Lasik is a refractive surgery, performed by an ophthalmologist, which can be divided into three steps:
(1) cutting a slight flap in the patient’s cornea;
(2) re-shaping the corneal stroma through laser-remodeling; and
(3) re-sealing the flap.
There are two ways in which the flap can be cut, being with a blade and with a laser and, when the Lasik procedure is carried out by laser, it is called IntraLasik or “Bladeless” Lasik.

IntraLasik was developed during the mid-1990s and the first IntraLasik procedure was completed during 2002. In the IntraLasik, the type of laser used to cut the flap is known as a femtosecond laser as it emits extremely short pulses of light. Other than the three abovementioned conditions, the IntraLasik procedure can also be used to correct cases of presbyopia (difficulty in focusing).

There is no appreciable difference between the action of the blade in Lasik procedures and the action of the femtosecond laser in the IntraLasik procedures and both have their pros and cons. The Lasik procedure, however, sometimes resulted in irregularities in the cutting of the cornea, including improperly formed flaps, unattached flaps and partial flaps or could damage the eye tissue itself. It is highly unlikely for the IntraLasik procedure to create these kinds of irregularities, however, and some ophthalmologists will prefer to use the bladeless Lasik surgery for this reason alone.

Flap predictability, that is, how the ophthalmologist believes the flap will turn out, is also better with the IntraLasik procedure than with the Lasik procedure. One reason for this is that, with a laser, it is guaranteed that the flap will always have the same overall thickness while, with a blade, flap thickness varies depending on the curvature of the cornea. Overall, the bladeless Lasik has a reputation for creating flaps that are highly accurate as far as flap shape, flap thickness and flap size are concerned.

At the moment, there is no conclusive evidence as to which procedure has better results. Whether a patient’s defective vision is likely to show greater improvement after the Lasik or the bladeless Lasik eye surgery procedure will be largely determined on a case by case basis by a good eye doctor.

One thing is clear though, the patient will now be able to see the light.

The major difference between the two in terms of technology is the way in which they measure vision problems. There are recognized low order aberrations (LOA) and higher-order aberrations (HOA). LOA are spherical and cylinder defects that cause such disorders as nearsightedness, farsightedness, and astigmatisms. These can be diagnosed by regular eye examinations and can be corrected efficiently with regular LASIK surgery. Wavefront LASIK surgery uses a 3D measurement of how the eye is actually processing the images in order to create a system to re-shape the cornea. This technology allows for a more personalized method to address not only the LOA but also the HOA you may be suffering from.

Although regular LASIK surgery has been able to address the amount that you can take in visually, but not the quality of those images in terms of contrast and detail. In fact, LASIK surgery is sometimes reported to cause problems that were not there before with these high order functions of the eye, causing such complications as glare, light halos and decreased night vision. Though there are still risks of complications from the custom LASIK surgeries, they are reported less frequently and there are more reports of improvement in the HOAs.

While the focus has been on the advantages of custom LASIK, there are reasons to consider conventional LASIK if it can address your visual problems adequately. For one thing, current wavefront-guided technology are extremely limited in their capability to under-correct, as would be required by those looking for a monovision correction. Another consideration is cost. Though your vision is precious, as all things in life, making corrections is subject to the ability to pay. Regular LASIK surgery tends to be less expensive. As always, discuss your options with your ophthalmologist before undergoing any procedures.

Effectively the surgeon makes use of this tiny little blade to create a flap in the corneal tissue. Removes are certain amount of this tissue with an “excimer laser” and replaces the flap. There is also a newer type of bladeless LASIK in which a Femtosecond laser is used to create the flap, after which the same technique is used to remove the required amount of corneal tissue.

This surgery has been designed to assist people to see better, and many patients who have had to wear spectacles or contact lenses for years have been helped. The concept or rational for this surgery remains the same with every practitioner, however the tools they used to perform the surgery differ. For some ophthalmologists the terminology “LASIK” means all laser, while other still make use of microkeratome LASIK in which a surgical scalpel is used.

Mayo Clinic studies are available which compare bladeless and mechanical LASIK surgery, and these studies have found that both types of surgery have equal results. So you can rest assured that if your ophthalmologist is using a blade or a laser the results you will obtain from the surgery will be of equal quality.

Test subjects were examined six months after both these types of surgery had been completed, and no differences were found in respect of visual acuity. This particular study involved twenty patients, all of whom received surgery for astigmatism or nearsightedness.

The fact that both of these forms of surgery are available to patients who want to undergo this operation (it is elective surgery) indicates that either complete laser or microkeratome surgery are just as good as one-another. In actual fact, in the study it was found that back-scatter was more prevalent in patients who received all-laser surgery as apposed to microkeratome. Backscatter does not affect the quality of vision it can only be seen by the physician under testing conditions.

photo credit: Mary Thorman

Here are some steps you can take:

First, make sure the LASIK center is licensed by your governing board. Search your states’ administrative website and there you should find all the licensed LASIK eye surgeons for your area. Also, you can check with the National Practicioner Data Bank for surgeons available to you.

After you have identified several candidates, call each LASIK surgery center and ask if they have any certifications beyond the minimum standards proscribed by their licensing board. Those that do will gladly give you this information and give you instructions on how to check for yourself. One criteria you might set is that your surgeon be a member of The American College of Surgeons (ACS). This is a self-governing organization that requires from its members the highest in ethical standards, patient care, and conduct. Those that are members will usually have “FACS” (Fellow of The American College of Surgeons) after their name.

Ask for referrals. Most, if not all, surgeons will have a list readily available to you. Get it and then actually contact these people. Ask pointed questions. Don’t be afraid to zero in on what concerns you most about your surgery, physician and LASIK surgery center. You might even still want to call the laser eye center or surgeon’s office and ask for referrals not on their original list. This will give you a much larger sample pool and, therefor, a better representation of how you can expect to be treated.

Don’t be afraid of investigating a LASIK eye care center or surgeon who advertises. Most physicians who advertise (and lawyers to, for that matter) are simply wanting to provide their superior service to as many people as possible. There’s nothing wrong with that, and, in this case, can work to your advantage. A surgeon who advertises will probably have an extensive patient list from which you can investigate.

Many people think that LASIK eye surgery has become as simple as getting a tooth pulled. While the procedure has advanced considerably, it is, after all, surgery. When choosing a LASIK vision center, your due diligence is definitely required.

Ophthalmic surgeons are highly trained and Wavefront eye surgery has been around for years. In fact it was first approved by the FDA as far back as 2002. In addition, other LASIK surgery methods have been available for a great deal longer than that.

Wavefront LASIK differs from regular LASIK surgery by incorporating a mapping process prior to surgery. With the Wavefront procedure, an extremely complex computerized system first maps the entire inner and outer eye to reveal a three dimensional image. Of particular interest to surgeons in this procedure is the cornea, as this is where the surgery takes place.

Allowing the surgeon to see the eye in all three dimensions means he or she has detailed information on that particular patients eye. This LASIK Wavefront technology enables them to pinpoint exactly where the incisions should be and which refraction points to change which will allow the best possible results for the patient.

photo credit: roger_mommaerts

Once this has been done, laser equipment targets the areas completely accurately to prepare for the custom Wavefront LASIK eye surgery. This entire operation is also diagnostic as it allows the physician to see if there are any other problems within the eye. Once the diagnosis has taken place, lasers are aimed directly into the cornea so the surgeon is able to see which refraction will enable the patient to see the best.

The outcome of these almost completely non-invasive surgeries is generally perfect 20/20 vision for the patient. In some cases it has been recorded that patients have better than 20/20 vision, they have “cyborg vision” (joke). While some LASIK surgeries have been known to result in less than perfect results, the are generally speaking very successful. The difference with Wavefront LASIK is that it is almost always completely successful with no side effects recorded.

1. Radial Keratotomy (RK) is the oldest form of refractive lens surgery and is most commonly used to cure nearsightedness. In this procedure a scalpel is used to make between 4 and 8 tiny cuts, in the shape of wheel spokes, in the cornea that allows it to flatten and greatly reduce the focusing effect of light as it enters the eye.

2. Photorefractive Keratectomy (PRK) is a much newer method and is used to treat nearsightedness and astigmatism. In this procedure a laser is used to remove the outer layer of the cornea and can be used to re-shape the cornea. Similar to RK, PRK refractive surgery flattens the cornea to reduce the focusing effect of light.

3. LASIK, which stands for Laser In Situ Keratomileusis, is another laser procedure that re-shapes the cornea. Unlike PRK, LASIK refractive surgery cuts a thin flap in the top of the cornea which is folded back. While this flap is back, the laser is used to reshape the tissue of the cornea and then the flap is replaced.

photo credit: 4444ndr333w

Although all of the refractive laser eye surgery methods discussed are safe it is still surgery and therefore there are some risks. These risks can be broken down into three main categories: over or under correction, complications after the surgery, and damage to the eye. The most common of these risk is the over or under correction of the eye. Basically, this means that the focusing power of the eye is either too great or too small. Luckily, this can be easily fixed by repeating the surgery. The second risk category, complications after surgery, can range from inflammation to infections to corneal scarring. Many of these refractive surgery complications are usually mild and will go away with time. However, some of them can be rather serious and a permanent loss of vision can result. The third and final refractive surgery risks category, damage to the eye, consists of the surgeon cutting too deep or not deep enough. A majority of the time damages to the eye are a result of an unskilled surgeon or faulty equipment. This is why it is extremely important to do your research before having a surgery of this magnitude.

So, how do you know if you should have refractive laser eye surgery? Well, the best way to make this decision is with your doctor, however people who suffer from the following conditions would be considered good candidates:
* Nearsightedness
* Farsightedness
* Astigmatism
* Cataracts
* Presbyopia

LASIK surgery is performed in a few steps:

First, with a lid speculum holding the patient’s eye open, the surgeon will create a corneal flap. Before cutting the flap, a suction ring will be placed on the eyeball to ensure that it stays immobile during the surgery. The actual flap is cut with a microkeratome blade.

Next, the flap is lifted so that the laser can reshape the cornea.

photo credit: ankarino

Then, an excimer (ultraviolet) laser reshapes the cornea by removing or vaporizing tissue. This step causes quite a bit of worry for some patients but, in actuality, is very safe. No slicing or burning is required in this step, and the laser method of reshaping allows for a minimum amount of pain and a faster recovery.

Finally, the flap is put back into position and the healing process begins.

The whole process is quick; it should take approximately half an hour. The patient is awake the entire time during the surgery. Numbing drops will be put in the patient’s eyes.

After the surgery, patients should be completely healed within six months. Side effects for the first few days include watery eyes, burning, itchiness, and mild pain. During the first week after surgery, patients may experience hazy vision or sensitivity to light. It is normal to experience fluctuations in vision for up to six months after surgery.

However, patients should remember that LASIK surgery is a relatively new method, and there are always risks involved. Patients should fully research their own individual cases and consult their eye doctors if they are considering LASIK surgery.

For example, if a patient’s eyesight prescription fluctuates or changes in any way, LASIK should not be an option. This can be due to many reasons, such as age, hormone level, and certain medications. Also take into consideration certain aspects of a patient’s lifestyle, such as sports participation (blows to the eye could cause serious problems) and jobs (certain jobs do not accept workers with refractory surgery). Also, some insurance companies do not pay for LASIK surgery, which is still a relatively expensive procedure.

Current prices for LASIK procedures generally range from $1,000 to $3,000 per eye, with an average of around $2,000 per eye. Major factors responsible for the price differences are the amount of treatment needed, and the type of technology used for the procedure.

photo credit: mmahaffie

The amount of treatment required varies from person to person, and therefore the price of LASIK is a little different for everyone. The main difference in technology is that some procedures use a blade called a microkeratome to make a flap on the front of the eye, while other procedures use a laser. A more recent development with LASIK surgery technology is called wavefront analysis. Wavefront analysis is used to make a map of the aberrations in your eyes to help customize a LASIK treatment for you. Procedures using microkeratome average $1,750, procedures with laser-created flaps average $2,140, while procedures using wavefront analysis average $2,315.

There are two important things to be aware of when looking at advertisements for LASIK. First and foremost, all prices and quotes are for one eye. An advertisement quoting $1,500 for LASIK means $3,000 for both eyes. Secondly, be skeptical of ads that have prices far below the averages. Ads with very low prices generally refer to people who need very little treatment, or only to the deposit.

To further educate yourself, don’t be shy about asking your surgeon a few questions about the price. At the very least, be sure you are clear on what is included in the price, as well as what is not included. Questions about medications, follow up visits and the rare event of complications are also good to ask. Most surgeons include pre-operative visits and testing, standard medications, and follow up visits in their fees. Find out if this is the case with your surgeon.

By taking a little time to educate yourself about the cost of LASIK, you can be sure to avoid surprises later on.