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A look at the myths and facts of laser eye surgery
It is one of the wonders of modern medicine and technology - the ability to improve vision and do away with spectacles or contact lenses
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t is one of the wonders of modern medicine and technology - the ability to improve vision and do away with spectacles or contact lenses. LASIK (short for laser-assisted in situ keratomileusis) has gained popularity over recent years, whether for aesthetics or for practicality. In fact, it is so popular that the Singapore National Eye Centre (SNEC) does some 5,000 procedures annually.
But questions and myths over this procedure still abound. Professor Donald Tan, medical director of the SNEC, answers some of the top misconceptions about LASIK.
MYTH: LASIK is done using a computer program and thus can be performed just as well by any clinic, so the main consideration is price.
FACT: There are many factors to consider other than the price. These include reputation of the center and its audit system, the ability to ensure personalized reviews by the surgeons and the range of treatment options offered. As with any surgery - and LASIK is considered surgery - a surgeon's skill and the level of care the center offers are essential elements. The laser is only one of the tools that the surgeon uses to perform the procedure. The surgeon must also create and manipulate the corneal flap, a delicate surgical procedure that requires experience and skill. Apart from the procedure itself, the success of LASIK also depends on the pre- and postoperative care. A good doctor will assess the suitability of the patient and the type of procedure required. As with all surgeries, there is potential for complications and a good center is prepared to offer close follow-up care to prevent and/or treat such complications.
MYTH: Everyone is suitable for LASIK.
FACT: Not everyone is suitable for LASIK. Those with thin corneas relative to the degree of improvement they want to achieve are not suitable for LASIK. There are also specific vocations where LASIK may be unsuitable. Generally, only a small number of people (about 10 percent or less) may be unsuitable. However, there are many other refractive surgery options available and a reputable center will be able to give advice on these other procedures. It is thus advantageous to go to a center with a wide range of refractive surgery options and experience.
MYTH: LASIK cannot be individualized.
FACT: LASIK can be tailored to an individual's eyes and requirements. Newer technology means that treatments can be much more accurate and for a higher degree level of correction, although some of these still need evaluation to determine their true benefits. In the past, the higher degree a person had, the more cornea had to be removed. With new LASIK technology, less tissue needs to be removed for higher levels of vision correction. It is important to choose a center with a wide range of femtosecond laser and excimer laser machines to find the best match in technology to an individual's requirement. Some refractive intraocular implants are also now available to treat extremes of myopia not amenable to LASIK surgery.
MYTH: LASIK uses heat energy and people can smell the cornea being burned.
FACT: The excimer is a "cool" laser and does not use heat energy to remodel the cornea. However, there may still be an element of tissue vaporization that may result in some smell during the treatment.
MYTH: LASIK is still a new technology and there are no long-term studies out there.
FACT: LASIK was first performed 20 years ago in 1989 by an ophthalmologist in Greece and then introduced to America in 1990. Since then, peer reviewed publications have shown excellent safety, efficacy and stability results for eyes up to 10 years after LASIK was first performed, and millions of LASIK treatment worldwide have shown no unexpected long-term complications.
MYTH: It is not possible to target the LASIK laser accurately all the time as eyeballs will make involuntary movement and there is a risk of the laser zapping the wrong areas of the eye.
FACT: Most LASIK platforms have highly advanced eye-tracking devices that compensate for any minor eye movements during the procedure. These active tracking systems follow the patient's eye position at a speed of up to 4,000 times per second and redirect the laser pulses precisely.
MYTH: LASIK is permanent and the effects last forever.
FACT: Yes, the results of LASIK are permanent and once your eyes are treated, vision rarely deteriorates back to the original state. But your eyes can still change shape, especially in younger patients in which myopia is not fully stable, and depending on the individual, some may need "adjustments" to correct future problems like near-sightedness, far-sightedness, or astigmatism. A major advantage of LASIK is the ability to enhance the treatment many years later, if there has been a change in refraction with time. In addition, as you age, the need for reading glasses is quite common, and presbyopic reading correction may still be needed after the age of 40 years.
cFlyFreeForHealth2009
Prof Donald Tan is also director of the Singapore Eye Research Institute, medical director of the Singapore Eye Bank, and head of the Department of Ophthalmology at the National University of Singapore.
Articles in this column, which appears every two weeks, are provided by a panel of doctors from www.flyfreeforhealth.com, a leading multimedia medical tourism platform dedicated to providing adopters of healthy lifestyle with travel and lifestyle incentives. The doctors and hospital include: Singapore National Eye Centre (SNEC), trusted one-stop eye care centre for the region. Email us at info@flyfreeforhealth.com. Join our free online seminar titled "Fertility Management" on Aug. 26, 2009 by SMSing your email address to +65 98473224 to get the link invite.
How LASIK works
LASIK is a procedure in which the cornea - the transparent front part of the eye that lets in light - is sculpted to improve vision.
The eye works like a camera: the cornea acts as a lens, allowing light (and images) into the eyeball and onto the retina - which acts like film - at the back of the eyeball. The shape of our corneas determines how "focused" this image is. An out-of-shape cornea transmits an unfocused image on the retina and the brain perceives this image to be fuzzy. LASIK helps to perfect the shape of the cornea so that images can be sharply focused. The procedure can be used to correct nearsightedness, farsightedness, and astigmatism.
LASIK involves two steps. First, the surface of the cornea is cut to create a flap to access the middle section of the cornea. Then an excimer laser is used to shape the cornea to achieve perfect vision. With regard to the making of the flap, previously, only microkeratomes involving the use of a mechanical high-speed oscillating blade were available. Now, bladeless LASIK, in which the flap is made with another type of laser (the femtosecond laser), is now available. Several femtosecond lasers are now available for bladeless LASIK.
The surgery takes about 15 minutes and does not require any general anesthesia, just topical anesthetic eye drops. Patients usually see an improvement in their vision immediately after the procedure, have close-to-normal vision by the next day and can resume normal activities in just one or two days.
