision correction, a LASIK enhancement, also know as a touch-up procedure, may be need by a small percentage of people within the first 12 months after surgery.
Some people have eyes that are constantly changing. This means that LASIK will not permanently improve their vision as they age. This is more common with farsightedness than with nearsightedness.

Bear in mind that overall, LASIK is a proven and safe procedure for vision correction. As reported by the American Refractive Surgery Council, the success rate is near 96 percent and there have been no cases of actual blindness as a direct result of LASIK surgery.

What is important is that you do your research, and consult with your ophthalmologist so that you can make an informed decision.

How to Choose Your Lasik Surgeon

While LASIK surgery is a relatively simple procedure and has a short recovery time, the skill of the surgeon is still crucial to both short and long term outcomes.

In order to get the best possible results from your surgery, the number one thing to focus on is not price – it is on obtaining the right surgeon. Here are the things you need to know and why they are important.

What You Should Look For in Your LASIK Surgeon

An excellent place to learn the basics to look for in a LASIK surgeon is The U.S. Food and and Drug Administration (FDA) . They give an excellent general overview of this subject. They have four suggestions you should follow:

Compare the level of experience of each surgeon your considering, taking into account reviews from former patients.
Research and investigate the reputation of the surgeon’s office and/or surgery center used.
Have realistic expectations. 20/20 vision cannot be guaranteed after LASIK and you should avoid any surgeon or surgery center that claims it can.
The device that will be used to perform your LASIK surgery should have a patient’s handbook. Make sure you read it before hand and that your surgeon explains anything you don’t understand.

Be sure that your surgeon will conduct a detailed assessment of your eyes prior to surgery. A scanning laser will likely be used to map your eyes, but the quality of the LASIK device that will be used and the surgeon’s skill will have the greatest impact on a successful procedure.

You’ll find that many surgeons and surgery centers will lay claim to having performed more LASIK surgeries and are more qualified than their competition. Know that these claims are difficult to prove or disprove, as up to date information on how many procedures have been performed by specific surgeons is hard to obtain.

Basically, you want a surgeon who speaks in an educated yet easy to understand manner regarding how many procedures they have performed and their personal rate of success. If they do this without making bold claims in regards to perfection of results, they should be high on your list.

Specific Questions Your Ask a Surgeon

If you want the greatest chance of a successful outcome, concentrate more on the surgeon you will use rather than how fancy or convenient you find the surgery center itself.

In fact, a national survey of 793 adults in the United States who had LASIK surgery in the past eight years found that the strongest predictor of overall satisfaction was satisfaction with the surgeon used. The highest satisfaction resulted from surgeons who conducted the proper tests and gave realistic counseling about the benefits and risks.

Specifically, these are the questions we recommend you ask any surgeon with whom you consult about laser vision correction.

Describe your presurgical evaluation. A proper evaluation can take up to three hours and should include time with the surgeon. You should receive an assessment of the quantity and quality of your tears, your pupil size under various lighting conditions, as well as the shape, thickness and surface quality of your corneas. Your medical history should also be taken into account, as some conditions may indicate that laser surgery is not a good option for you.
How extensive is your training? Ideally, you want an ophthalmologist who is board-certified and does at least 250 procedures a year. More is better. They should be procedures using the same techniques and equipment that will be used with yours. Other things to look for are a related teaching position, publication in professional journals, and fellowships in refractive and corneal surgery.
Do my results indicate than I’m a good candidate? If you have some borderline scores, ask if that will affect your outcome and risk of side effects.
What is your rejection rate? Their screen standards should be high, which means they typically reject at least 10% of prospective patients. You do not want a surgeon or facility with an extremely low rejection rate, as it likely means insufficient screening.
What type of equipment do you use? Be sure their equipment is approved by the Food and Drug Administration. You can find patient information on that specific laser by going to the FDA’s LASIK pages.
What are the results I can realistically expect? A good surgeon will give you reasonable expectations for the likelihood of specific issues such as: glare at nighttime, dry eyes, fluctuations in your vision during healing, the odds that you may need a second procedure (2 to 10 percent nationally, and that chance you’ll need to still wear glasses or contacts for some activities.

Red flags to look for in choosing your surgeon

They minimize the risk of complication.
They tell you that you’ll be able to get rid of your glasses or contacts for good.
They are vague about either the equipment or procedures that will be used.
They deflect questions by assuring you that the surgery is risk free.
There do not provide former patients as a reference for you.
They provide only sketchy details about the surgeon’s training.
The surgeon is no available at all to meet with you prior to your surgery.

If you encounter any of these red flags, that should be the sign to pass on that surgeon and continue your search.

How to Find a LASIK Surgeon

Now that you know what to look for in surgeons you are considering, here are some suggestions for how to locate surgeons to which you can apply these criteria.

Ask your regular ophthalmologist for recommendations. They are likely to know the ones with whom they are comfortable.
Ask people you may know who have had laser surgery for their recommendation.
If you know of a well respected LASIK surgeon in another state, call their office and ask if they can recommend a good surgeon in your area.
Check the websites for the American Society of Cataract and Refractive Surgery (ASCRS) and the American Academy of Ophthalmology (AAO) for their eye surgeon directories.
You can also do online research using Google by searching for “LASIK surgeons in Seattle”, or wherever city you are in. Just be aware that you get a long list with no indications as to quality.
Finally, be very cautious of advertisements you see about laser surgery. There is much competition in this field currently, which can lead to aggressive advertising. If the ad overly promises on results or offers deals that look too good to be true, then proceed with caution and do your homework.