LASIK , laser-assisted-in-situ-keratomileusis is a procedure to reduce refractive error by laser rays over the cornea, the black spherical part of eyeball. Need to know what is cornea, it is round, black part, it is naturally clear, no colour, it has reflection of iris colour. Cornea has 5 layers without blood vessels. Epithelium layer, bowmen’s layer, stroma, Desmet membrane and Endotheliam layer. The outer most layer is epithelium has property to regrowth within 24 hrs.
Lasik is pain less procedure hardly take 15 min each eye, vision recovery time within 24 hrs.
LASIK Surgery Procedure:-
Flap Making: At first surgeon makes a thin flap over the center of cornea by the use of microkeratome( blade ). Another process is by use of femtosecond laser, the flap is very refine to handling consciously lifted.
Apply Laser: For reshape cornea the exerciser laser apply over the stroma layer, some amount of tissue remove thickness about 10 micrometers. The patient vision may become hazy and able to see light surrounding in flap lift position. Laser abalation over stromal deeper layer gives quick recovery in vision and minimum pain than older procedure unlike PRK.
Flap Reposition: After application of laser on corneal stromal layer the flap is lifted back or reposition as it was before, doctor will check perfect position of flap, any air bubbles, any particles.
Recovery: Need to take rest about 5 to 7 days, use black or white goggle to protect eye from outside particles, excessive lights, reduce chance of rubbing while sleep, doctor will prescribe significantly antibiotic, non-steroidal anti inflammatory, artificial eye drops. Sometimes bandage contact lens are advised to better drop penetration. Post-operative care is vital to decrease the risk of complication.
Examination Important for LASIK:-
- Vision without glass and with best corrected glass.
- Refraction: Dry refraction, subjective best possible, with drops dilated refraction should be noted.
- Slit lamp examination in detail and axial length measure by A-scan.
- Dilated retina check up with indirect ophthalmoscopy.
- Pupil size measurement in low light .
- Dryness test with Schirmer strip, it gives the state of tears of eyes.
- Eye pressure or intraocular pressure measurement.
Corneal topography and corneal thickness are very much essential, it helps to study the shape of cornea, any corneal deformaties. This system include keratometry(corneal curvature), Pentacam imaging, placido-disc, OCT of corneal anterior segment.
Selection of Right Candidate:-
Correct Age: Best age to perform Lasik after 18 years to before 40 or before presbyopia. Below 18 years candidate is not perfect selection due to unstable power or refraction. Generally Lasik performs when the refractive error has been stable since last one year.
Refractive Error: Surgery depends on which type of refractive error that person has, it can correct myopia or minus power upto 8 dioptre, hypermetropia upto 4 dioptre, astigmatism upto 5 dioptre .
Ocular Pathology: Any pathology detected on patient eye that may be complication for surgery, that person will not select for lasik, these are following pathology – keratoconus, glaucoma, viral infection in cornea, dry eyes, uveitis, diabetes, one eyed.
Motivation: The person should be positive to result of lasik, sometime surgeon will explain all risks and good out comes about surgery, candidate has to self motivated about surgery that gives spectacle free vision with cosmetic good looks.
Risk of LASIK Eye Surgery: –
- Need of glass after Lasik surgery, this is rare condition regrowth of power, better to discuss with your doctor how much need of glass you require, but after age of 40 for near work glass necessary to see clear.
- Need of Second Surgery: Most of the time first surgery will successful 99% of power correction done but some case while high power second surgery need to achieve the sharp vision. If cornea is thin or abnormal second surgery is not advice.
- Person already performed lasik may experience light sensitivity, glare, different image size, difficulty reading in low light.
- Dry eyes, very common experience by most of people after lasik, may face dryness, redness, irritation.
- Corneal pathology, surgery is performed directly over cornea, chance of corneal infection, keratitis, opacity, weak cornea may happens.
Side Effects of LASIK Eye Surgery: –
- Light sensitivity or glare at the time of night driving may occurs immediate after few days of surgery.
- Colour halos, rainbow can be seen at light.
- Corneal flap complication may rarely occurs.
- Dry eyes very often side effect ,once recovery done dry eyes may gone.
- Residual refractive errors, not every person achieve 6/6 or 20/20 vision some amount of refractive error will remains, glass or contact lens correction needs.
LASIK Eye Surgery Cost:-
Lasik cost differ from clinic to clinic in India. It depend on which technology laser patient is ready to avail the cost will differ, there are types of laser:-
- Femtosecond lasik cost ₹80000 to ₹90000 both eyes.
- Customized lasik with blade( microkeratome) ₹40000 to ₹60000 for both eyes .
- ReLEX smile ₹1,20,000 to ₹1,30,000.
- Optimized lasik (with blade) ₹25000 to ₹40000, known as Aspheric LASIK.
SMILE Eye Surgery How it is Differ from LASIK:-
SMILE is small incision lenticule extraction same like LASIK where surgeon makes a half circle incision over cornea and remove very small amount of lenticule(tissue) from cornea with the help of femtosecond laser. This laser eye surgery is best for nearsightedness or the people who has minus power. After surgery the shape of the cornea has a bit change, cornea will heal within 7 days. This can correct upto -10 dioptre, the best age to perform minimum 22 years, the power will stable since 1 year.
- Smile gives sharp vision
- No corneal flap complication
- No more dryness
More effective for myopia, not for hypermetropia or astigmatism.