For many people, laser eye surgery can correct their vision so they no longer need glasses or contact lenses. Laser eye surgery reshapes the cornea, the clear front part of the eye. This changes its focusing power.

There are different types of laser eye surgery. LASIK - laser-assisted in situ keratomileusis - is one of the most common. Many patients who have LASIK end up with 20/20 vision. But, like all medical procedures, it has both risks and benefits. Only your eye doctor can tell if you are a good candidate for laser eye surgery.

LASIK is corrective surgery to a very delicate part of the eye. Millions of people have had LASIK surgery to correct their vision, many with great success. But everyone is not a good candidate for the surgery.

LASIK Basics

If you wear glasses or contact lenses, you might think about surgery to correct your vision. In a LASIK procedure, a laser is used to reshape your cornea — the clear, round dome at the front of your eye — to improve the way your eye focuses light rays onto your retina. LASIK is shorthand for laser-assisted in situ keratomileusis.

Before you sign up for this surgery, here are a few things to think about:

• LASIK is surgery to a very delicate part of your eye, and cannot be reversed.
• As with any surgery, there are risks and possible complications.
• Millions of people have had LASIK, many very successfully, but it’s not for everyone.
• LASIK may not give you perfect vision. The American Academy of Ophthalmology (AAO) reports that nine out of 10 patients achieve somewhere between 20/20 and 20/40 vision, but 20/40 vision may not be sharp enough for certain work or leisure activities. Even 20/20 does not always mean perfect vision. Detailed, precise vision may be slightly diminished.
• Even with LASIK to correct your distance vision, you are likely to need reading glasses in your mid-40s. LASIK surgery cannot correct or prevent presbyopia, the age-related loss of focusing power for seeing near objects.
• If you are nearsighted and don't yet need reading glasses, having LASIK may mean you will need reading glasses earlier than if you had not had the surgery.
• The benefits of the LASIK procedure may diminish over time. More than 10 percent of LASIK patients in the U.S. require a second surgery, called “retreatment,” to restore the desired vision correction. This is more likely for people who were more nearsighted or farsighted, or had higher astigmatism before LASIK.
• Most insurance plans don’t cover the surgery.

Understanding Your Eyes

To see clearly, the cornea and the lens must bend, or refract, light rays so they focus on the retina — a layer of light-sensing cells that line the back of the eye. The retina converts the light rays into impulses that are sent to the brain, where they are recognized as images. If the light rays don’t focus on the retina, the image you see is blurry. This is called a refractive error. Glasses, contact lenses, and refractive surgery try to reduce these errors by making light rays focus on the retina.

Refractive errors are caused by an imperfectly shaped eyeball, cornea, or lens — or in the case of presbyopia, a lens that can't change shape enough to focus on close objects — and are of these basic types:

• myopia is another word for nearsightedness, where only nearby objects are clear or distinct
• hyperopia is another word for farsightedness, where only objects far away are clear or distinct
• astigmatism is when images are blurred, regardless of whether they are near or far
• presbyopia, or "aging eye," is a condition that typically develops between ages 40 and 50 and makes it more difficult to see very close. It can be corrected with bifocals or reading glasses, but usually can't be corrected by LASIK or some other refractive surgery.

Are You a Good Candidate for LASIK?

LASIK isn’t for everyone

• You should be at least 18 years old (21 for some lasers). The vision of people younger than 18 still is changing.
• You shouldn’t be pregnant or nursing. It might change the measured refraction of the eye.
• You shouldn’t be taking certain prescription drugs, like Accutane or oral prednisone.
• Your eyes must be healthy and your prescription stable. If you’re myopic, you should postpone LASIK until your refraction has stabilized. Myopia may continue to increase in some patients until their mid- to late 20s.
• Your general health should be good. LASIK may not be recommended for patients with diabetes, rheumatoid arthritis, lupus, glaucoma, herpes infections of the eye, cataracts, disorders of the cornea, and retinal disease. Discuss your general health status with your surgeon.
• A history of “dry eye” could matter. If you’ve had problems with dry eye, from wearing contact lenses, taking certain medications, or some other reason, talk to your eye doctor about how it could impact LASIK. You should be screened for dry eye before you have LASIK or other refractive surgery.

Other considerations

• The risks and rewards. If you’re happy wearing contacts or glasses, you may want to forgo the surgery.
• Your expectations from the surgery. Are they realistic? In general, having very poor eyesight reduces the chance of LASIK success and increases the chance of retreatment.
• Workplace requirements and lifestyle activities. Discuss work, sports, and recreation with your doctor to make sure LASIK is appropriate for you.
• If you're a candidate for monovision, which corrects one eye for distance vision and the other eye for near vision. LASIK cannot correct presbyopia so that one eye can see both near and far. However, it can be used to correct one eye for distance and the other for near vision. If you can adjust to this correction, it may eliminate or reduce your need for reading glasses. Yet monovision has its own risks:
  • After monovision, the two eyes no longer work together. This causes poorer quality vision and a decrease in depth perception. These effects are most noticeable in low lighting conditions and when performing tasks requiring very sharp vision.
  • As a result, you may need to wear glasses or contact lenses for distance or near vision when performing visually demanding tasks, such as driving at night, operating dangerous equipment, or performing occupational tasks requiring very sharp, close vision.

Finding a Surgeon

Only ophthalmologists are permitted to perform LASIK. Ask your ophthalmologist or optometrist for a referral to a medical doctor who performs LASIK. The can provide you with a list of its members who perform LASIK. About 95 percent of all ophthalmologists are AAO members.

Questions to ask your surgeon

• How long have you been doing LASIK surgery?
• How much experience do you have with the LASIK procedure?
• How do you define success? What’s your success rate? What is the chance for me (with my correction) to achieve 20/20? How many of your patients have achieved 20/20 or 20/40 vision? How many patients return for retreatments? (A five to 15 percent return is not unusual.)
• What laser will you be using for my surgery? Make sure the surgeon is using a laser approved by the U.S. Food and Drug Administration (FDA).
• What’s involved in after-surgery care?
• Who will handle my after-surgery care? Who will be responsible?
• What are the risks and possible complications?

Risks and Complications

Before the surgery, your surgeon should explain the risks and possible complications, including the pros and cons of having one or both eyes done on the same day. This is the “informed consent” process.

Risks

• Blindness and irreversible eye damage. In rare cases, errors during surgery (like the malfunctioning of the laser device) or complications after surgery (for example, inflammation) may cause irreversible damage to the eye, including permanent blindness. In other cases, the problems can be corrected with additional surgeries or other treatments.
• Vision loss. You may not see as well after the surgery — even with glasses or contacts — as you did with glasses or contacts before the surgery. Or, you may need glasses or contacts to see as well as you did before surgery.
• Severe night vision problems. You may develop debilitating visual symptoms, particularly glare, halos, and/or double vision that can seriously affect nighttime vision.
• Decrease in contrast sensitivity, “crispness,” or sharpness. Objects may appear fuzzy or grayish. Even with good vision on the vision chart, you may not see as well in situations of low contrast — like at night or in fog — after treatment compared to before.
• Severe dry eye syndrome. As a result of surgery, your eye may not be able to produce enough tears to keep it moist and comfortable. Dry eye not only causes discomfort, but can reduce visual quality due to intermittent blurring and other visual symptoms. This condition may be permanent. Intensive drop therapy and use of plugs or other procedures may be required.

Complications

• Corneal infection or inflammation. These problems may require additional surgery or other treatments.
• Problems with the corneal flap after surgery. These include irregular or incomplete flaps, ingrowth of cells under the flap that may need to be surgically removed, and irregular healing that results in a distorted cornea, which can only be corrected with a corneal transplant.

What to Expect Before, During, and After Surgery

Before

You’ll need a complete eye examination by your refractive surgeon. Your referring eye care professional may perform a preliminary eye exam. Take your eye prescription records with you to the exams. If you wear contact lenses, stop wearing them before your baseline evaluation (soft contact lenses — two weeks; toric soft lenses or rigid gas permeable lenses — three weeks; hard lenses — four weeks). Contacts can temporarily change the shape of the cornea and compromise precise measurements in the pre-op exam.

Your doctor should:

• dilate your pupils to fine-tune your prescription
• examine your eyes to make sure they’re healthy, including testing for glaucoma, performing a retinal exam, and assessing for dry eye
• take the following measurements:
  • the curvature of your cornea and your pupils
  • the topography of your eyes, to make sure you don’t have an irregular astigmatism or a cone-shaped cornea — a condition called keratoconus
  • the thickness of your cornea. You need to have enough tissue left after your corneas have been cut and reshaped.
• ask you to sign an informed consent form after a thorough discussion of the risks, benefits, options, and possible complications of LASIK surgery. Review the form carefully, and don’t sign until you understand everything in the form.

If your doctor doesn’t think LASIK is right for you, you might consider getting a second opinion; however, if the opinion is the same, believe it.

If you qualify for surgery, your doctor may tell you to stop wearing your contact lenses for a while before the surgery for the same reason that you stopped wearing them before your baseline exam: contacts can temporarily change the shape of the cornea. Your cornea should be in its natural shape the day of surgery. Your doctor also may tell you to stop wearing makeup, lotions, or perfume for a few days before surgery. These products can interfere with the laser treatment or increase the risk of infection after surgery.

During

LASIK is an outpatient surgical procedure. The only anesthetic is an eye drop that numbs the surface of the eye. The surgery takes 10 to 15 minutes for each eye. Sometimes, both eyes are done during the same procedure; but sometimes, surgeons wait (sometimes days or weeks) to see the result on one eye before doing surgery on the other.

The Surgical Procedure: The eye is moistened. A suction ring is positioned to keep the eye from moving and the cornea in the correct position. A special device cuts a hinged flap of thin corneal tissue off the outer layer of the eyeball (cornea) and the flap is lifted out of the way. The laser reshapes the underlying corneal tissue, and the surgeon replaces the flap, which quickly adheres to the eyeball. There are no stitches. A shield — either clear plastic or perforated metal — is placed over the eye to protect the flap.

After

Healing is relatively fast, but you may want to take a few days off from work after the surgery. Avoid sports for three days after surgery; impact sports or similar activities for four weeks. Be aware that:

• you may experience a mild burning or sensation for a few hours after surgery. Don’t rub your eye. Your doctor can prescribe a painkiller, if you need one, to ease any discomfort.
• your vision probably will be blurry the day of surgery, but it should improve considerably by the next day when you return for a follow-up exam
• you should report aggravating or unusual side effects to your doctor immediately
• you shouldn’t drive until your vision has improved enough to do so safely
• you should avoid swimming, hot tubs, and whirlpools for two weeks after surgery

Surgical Alternatives to LASIK

You may want to discuss some surgical alternatives to LASIK with your eye doctor. In general, these procedures are relatively new and are performed less often than traditional LASIK surgery.

Photorefractive Keratectomy (PRK)

In surgery using PRK, including Epi-LASIK and LASEK, surgeons use lasers to create “surface ablations” on the cornea without creating a corneal flap. Because these procedures cut only the very top (epithelial) layer of the cornea, the risk of certain complications associated with LASIK surgery may be reduced.

Conductive Keratoplasty (CK)

This is a thermal refractive surgery procedure used to correct mild to moderate farsightedness (hyperopia) in people over age 40 by use of a tiny probe that releases controlled amounts of radio frequency (RF) energy, instead of a laser, to apply heat to the peripheral portion of the cornea. Farsightedness may return over time.

Phakic Intraocular Lens (IOL)

An IOL is a form of contact lens that is surgically implanted inside the eye in front of the lens. These implants are used to correct vision problems caused by cataracts and other refractory problems that are too severe to be corrected with corneal-based refractive surgery. Certain types of IOLs, such as Multifocal or accommodative lenses, may not only improve distance vision but also eliminate the need for reading glasses.

The eye and vision errors

The cornea is a part of the eye that helps focus light to create an image on the retina. It works in much the same way that the lens of a camera focuses light to create an image on film. The bending and focusing of light is also known as refraction. Usually the shape of the cornea and the eye are not perfect and the image on the retina is out-of-focus (blurred) or distorted. These imperfections in the focusing power of the eye are called refractive errors. There are three primary types of refractive errors: myopia, hyperopia and astigmatism. Persons with myopia, or nearsightedness, have more difficulty seeing distant objects as clearly as near objects. Persons with hyperopia, or farsightedness, have more difficulty seeing near objects as clearly as distant objects. Astigmatism is a distortion of the image on the retina caused by irregularities in the cornea or lens of the eye. Combinations of myopia and astigmatism or hyperopia and astigmatism are common. Glasses or contact lenses are designed to compensate for the eye's imperfections. Surgical procedures aimed at improving the focusing power of the eye are called refractive surgery. In LASIK surgery, precise and controlled removal of corneal tissue by a special laser reshapes the cornea changing its focusing power.

Other types of refractive surgery

Radial Keratotomy or RK and Photorefractive Keratectomy or PRK are other refractive surgeries used to reshape the cornea. In RK, a very sharp knife is used to cut slits in the cornea changing its shape. PRK was the first surgical procedure developed to reshape the cornea, by sculpting, using a laser. Later, LASIK was developed. The same type of laser is used for LASIK and PRK. Often the exact same laser is used for the two types of surgery. The major difference between the two surgeries is the way that the stroma, the middle layer of the cornea, is exposed before it is vaporized with the laser. In PRK, the top layer of the cornea, called the epithelium, is scraped away to expose the stromal layer underneath. In LASIK, a flap is cut in the stromal layer and the flap is folded back.

Another type of refractive surgery is thermokeratoplasty in which heat is used to reshape the cornea. The source of the heat can be a laser, but it is a different kind of laser than is used for LASIK and PRK. Other refractive devices include corneal ring segments that are inserted into the stroma and special contact lenses that temporarily reshape the cornea (orthokeratology).

Ablate - in surgery, is to remove.

Ablation zone - the area of tissue that is removed during laser surgery.

Accommodation - the ability of the eye to change its focus from distant objects to near objects.

Acuity - clearness, or sharpness of vision.

All-Laser LASIK - (also known as “Bladeless LASIK”) a laser keratome device is used to cut a corneal flap for LASIK surgery.

Astigmatism - a distortion of the image on the retina caused by irregularities in the cornea or lens.

Cornea - the clear, front part of the eye. The cornea is the first part of the eye that bends (or refracts) the light and provides most of the focusing power.

Diopter - the measurement of refractive error. A negative diopter value signifies an eye with myopia and positive diopter value signifies an eye with hyperopia.

Dry Eye Syndrome - a common condition that occurs when the eyes do not produce enough tears to keep the eye moist and comfortable. Common symptoms of dry eye include pain, stinging, burning, scratchiness, and intermittent blurring of vision.

Endothelium - the inner layer of cells on the inside surface of the cornea.

Epithelium - the outermost layer of cells of the cornea and the eye's first defense against infection.

Excimer laser - an ultraviolet laser used in refractive surgery to remove corneal tissue.

Farsightedness - the common term for hyperopia.

FDA - the abbreviation for the Food and Drug Administration. It is the United States governmental agency responsible for the evaluation and approval of medical devices.

Flap & Zap - a slang term for LASIK.

Ghost Image - a fainter second image of the object you are viewing.

Glare - scatter from bright light that decreases vision.

Halos are rings around lights due to optical imperfections in or in front of the eye.

Haze - corneal clouding that causes the sensation of looking through smoke or fog.

Higher order aberrations refractive errors, other than nearsightedness, farsightedness, and astigmatism, that cannot be corrected with glasses or contacts.

Hyperopia - the inability to see near objects as clearly as distant objects, and the need for accommodation to see distant objects clearly.

Inflammation - the body's reaction to trauma, infection, or a foreign substance, often associated with pain, heat, redness, swelling, and/or loss of function.

Informed Consent Form a document disclosing the risks, benefits, and alternatives to a procedure.

In Situ a Latin term meaning "in place" or not removed.

Iris - the colored ring of tissue suspended behind the cornea and immediately in front of the lens.

Keratectomy - the surgical removal of corneal tissue.

Keratotomy - a surgical incision (cut) of the cornea.

Keratitis - inflammation of the cornea.

Kerato - prefix indicating relationship to the cornea.

Keratoconus a disorder characterized by an irregular corneal surface (cone-shaped) resulting in blurred and distorted images.

Keratomileusis - carving of the cornea to reshape it.

Laser - the acronym for light amplification by stimulated emission of radiation. A laser is an instrument that produces a powerful beam of light that can vaporize tissue.

Laser Keratome - a laser device used to create a corneal flap

LASIK - the acronym for laser assisted in situ keratomileusis which refers to creating a flap in the cornea with a microkeratome and using a laser to reshape the underlying cornea.

Lens - a part of the eye that provides some focusing power. The lens is able to change shape allowing the eye to focus at different distances.

Microkeratome - a mechanical surgical device that is affixed to the eye by use of a vacuum ring. When secured, a very sharp blade cuts a layer of the cornea at a predetermined depth.

Monovision - the purposeful adjustment of one eye for near vision and the other eye fordistance vision.

Myopia - the inability to see distant objects as clearly as near objects.

Nearsightedness - the common term for myopia.

Ophthalmologist - a medical doctor specializing in the diagnosis and medical or surgical treatment of visual disorders and eye disease.

Optician - an expert in the art and science of making and fitting glasses and may also dispense contact lenses.

Optometrist - a primary eye care provider who diagnoses, manages, and treats disorders of the visual system and eye diseases.

Overcorrection - a complication of refractive surgery where the achieved amount of correction is more than desired.

PRK - the acronym for photorefractive keratectomy which is a procedure involving the removal of the surface layer of the cornea (epithelium) by gentle scraping and use of a computer-controlled excimer laser to reshape the stroma.

Presbyopia - the inability to maintain a clear image (focus) as objects are moved closer. Presbyopia is due to reduced elasticity of the lens with increasing age.

Pupil - a hole in the center of the iris that changes size in response to changes in lighting. It gets larger in dim lighting conditions and gets smaller in brighter lighting conditions.

Radial Keratotomy - commonly referred to as RK; a surgical procedure designed to correct myopia (nearsightedness) by flattening the cornea using radial cuts.

Refraction - a test to determine the refractive power of the eye; also, the bending of light as it passes from one medium into another.

Refractive Errors - imperfections in the focusing power of the eye, for example, hyperopia, myopia, and astigmatism.

Refractive Power - the ability of an object, such as the eye, to bend light as light passes through it.

Retina - a layer of fine sensory tissue that lines the inside wall of the eye. The retina acts like the film in a camera to capture images, transforms the images into electrical signals, and sends the signals to the brain.

Sclera - the tough, white, outer layer (coat) of the eyeball that, along with the cornea, protects the eyeball.

Snellen Visual Acuity Chart - one of many charts used to measure vision.

Stroma - the middle, thickest layer of tissue in the cornea.

Undercorrection - a complication of refractive surgery where the achieved amount of correction is less than desired.

Visual Acuity - the clearness of vision; the ability to distinguish details and shapes.

Vitreous Humor - the transparent, colorless mass of gel that lies behind the lens and in front of the retina and fills the center of the eyeball.

Wavefront - a measure of the total refractive errors of the eye, including nearsightedness, farsightedness, astigmatism, and other refractive errors that cannot be corrected with glasses or contacts.

You are probably NOT a good candidate for refractive surgery if:

• You are not a risk taker. Certain complications are unavoidable in a percentage of patients, and there are no long-term data available for current procedures.

• It will jeopardize your career. Some jobs prohibit certain refractive procedures. Be sure to check with your employer/professional society/military service before undergoing any procedure.

• Cost is an issue. Most medical insurance will not pay for refractive surgery. Although the cost is coming down, it is still significant.

• You required a change in your contact lens or glasses prescription in the past year. This is called refractive instability. Patients who are:
  • In their early 20s or younger,
  • Whose hormones are fluctuating due to disease such as diabetes,
  • Who are pregnant or breastfeeding, or
  • Who are taking medications that may cause fluctuations in vision,
  • Who are more likely to have refractive instability and should discuss the possible additional risks with their doctor.
• You have a disease or are on medications that may affect wound healing. Certain conditions, such as autoimmune diseases (e.g., lupus, rheumatoid arthritis), immunodeficiency states (e.g., HIV) and diabetes, and some medications (e.g., retinoic acid and steroids) may prevent proper healing after a refractive procedure.
• You actively participate in contact sports. You participate in boxing, wrestling, martial arts or other activities in which blows to the face and eyes are a normal occurrence.
• You are not an adult. Currently, no lasers are approved for LASIK on persons under the age of 18.

Precautions
The safety and effectiveness of refractive procedures has not been determined in patients with some diseases. Discuss with your doctor if you have a history of any of the following:

• Herpes simplex or Herpes zoster (shingles) involving the eye area.
• Glaucoma, glaucoma suspect, or ocular hypertension.
• Eye diseases, such as uveitis/iritis (inflammations of the eye)
• Eye injuries or previous eye surgeries.
• Keratoconus

Other Risk Factors
Your doctor should screen you for the following conditions or indicators of risk:

• Blepharitis. Inflammation of the eyelids with crusting of the eyelashes, that may increase the risk of infection or inflammation of the cornea after LASIK.
• Large pupils. Make sure this evaluation is done in a dark room. Although anyone may have large pupils, younger patients and patients on certain medications may be particularly prone to having large pupils under dim lighting conditions. This can cause symptoms such as glare, halos, starbursts, and ghost images (double vision) after surgery. In some patients these symptoms may be debilitating. For example, a patient may no longer be able to drive a car at night or in certain weather conditions, such as fog.
• Thin Corneas. The cornea is the thin clear covering of the eye that is over the iris, the colored part of the eye. Most refractive procedures change the eye’s focusing power by reshaping the cornea (for example, by removing tissue). Performing a refractive procedure on a cornea that is too thin may result in blinding complications.
• Previous refractive surgery (e.g., RK, PRK, LASIK). Additional refractive surgery may not be recommended. The decision to have additional refractive surgery must be made in consultation with your doctor after careful consideration of your unique situation.
• Dry Eyes. LASIK surgery tends to aggravate this condition.

Most patients are very pleased with the results of their refractive surgery. However, like any other medical procedure, there are risks involved. That's why it is important for you to understand the limitations and possible complications of refractive surgery.

Before undergoing a refractive procedure, you should carefully weigh the risks and benefits based on your own personal value system, and try to avoid being influenced by friends that have had the procedure or doctors encouraging you to do so.

• Some patients lose vision. Some patients lose lines of vision on the vision chart that cannot be corrected with glasses, contact lenses, or surgery as a result of treatment.
• Some patients develop debilitating visual symptoms. Some patients develop glare, halos, and/or double vision that can seriously affect nighttime vision. Even with good vision on the vision chart, some patients do not see as well in situations of low contrast, such as at night or in fog, after treatment as compared to before treatment.
• You may be under treated or over treated. Only a certain percent of patients achieve 20/20 vision without glasses or contacts. You may require additional treatment, but additional treatment may not be possible. You may still need glasses or contact lenses after surgery. This may be true even if you only required a very weak prescription before surgery. If you used reading glasses before surgery, you may still need reading glasses after surgery.
• Some patients may develop severe dry eye syndrome. As a result of surgery, your eye may not be able to produce enough tears to keep the eye moist and comfortable. Dry eye not only causes discomfort, but can reduce visual quality due to intermittent blurring and other visual symptoms. This condition may be permanent. Intensive drop therapy and use of plugs or other procedures may be required.
• Results are generally not as good in patients with very large refractive errors of any type. You should discuss your expectations with your doctor and realize that you may still require glasses or contacts after the surgery.
• For some farsighted patients, results may diminish with age. If you are farsighted, the level of improved vision you experience after surgery may decrease with age. This can occur if your manifest refraction (a vision exam with lenses before dilating drops) is very different from your cycloplegic refraction (a vision exam with lenses after dilating drops).
• Long-term data are not available. LASIK is a relatively new technology. The first laser was approved for LASIK eye surgery in 1998. Therefore, the long-term safety and effectiveness of LASIK surgery is not known.

Additional Risks if you are Considering the Following:

• Monovision

Monovision is one clinical technique used to deal with the correction of presbyopia, the gradual loss of the ability of the eye to change focus for close-up tasks that progresses with age. The intent of monovision is for the presbyopic patient to use one eye for distance viewing and one eye for near viewing. This practice was first applied to fit contact lens wearers and more recently to LASIK and other refractive surgeries. With contact lenses, a presbyopic patient has one eye fit with a contact lens to correct distance vision, and the other eye fit with a contact lens to correct near vision. In the same way, with LASIK, a presbyopic patient has one eye operated on to correct the distance vision, and the other operated on to correct the near vision. In other words, the goal of the surgery is for one eye to have vision worse than 20/20, the commonly referred to goal for LASIK surgical correction of distance vision. Since one eye is corrected for distance viewing and the other eye is corrected for near viewing, the two eyes no longer work together. This results in poorer quality vision and a decrease in depth perception. These effects of monovision are most noticeable in low lighting conditions and when performing tasks requiring very sharp vision. Therefore, you may need to wear glasses or contact lenses to fully correct both eyes for distance or near when performing visually demanding tasks, such as driving at night, operating dangerous equipment, or performing occupational tasks requiring very sharp close vision (e.g., reading small print for long periods of time).

Many patients cannot get used to having one eye blurred at all times. Therefore, if you are considering monovision with LASIK, make sure you go through a trial period with contact lenses to see if you can tolerate monovision, before having the surgery performed on your eyes. Find out if you pass your state's driver's license requirements with monovision.

In addition, you should consider how much your presbyopia is expected to increase in the future. Ask your doctor when you should expect the results of your monovision surgery to no longer be enough for you to see near-by objects clearly without the aid of glasses or contacts, or when a second surgery might be required to further correct your near vision.

• Bilateral Simultaneous Treatment

You may choose to have LASIK surgery on both eyes at the same time or to have surgery on one eye at a time. Although the convenience of having surgery on both eyes on the same day is attractive, this practice is riskier than having two separate surgeries.

If you decide to have one eye done at a time, you and your doctor will decide how long to wait before having surgery on the other eye. If both eyes are treated at the same time or before one eye has a chance to fully heal, you and your doctor do not have the advantage of being able to see how the first eye responds to surgery before the second eye is treated.

Another disadvantage to having surgery on both eyes at the same time is that the vision in both eyes may be blurred after surgery until the initial healing process is over, rather than being able to rely on clear vision in at least one eye at all times.

Finding the Right Doctor

If you are considering refractive surgery, make sure you:

• Compare. The levels of risk and benefit vary slightly not only from procedure to procedure, but from device to device depending on the manufacturer, and from surgeon to surgeon depending on their level of experience with a particular procedure.

• Don't base your decision simply on cost and don't settle for the first eye center, doctor, or procedure you investigate. Remember that the decisions you make about your eyes and refractive surgery will affect you for the rest of your life.

• Be wary of eye centers that advertise, "20/20 vision or your money back" or "package deals." There are never any guarantees in medicine.

• Read. It is important for you to read the patient handbook provided to your doctor by the manufacturer of the device used to perform the refractive procedure. Your doctor should provide you with this handbook and be willing to discuss his/her outcomes (successes as well as complications) compared to the results of studies outlined in the handbook.

Even the best screened patients under the care of most skilled surgeons can experience serious complications.

• During surgery. Malfunction of a device or other error, such as cutting a flap of cornea through and through instead of making a hinge during LASIK surgery, may lead to discontinuation of the procedure or irreversible damage to the eye.

• After surgery. Some complications, such as migration of the flap, inflammation or infection, may require another procedure and/or intensive treatment with drops. Even with aggressive therapy, such complications may lead to temporary loss of vision or even irreversible blindness.

Under the care of an experienced doctor, carefully screened candidates with reasonable expectations and a clear understanding of the risks and alternatives are likely to be happy with the results of their refractive procedure.

Advertising

Be cautious about "slick" advertising and/or deals that sound "too good to be true." Remember, they usually are. There is a lot of competition resulting in a great deal of advertising and bidding for your business. Do your homework.

What to expect before, during, and after surgery will vary from doctor to doctor and patient to patient. This section is a compilation of patient information developed by manufacturers and healthcare professionals, but cannot replace the dialogue you should have with your doctor. Read this information carefully and with the checklist, discuss your expectations with your doctor.

Before Surgery

If you decide to go ahead with LASIK surgery, you will need an initial or baseline evaluation by your eye doctor to determine if you are a good candidate. This is what you need to know to prepare for the exam and what you should expect:

If you wear contact lenses, it is a good idea to stop wearing them before your baseline evaluation and switch to wearing your glasses full-time. Contact lenses change the shape of your cornea for up to several weeks after you have stopped using them depending on the type of contact lenses you wear. Not leaving your contact lenses out long enough for your cornea to assume its natural shape before surgery can have negative consequences. These consequences include inaccurate measurements and a poor surgical plan, resulting in poor vision after surgery. These measurements, which determine how much corneal tissue to remove, may need to be repeated at least a week after your initial evaluation and before surgery to make sure they have not changed, especially if you wear RGP or hard lenses. If you wear:

• soft contact lenses, you should stop wearing them for 2 weeks before your initial evaluation.
• toric soft lenses or rigid gas permeable (RGP) lenses, you should stop wearing them for at least 3 weeks before your initial evaluation.
• hard lenses, you should stop wearing them for at least 4 weeks before your initial evaluation.

You should tell your doctor:

• about your past and present medical and eye conditions
• about all the medications you are taking, including over-the-counter medications and any medications you may be allergic to

Your doctor should perform a thorough eye exam and discuss:

• whether you are a good candidate
• what the risks, benefits, and alternatives of the surgery are
• what you should expect before, during, and after surgery
• what your responsibilities will be before, during, and after surgery

You should have the opportunity to ask your doctor questions during this discussion. Give yourself plenty of time to think about the risk/benefit discussion, to review any informational literature provided by your doctor, and to have any additional questions answered by your doctor before deciding to go through with surgery and before signing the informed consent form.

You should not feel pressured by your doctor, family, friends, or anyone else to make a decision about having surgery. Carefully consider the pros and cons.

The day before surgery, you should stop using:

• creams
• lotions
• makeup
• perfumes

These products as well as debris along the eyelashes may increase the risk of infection during and after surgery. Your doctor may ask you to scrub your eyelashes for a period of time before surgery to get rid of residues and debris along the lashes.

Also before surgery, arrange for transportation to and from your surgery and your first follow-up visit. On the day of surgery, your doctor may give you some medicine to make you relax. Because this medicine impairs your ability to drive and because your vision may be blurry, even if you don't drive make sure someone can bring you home after surgery.

During Surgery

The surgery should take less than 30 minutes. You will lie on your back in a reclining chair in an exam room containing the laser system. The laser system includes a large machine with a microscope attached to it and a computer screen.

A numbing drop will be placed in your eye, the area around your eye will be cleaned, and an instrument called a lid speculum will be used to hold your eyelids open.

Your doctor may use a mechanical microkeratome (a blade device) to cut a flap in the cornea.

If a mechanical microkeratome is used, a ring will be placed on your eye and very high pressures will be applied to create suction to the cornea. Your vision will dim while the suction ring is on and you may feel the pressure and experience some discomfort during this part of the procedure. The microkeratome, a cutting instrument, is attached to the suction ring. Your doctor will use the blade of the microkeratome to cut a flap in your cornea. Microkeratome blades are meant to be used only once and then thrown out. The microkeratome and the suction ring are then removed.

Your doctor may use a laser keratome (a laser device), instead of a mechanical microkeratome, to cut a flap on the cornea.

If a laser keratome is used, the cornea is flattened with a clear plastic plate. Your vision will dim and you may feel the pressure and experience some discomfort during this part of the procedure. Laser energy is focused inside the cornea tissue, creating thousands of small bubbles of gas and water that expand and connect to separate the tissue underneath the cornea surface, creating a flap. The plate is then removed.

You will be able to see, but you will experience fluctuating degrees of blurred vision during the rest of the procedure. The doctor will then lift the flap and fold it back on its hinge, and dry the exposed tissue.

The laser will be positioned over your eye and you will be asked to stare at a light. This is not the laser used to remove tissue from the cornea. This light is to help you keep your eye fixed on one spot once the laser comes on. NOTE: If you cannot stare at a fixed object for at least 60 seconds, you may not be a good candidate for this surgery.

When your eye is in the correct position, your doctor will start the laser. At this point in the surgery, you may become aware of new sounds and smells. The pulse of the laser makes a ticking sound. As the laser removes corneal tissue, some people have reported a smell similar to burning hair. A computer controls the amount of laser energy delivered to your eye. Before the start of surgery, your doctor will have programmed the computer to vaporize a particular amount of tissue based on the measurements taken at your initial evaluation. After the pulses of laser energy vaporize the corneal tissue, the flap is put back into position.

A shield should be placed over your eye at the end of the procedure as protection, since no stitches are used to hold the flap in place. It is important for you to wear this shield to prevent you from rubbing your eye and putting pressure on your eye while you sleep, and to protect your eye from accidentally being hit or poked until the flap has healed.

After Surgery

Immediately after the procedure, your eye may burn, itch, or feel like there is something in it. You may experience some discomfort, or in some cases, mild pain and your doctor may suggest you take a mild pain reliever. Both your eyes may tear or water. Your vision will probably be hazy or blurry. You will instinctively want to rub your eye, but don't! Rubbing your eye could dislodge the flap, requiring further treatment. In addition, you may experience sensitivity to light, glare, starbursts or haloes around lights, or the whites of your eye may look red or bloodshot. These symptoms should improve considerably within the first few days after surgery. You should plan on taking a few days off from work until these symptoms subside. You should contact your doctor immediately and not wait for your scheduled visit, if you experience severe pain, or if your vision or other symptoms get worse instead of better.

You should see your doctor within the first 24 to 48 hours after surgery and at regular intervals after that for at least the first six months. At the first postoperative visit, your doctor will remove the eye shield, test your vision, and examine your eye. Your doctor may give you one or more types of eye drops to take at home to help prevent infection and/or inflammation. You may also be advised to use artificial tears to help lubricate the eye. Do not resume wearing a contact lens in the operated eye, even if your vision is blurry.

You should wait one to three days following surgery before beginning any non-contact sports, depending on the amount of activity required, how you feel, and your doctor's instructions.

To help prevent infection, you may need to wait for up to two weeks after surgery or until your doctor advises you otherwise before using lotions, creams, or make-up around the eye. Your doctor may advise you to continue scrubbing your eyelashes for a period of time after surgery. You should also avoid swimming and using hot tubs or whirlpools for 1-2 months.

Strenuous contact sports such as boxing, football, karate, etc. should not be attempted for at least four weeks after surgery. It is important to protect your eyes from anything that might get in them and from being hit or bumped.

During the first few months after surgery, your vision may fluctuate.

• It may take up to three to six months for your vision to stabilize after surgery.
• Glare, haloes, difficulty driving at night, and other visual symptoms may also persist during this stabilization period. If further correction or enhancement is necessary, you should wait until your eye measurements are consistent for two consecutive visits at least 3 months apart before re-operation.
• It is important to realize that although distance vision may improve after re-operation, it is unlikely that other visual symptoms such as glare or haloes will improve.
• It is also important to note that no laser company has presented enough evidence for the FDA to make conclusions about the safety or effectiveness of enhancement surgery.

Contact your eye doctor immediately, if you develop any new, unusual or worsening symptoms at any point after surgery. Such symptoms could signal a problem that, if not treated early enough, may lead to a loss of vision.

Know what makes you a poor candidate

• Career impact - does your job prohibit refractive surgery?
• Cost - can you really afford this procedure?
• Medical conditions - e.g., do you have an autoimmune disease or other major illness? Do you have a chronic illness that might slow or alter healing?
• Eye conditions - do you have or have you ever had any problems with your eyes other than needing glasses or contacts?
• Medications - do you take steroids or other drugs that might prevent healing?
• Stable refraction - has your prescription changed in the last year?
• High or Low refractive error - do you use glasses/contacts only some of the time? Do you need an unusually strong prescription?
• Pupil size - are your pupils extra large in dim conditions?
• Corneal thickness - do you have thin corneas?
• Tear production - do you have dry eyes?

Know all the risks and procedure limitations

• Over-treatment or under-treatment - are you willing and able to have more than one surgery to get the desired result?
• May still need reading glasses - do you have presbyopia?
• Results may not be lasting - do you think this is the last correction you will ever need? Do you realize that long-term results are not known?
• May permanently lose vision - do you know some patients may lose some vision or experience blindness?
• Dry eyes – do you know that if you have dry eyes they could become worse, or if you don’t have dry eyes before you could develop chronic dry eyes as a result of surgery?
• Development of visual symptoms - do you know about glare, halos, starbursts, etc. and that night driving might be difficult?
• Contrast sensitivity - do you know your vision could be significantly reduced in dim light conditions?
• Bilateral treatment - do you know the additional risks of having both eyes treated at the same time?
• Patient information - have you read the patient information booklet about the laser being used for your procedure?

Know how to find the right doctor

• Experienced - how many eyes has your doctor performed LASIK surgery on with the same laser?
• Equipment - does your doctor use an FDA-approved laser for the procedure you need? Does your doctor use each microkeratome blade only once?
• Informative - is your doctor willing to spend the time to answer all your questions?
• Long-term care - does your doctor encourage follow-up and management of you as a patient? Your preop and postop care may be provided by a doctor other than the surgeon.
• Be comfortable - do you feel you know your doctor and are comfortable with an equal exchange of information?

Know preoperative, operative, and postoperative expectations

• No contact lenses prior to evaluation and surgery - can you go for an extended period of time without wearing contact lenses?
• Have a thorough exam - have you arranged not to drive or work after the exam?
• Read and understand the informed consent - has your doctor given you an informed consent form to take home and answered all your questions?
• No makeup before surgery - can you go 24-36 hours without makeup prior to surgery?
• Arrange for transportation - can someone drive you home after surgery?
• Plan to take a few days to recover - can you take time off to take it easy for a couple of days if necessary?
• Expect not to see clearly for a few days - do you know you will not see clearly immediately?
• Know sights, smells, sounds of surgery - has your doctor made you feel comfortable with the actual steps of the procedure?
• Be prepared to take drops/medications - are you willing and able to put drops in your eyes at regular intervals?
• Be prepared to wear an eye shield - do you know you need to protect the eye for a period of time after surgery to avoid injury?
• Expect some pain/discomfort - do you know how much pain to expect?
• Know when to seek help - do you understand what problems could occur and when to seek medical intervention?
• Know when to expect your vision to stop changing - are you aware that final results could take months?
• Make sure your refraction is stable before any further surgery - if you don't get the desired result, do you know not to have an enhancement until the prescription stops changing?

Q: Can you refer me to a good LASIK surgeon in my area?

A: Refer to the Other Resources section of this site. You may want to contact the organizations listed there for additional information. While FDA regulates medical devices and drugs, FDA does not regulate the practice of medicine and does not have a registry of doctors. FDA does not know of any government agency that can provide a referral for any medical procedure. You may want to go to your library and see if there is a local community services magazine that may provide comparison information of services for doctors in your area.

Q: How do I report a bad experience or who do I notify about a 'bad' doctor?

A: If you had a bad experience or sustained an injury, you should file a voluntary MedWatch report (1-800-FDA-1088) to the FDA. Also, you could contact your state medical licensing board and file a complaint with them. In addition, you could contact your state health department or consumer complaint organization (e.g., Better Business Bureau).

Q: How much does LASIK cost?

A: The FDA regulates the safety and effectiveness of medical devices for their intended use. The FDA does not regulate the marketing of or any fees associated with the use of that product. Again, you may want to go to your library and see if there is a local community services magazine that may provide comparison information of services for doctors in your area.

Q: How can I find out if a particular laser has been approved to treat my refractive error (nearsightedness, farsightedness and/or astigmastism)?

A: You can find approved devices, their approval date, and a synopsis of the approved indications on the FDA-Approved Lasers page.

Q: If the laser I am interested in has not yet been approved for a particular indication, how can I find out when it will be approved?

A: Confidentiality restrictions prohibit FDA from commenting on the status of a device under regulatory review, but you can try asking the laser company for this information.

Q: Which laser is the best for treating my refractive error?

A: FDA does not provide comparisons between refractive lasers. FDA approves the safety and effectiveness of a device independent of any other product. However, you are encouraged to review the approval documents to assess the capabilities of specific laser systems and make your own comparisons. The approval number for each laser on the FDA-Approved Lasers page is linked to these documents, which provide additional, detailed information about the clinical trial results and indications for use. Discuss any concerns you may have with your doctor.

Q: How does wavefront LASIK compare to conventional LASIK?

A: Wavefront adds an automatic measurement of more subtle distortions (called higher order aberrations) than just nearsightedness, farsightedness, and astigmatism corrected by conventional LASIK. However, these “higher order aberrations” account for only a small amount (probably no more than 10%) of the total refractive error of the average person’s eye. Conventional LASIK increases higher order aberrations. Although wavefront-guided treatments attempt to eliminate higher order aberrations, results from the clinical studies have shown that the average aberrations still increase, but less than they do after conventional LASIK. In a few studies comparing wavefront-guided LASIK to conventional LASIK, a slightly larger percentage of subjects treated with wavefront LASIK achieved 20/20 vision without glasses or contact lenses compared to subjects treated with conventional LASIK. Patient selection (“When is LASIK not for me?”) and the experience and competence of the surgeon are still the most important considerations.

Q: What is “All-Laser LASIK” and how does it compare to traditional LASIK surgery?

A: The difference between traditional LASIK and “All-Laser LASIK” (also known as “Bladeless LASIK”) is the method by which the LASIK flap is created. In “All-Laser LASIK”, a laser device called a laser keratome, is used to cut a corneal flap for LASIK surgery. This is a newer method to create a corneal flap than the traditional method of using a microkeratome, a mechanical device with a blade. There is no absolute agreement among eye surgeons on the better choice for flap creation. Some of the factors a surgeon considers when choosing a preferred method of flap creation during LASIK are as follows:

• Quality of vision
• Rate of complications
• Pain during and after surgery
• Precision of flap size and thickness
• Time to recovery of vision
• Expense

Discuss with your doctor any questions and concerns you have about how they chose their preferred method of flap creation.

Q: What percentage of patients attain 20/20 vision or better without glasses or contacts?

A: Data in the Approval Orders and related documents summarizes the outcomes from the clinical trials submitted to the FDA for each approved device. Links to these documents are included on the FDA-Approved Lasers page.

Q: Can I use information from the FDA LASIK website?

A: Yes. Information on this website can be used freely by the public. Any use on other websites or in publications should be properly cited.