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LASIK stands for Laser Assisted In-Situ Keratomileusis. It is widely recognised as the procedure of choice for correcting most cases of myopia. In selected cases, it can also be used to correct mild to moderate degrees of astigmatism and farsightedness. Lasik is sometimes called the “flap and zap” procedure.

First a circular cornea flap is made with the help of a microkeratome. Next, the flap is folded back to allow the excimer laser to reshape the deeper layers of the cornea according to the patient’s spectacles prescription. The flap is then folded back and will adhere naturally without the need for stiches.

LASIK is done as outpatient surgery. It is a painless procedure that is done under “eye drop” anesthesia. The procedure takes about 10 minutes per eye. Both eyes can be treated at the same time.

Before the surgery, you will need to carefully read through and signed the informed consent form. If you have any further questions, please do not hesitate to raise them. There is no charge or penalty if you do not wish to proceed with the surgery at this stage. You will be asked to wear clean surgical gowns, caps and socks.

Next, you will lie down under the laser machine and your face will be covered with plastic drapes exposing only the treated eye. Numbing eye drops will be instilled. An eyelid holder is inserted to prevent blinking. You may feel a tight stretch at this stage. You will be asked to look at a blinking fixation light at all times and to keep your eyes relaxed. A suction ring is placed on the eye and suction is turned on to secure and maintain pressure within the eye while the cornea flap is created. Your vision will turn dark so do not be alarmed.

Next you will hear a “buzzing” sound while the microkeratome is creating the cornea flap. It is important that you remain relax and do not squeeze your eyes at this stage. Then suction is released and you can see the red blinking light again. The flap is folded back and the laser treatment begins. At this stage, you will hearing a fast clicking noise and notice a slight burnt smell. It is very important that you stay alert, keep both eyes opened and remain staring at the fixation light throughout this stage. Your co-operation at this stage will avoid problems of de-centred treatment and tissue dehydration that may affect the outcome of the procedure.

The cornea tissue is sculpted with the laser according to your spectacles prescription. When this is complete, the cornea flap is flipped back and the eye is rinsed. A soft ponge is then used to squeegee out the water and the flap will bond itself back naturally without the need for stitches. All surgical instruments are removed from your eyes and a transparent plastic shield will be tape the eye. You will be taken to the waiting room to rest and your doctor will re-examined your eyes again before you can go home. Typically, the Lasik procedure take about 10 minutes per eye.

It is important that you use the antibiotic eye drops prescribed to prevent infection. The protective eye shields should be worn while sleeping for the first five days to prevent accidental trauma to the cornea flap during the early healing period. You should be careful not to rub or squeeze the eyelids hard for the first 24 hours. Common painkillers and sedatives may be prescribed to alleviate discomfort and sleeplessness.

Most patients can return to work after a day’s rest. However, swimming and vigorous sport activities should be avoided for two weeks. You should avoid crowded and dusty places for one week to reduce the risk of infection. You should also avoid exposure to strong sunlight and wear sunglasses when outdoors. Contact sports should be avoided for three months.

Please keep to the scheduled follow-up visits to ensure your eyes are healing properly. Typically, the visits are the first day after op, five days later, two weeks later, one month and then three months later.

The goal of LASIK is to reduce or eliminate dependence on spectacles and contact lenses. Whilst perfect vision cannot be guaranteed, many patients have vision excellent enough to carry out daily activities like driving and taking part in sports without the need to wear spectacles or contact lenses. Even if spectacles are needed, they will be of much reduced power, thickness and dependence.

You may be motivated to go for LASIK if you:

Suffer from high myopia and are thus very dependent on glasses or contacts.
Are an active in sports like mountain biking, triathlons, windsurfing, diving, surfing, skydiving etc.
Cannot wear spectacles and contact lenses for occupational reasons e.g. fireman, airlines cabin crew, oil rig worker.
Find spectacles wear make you dizzy.
Wish to be rid of wearing spectacles for cosmetic reasons.
Suffer from contact lens intolerance such as dry eyes, allergies or frequent eye infections.
Find it a chore to wear and maintain contact lenses daily. Poor hygiene here puts your eye at risk of developing cornea ulcers, a potentially blinding complication of contact lens wear.
Feel your lifestyle and enjoyment of life curtailed by dependence on glasses or contacts.

Note that LASIK does not alter the aging process of the eye. Those approaching the age of 40 years or older may find that they need to use reading glasses after the procedure.

The decision to have LASIK is a personal one. Consider your lifestyle, visual needs, dependence on glasses or contacts and risk tolerance in making your decision. As with any cosmetic surgery, realistic expectations are key to satisfaction and deciding to proceed with the surgery. To reiterate, after LASIK, you are very likely to have vision good enough to carry out most of your daily activities and sports without having to resort to wearing spectacles or contacts. If spectacles are needed, they will be of much reduced power, thickness and dependence. However, do not expect LASIK to guarantee perfect or better than perfect vision.

As with any surgery, complications can occur. Serious complications are uncommon and occur in 1% or less of patients.

Under or over-correction
Due to individual differences in tissue structure and wound healing, under or over-correction of eye power may occur. Enhancement may be recommended if this is significant. It is usually done after three months and before one year as the cornea flap can be simply re-lifted without cutting. However, the cornea bed must be thick enough to tolerate the additional tissue removal (250 microns thickness).
Loss of best corrected visual acuity
This can result from poor wound healing, cornea haze or cornea flap complications. The cornea has a lot natural healing ability so the problem usually improves with time and use of steroid eye drops. Hence vision loss is usually limited to one or two lines of the standard vision chart.
Glare and halos
Some patients may experience light sensitivity and glare or complain that they see halos around lights at night. It is more common in patients with large pupils. It may be bothersome enough to limit driving or working at night. Eye drops that constrict the pupils may help. The problem tends to improve with time although in some case, it may persist indefinitely.
Cornea Flap Complications
The procedure may be aborted because of problems in creating a good cornea flap. This run the gamut of eccentrically cut flap, too small flap, button-hole flap or free cap. The cornea flap may develop wrinkles if there is rubbing or hard squeezing of the eyelids soon after surgery. In some patients, a sterile inflammation of the flap interface (DLK) may occur. Epithelium cells may also migrate into the undersurface. Severe infection can occur but is this fortunately rare (1 in 5,000 cases).
Other Complications
LASIK eyes are always dry the first few weeks. In some patients, the dryness can be severe, the condition usually improves with time'But in some patients, they may take months to years to recover. Patients with thin corneas or who underwent high power treatment may develop a condition call ectasia where an irreversible bulging of the cornea occurs. There is the risk that should you want to wear contact lenses after the procedure, they may not fit comfortably after the surgery. Retinal detachment and glaucoma (from long term steroid eyedrops therapy) have also been reported.