LASIK Frequently Asked Questions
Am I a good candidate for refractive surgery?
To be a candidate for refractive surgery you should be:
- At least 18 years old and preferably over 21 years old
- Have a stable refraction for several years
- Have healthy eyes
- Not have certain medical conditions, which decrease the success of the surgery
- Not be pregnant or nursing
- Have a good understanding of the surgery and realistic expectations
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Why Dr. Rapuano?
Dr. Rapuano is the Co-Director of the Refractive Department at Wills and has been performing refractive surgery since 1992. At that time he was instrumental in reintroducing radial keratotomy to Wills Eye Hospital. That year he also began performing PRK as part of the VISX FDA trials at Wills. He has been performing LASIK since 1997. He has excellent experience in many forms of refractive surgery and can advise patients as to their best options. As a corneal specialist, Dr. Rapuano is referred many patients with problems after refractive surgery, so he is quite experienced in complication management. His surgical results are comparable with the published studies from the best refractive surgeons in the country. Above all, Dr. Rapuano is a compassionate physician who will personally discuss your particular refractive surgery options with you in detail prior to surgery and spend time examining you and discussing the results of your procedure after surgery.
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Is LASIK better than PRK?
Both PRK and LASIK are safe and effective refractive surgery procedures. PRK has a longer track record as it is an older procedure. PRK is a more straightforward procedure as it does not involve creating a flap. LASIK is a newer procedure, but it is developing an excellent track record. Benefits of LASIK over PRK are that it is less painful post-operatively, the visual recovery is faster and there is less chance of corneal haze/scar after surgery. Medication is used for a shorter period of time and there are fewer post-operative visits after LASIK than PRK. However, complications from the use of the microkeratome can occur after LASIK, including thin flaps, partial flaps, dislodged flaps, and cell growth or infection under the flap. Many of these problems are easily fixable but some can result in loss of vision. The long-term visual results are similar for PRK and LASIK, but in the short-term, LASIK patients are much more comfortable and see better.
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What is LASEK?
LASEK/Laser Sub-Epithelial Keratectomy is a variant of PRK. In LASEK, the surface epithelial layer is loosened with medication, moved to the side, allowing excimer laser treatment of the surface, after which the surface epithelial layer is moved back in position. Potential advantages over PRK include less postoperative pain and haze, but Dr. Rapuano feels that the results of PRK and LASEK are pretty similar.
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What is "Wavefront?"
Wavefront is simply a different method of obtaining the refraction of the eye. The wavefront machine sends multiple rays of light into the ye and records how they exit the eye -- giving refractive data over a large area of the cornea. That information can be transmitted to the laser to reshape the cornea. While the end result is similar to standard LASIK, it has the potential to give a more individualized of "custom" ablation, ideally yielding better visual results. It is FDA approved for mild to moderate myopia with mild to moderate degrees of astigmatism. The cost for Wavefront is slightly higher that standard LASIK, and involves additional testing.
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What is the LASIK procedure like?
After preparation of the eyes with drops, an eyelid holder is placed so you cannot close the eye. A suction ring is placed on your eye to increase the eye pressure. You will feel a pressure sensation and your vision will dim. The microkeratome is used to create the flap. Then the pressure ring is removed and your vision returns but it is fuzzy. The flap is lifted, the laser treatment performed and the flap is replaced. The interface is irrigated and the flap adheres for several minutes. After the surgery the vision is moderately blurred for several hours.
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Is LASIK painful?
There is minimal discomfort during the LASIK procedure because the eye is numbed with anesthetic drops. The eyelid holder can cause mild irritation when it is opened wide. When the suction ring is placed on your eye, you will feel a pressure sensation, but not real pain. After the surgery, the eye often has a sandy or gritty feeling for 4-6 hours. By the next day the eye usually feels back to normal.
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Can I have both eyes done the same day?
Most patients elect to have both eyes treated the same day, although it is totally up to you. Advantages of surgery on both eyes on the same day include convenience (fewer trips for surgery, fewer post-operative visits), fewer days off from work, and minimal imbalance between the two eyes. Disadvantages include safety issues such as infection or severe inflammation, which could occur in both eyes if treated the same day, or rare cases of decreased vision from corneal scarring or irregularity.
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What kind of vision can I expect?
The day of surgery the vision is often moderately blurred. By the next day the vision has improved greatly, although it is often not perfect. Most patients experience glare and halos, especially in dim illumination, after LASIK. These symptoms typically last a few weeks but in rare cases can last longer. The chances of achieving 20/40 uncorrected vision is around 95-98%. The chance of reaching 20/20 uncorrected vision is about 60-70%. The exact numbers depend on your initial amount of nearsightedness or farsightedness and astigmatism.
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Is LASIK safe?
LASIK has an excellent safety record. The chance of complications is approximately 1-2%, including significant under correction, overcorrection, flap problems and rarely, infection. Most of these complications did not cause a loss of final best-corrected vision.
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What is an "enhancement"?
When a significant undercorrection or overcorrection occurs, it is often (but not always) possible to lift the LASIK flap and retreat with the laser. The "enhancement" rate is 5-15%, depending on the original refraction. Higher corrections have higher "enhancement" rates. There is no additional cost for enhancements done during the first year.
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Can I get more information?
We are happy to send you an information packet regarding refractive surgery. Please call our office 215-928-3180 to request this information.
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What do I do next?
If you are interested in a refractive surgery evaluation with Dr. Rapuano, please call our office 215-928-3180 and make a refractive surgery evaluation appointment. You should be out of soft contact lenses for at least 2 weeks and rigid contact lenses for at least 3 weeks before your appointment. This complete ophthalmic examination, which includes dilation, takes about 1 and a half to 2 hours and costs $100. If you have additional question, please feel free to call and speak to Mary Sprague, Dr. Rapuano's refractive surgery coordinator. If she cannot answer your questions Dr. Rapuano will call you back.
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