Sign In

    Flapless LASIK - LASIK Surgery Development and Options

    Last updated 2 months ago

    Refractive errors in the eye could cause vision problems among people from different age group. To address refractive problems like nearsightedness or myopia, farsightedness or hyperopia and completely blurred vision or astigmatism, some people use corrective eyeglasses, while others use contact lenses.

    In the past few years, laser surgery has also been employed to fix refractive errors of the eye. The procedure works on reshaping the cornea or natural outside lens of the eye so that the patient gets the ideal visual acuity.

    Over time, developments in the field of medical science has brought varying techniques used for laser eye surgery. Each of these techniques uses different equipment designed to perform the procedures on the eye with utmost precision.

     

    LASIK versus Photorefractive Keratectomy

    Both LASIK and PRK use laser to reshape the cornea of the eye to achieve ideal contour and help the eye see clearer. PRK removes the epithelium or the membrane covering the cornea in the process of reshaping the cornea. LASIK, on the other hand, keeps the epithelium by creating a flap that is folded away from the treatment zone before actually reshaping the cornea. This approach helps speed up the recovery as the epithelium serves as a natural bandage to the eye.

    It has been observed that patients undergoing LASIK has faster recovery period with lesser irritation compared to those who had PRK. However, these patients appear to experience dryness of the eye more than those who went through PRK surgery.

    Risks Associated To Flap Creation

    While creating and keeping the epithelial membrane seems ideal to promote faster healing, there are associated risks that are unique only to LASIK. The following are examples of flap-related complications.

    Epithelial ingrowth. The epithelial membrane that is placed back after the corneal ablation is allowed to heal completely through natural processes. However, there are reported cases of epithelial ingrowth wherein the cells from the surface layer grows underneath the corneal flap.

    Slipped flap. In some cases the flap detaches from the rest of the cornea. The risk of dislodged flap is greatest immediately after the procedure. To avoid this, patients are advised to get a good rest and wear protective gears like goggles when sleeping to avoid touching and moving the flap while it reattaches itself to the cornea through natural healing processes.

    Diffuse lamellar keratitis. There are reported cases of diffuse lamellar keratitis or eye allergy after laser eye surgery. This complication is not exclusive to LASIK and could happen on other types of laser eye surgeries. However, chances of inflammation is higher in LASIK due to the creation of the flap as this process makes room for cells between the cornea and the epithelial membrane.

    Displaced flap or fold. The flap must be properly placed after corneal ablation to avoid instances of displaced flap or fold. It is also important not to touch or move the flap to avoid the said complication. Although instances or occurrence of displaced flap are small and decreases with the surgeon's experience, it can affect the vision of the patient. As such, correction might be necessary.

    Flap interface particle. Surgeons must carefully and skillfully put the flap back in place after ensuring that there are no particle or air bubble on the flap that might be trapped. These interface particles does not have clinical significance determined yet but are observable.

    LASIK Procedures

    LASIK surgery starts by applying alcohol on the epithelial membrane to weaken the cells. A flap is then created and is folded away from the cornea or the range of the laser. The creation of the flap might be done through mechanical blade or microkeratome or through femtosecond laser depending on the technique used.

    After the flap is folded, actual reshaping of the cornea takes place through the use of excimer laser that ablated corneal tissues causing them to evaporate. The laser ablates tissues that are few micrometers thick until the desired shape and contour of the cornea is achieved.

    Reshaping the cornea usually takes just a few minutes on each eye. After the said procedure, the flap is carefully placed. There are instances wherein re-placing the flap is not ideal, such as when the flap dislodges. The process therefore becomes more of an alcohol-treated PRK than that of LASIK. Healing process becomes much like of PRK.

    Further Developments

    The idea of keeping the flap in LASIK surgery comes with both advantages and disadvantages. Developments in the field of eye medicine tries to get the best of LASIK with lesser complication that comes with keeping the epithelial membrane.

    Although it is still in the stage of advanced testing and evaluation and therefore not yet available for the general public, the idea of an all-laser, flapless LASIK is being considered. This means that the patients gets the benefit of keeping the epithelial membrane to provide continuous nourishment for the eye to fasten recovery with much lesser flap-related complications.

    The procedure includes the reshaping of the cornea through laser and the lenticule that is created inside the cornea is extracted through a small incision which is about three millimeters long. The procedure is still being tested and is in its advanced stages but so far, results collected over a year interval appears promising.

    Positive observation include the minimal occurrence of dry eyes and faster healing. Complication associated with the creation of the flap is also eliminated.

    While LASIK has been observed to be of high success rate, developments in the field like flapless LASIK is surely something every patient is very glad to welcome. This should help future generations perform laser surgeries to correct refractive issues affecting clarity of vision.

    Thanks to the people who tirelessly work on developing new techniques that are useful in the field of medicine and those surgeons who are willing to test the processes together with their expertise for actual application, and the researchers who keep track of the developments, we have something exciting to look forward to. This development brings LASIK a little bit closer to perfection, with lesser risks and complications with better chance of success.

    Hard Look on LASIK Surgery

    Last updated 3 months ago

    Laser eye surgery has improved the vision of millions of people around the world who are suffering from eye conditions since it was used by medical practitioners a few years back. This helped them live better quality of life due to improved visual acuity. This breakthrough is one perfect example of how advances in technology could help people with medical or visual conditions live a healthier and better life.

    LASIK surgery has been the choice of many people to correct refractive errors in vision. Its tried and tested method and ongoing developments help patients build confidence that the surgery on one of the body's most important organs would be successful. Let us take a look at what happens during LASIK surgery and how it differs from other laser eye surgeries.

     

    How It Works

    LASIK or Laser-Assisted in situ Keratomileusis is a type of refractive surgery that uses laser to reshape the cornea of the eye. Reshaping the cornea gives the patient with impaired vision better image clarity. The way the cornea is shaped depends on the specific eye condition that the patient is suffering from. The result of the operation should be comparable to that of using corrective eyeglasses or contact lenses but with permanent effect.

    Nearsighted people need the cornea to be shaped flatter to allow the light waves that enters the eye reach focus exactly at the retina so they could see distant images clearer. Farsighted people on the other hand needs a rounder cornea to achieve normal sight.

    Some people might experience blurry vision when viewing either distant or close objects. This usually happens when the cornea is irregularly shaped which causes the image not to reach focus on the retina. This condition is called astigmatism. Although it has several types, most are easily corrected through laser surgery by making the shape of the cornea more even.

    The cornea is covered with a thin membrane that provides natural nourishment to the eye. Since LASER eye surgery involves reshaping only the cornea, the membrane is removed or placed away from the laser 's treatment zone. LASIK surgery involves keeping the membrane by creating a flap instead of removing it completely so it can be placed back after the procedure, thereby promoting faster healing compared to the other types of refractive eye operations.

    What Happens During the Procedure

    The surgical equipment is computer-aided to ensure precision. A soft suction ring is applied to the eye to hold the eye in place. The computer system keeps track of the position of the eye with utmost accuracy that could go as much as 4000 times per second. In the event that the eye is moved, the laser is redirected to the treatment zone automatically.

    After the eye is positioned, alcohol is applied to the epithelial membrane to weaken the cells. A flap is then made and folded away from the treatment zone. Earlier versions of LASIK equipment use microkeratome or mechanical blade to create the flap, however, newer models use femtosecond laser to create the flap.

    After the flap is folded, an excimer laser is used to reshape the cornea. The laser is applied to predetermined treatment zone to achieve the ideal shape. The laser causes small layer of the tissue to evaporate without burning with heat.

    Once reshaping is completed, the flap is placed back to serve as a natural bandage. The surgeon ensures that the flap is correctly placed and has no debris or air bubbles when placed.

    The process is performed on one eye at a time and would take only a few minutes on each eye. The surgery is an out patient procedure and the patient is left to take care of the eyes as it undergoes natural healing process.

    Technology Used

    A number of technologies are used to achieve precise results of a safe operation. Over the years, several changes were made in the surgical process as well as equipment used. One major difference is the use of laser to create the flap instead of small mechanical blade. This does not signify that microkeratome would be permanently replaced by laser through as there are advantages and disadvantages in using laser to create the flap.

    Excimer lasers used to reshape the cornea is a development in laser technology used in the field of medicine. The technology involves the use of a halide molecule which, under appropriate condition of electrical simulation and high pressure, emits laser light. The properties of this type of laser is ideal for eye surgery because the laser can ablate but a thin piece of tissue with pinpoint accuracy without affecting the surrounding tissues making it possible to reshape the cornea with utmost precision.

    Further developments have brought about different types of LASIK surgery, each offering new possibilities and new level of safety and precision. Several techniques are being tested to achieve the best result of the operation as much as possible.

    The idea of Thin Flap LASIK is already in its testing stage to hopefully address and minimize risks that appears after a surgery which are usually due to improperly cut or shaped flap.

    Developments are also ongoing regarding the use of all-femtosecond correction that uses femtosecod laser during the operation – from creating the flap to the ablation process.

    Another exciting development is the wavefront-guided PRK. This technique would allow surgeons to do surgical operation on rather complicated cases of astigmatism with the aid of equipment with wavefront sensors.

    The field of medicine has drastically changed over the past years thanks to scientific research and technological developments. These changes have cause unprecedented improvements in out lives and health as well. And with ongoing effects to improve if not perfect the technology, we can expect more. However, these technologies could not stand alone and still needs expertise to achieve optimal effect and result. So no matter what type of laser eye surgery of what technology one wishes to take advantage of, there is no denying that the surgeon's skill and experience still remains a top priority.

    Reducing Risks of LASIK Surgery: What You Can Do

    Last updated 3 months ago

    Surgery almost always comes bundled with risks. This is true with any forms of surgery. Understanding these risks, including the factors affecting them and how to reduce them, could help a prospective patient deal with, decide about and prepare for the procedure better.

    How to Reduce Risks

    The use of top-of-the-line surgical equipment and cutting-edge features coupled with the service of a skilled and experienced surgeon almost guarantees a very successful operation. However, in the field of medicine, the result would be also dependent on how the patient prepares for the procedure and how he takes care of himself after the procedure.

    The patient plays a very vital role in the success of the operation. The task of minimizing the risks starts with the preparation before the operation and continues even after the eye fully recovers.

    Although there are known risks associated with LASIK surgery, it can be significantly minimized with proper preoperative consultation and appropriate postoperative care. Understanding the risks and how to eliminate them could absolutely help make the patient feel better and be more confident about the operation. Hence, it is essential to take time to read through the guidelines.

     

    Red Eyes, Irritation and Discomfort

    Some common side effects experienced by nearly everyone who has undergone LASIK surgery are irritation, redness of the eye and mild discomfort. It is also common to experience sensitivity to bright light. These things tend to appear almost immediately after the procedure, but are oftentimes temporary. Such complications typically disappear after a few days or weeks as the eye slowly recovers.

    To help speed up the recovery process, patients could use prescribed medicines along with proper care of the eyes. Moreover, a prospective LASIK surgery patient needs to undergo thorough check up with the ophthalmologist to ensure that the eye is at its best condition prior to the operation, which is critical to help it recover faster.

    To optimize the eye's health, people who have been wearing contact lenses for a few months or years have to use special gas-permeable lenses. Better yet, they should stop using contact lenses altogether weeks or months before the scheduled operation. This is because the use of artificial lenses could affect the natural membranes of the eye, which is generally responsible for the eye's nourishment. If this membrane is not in good condition, then recovery could take longer time.

    Complications of the Flap

    Compared to other laser eye surgeries, LASIK keeps the epithelial membrane that covers the cornea. Since this membrane provides natural nutrients for the eye, keeping it promotes faster recovery.

    However, creating and replacing the corneal flap has possible complications, too. For instance, a misplaced corneal flap could cause aberrations. This could be a permanent condition and might require total removal of the membrane in order to address the problem.

    Luckily, the years of enhancing the procedure found a way to attend to this concern. The help of technologically-advanced, computer-aided surgical equipment minimizes the risk of incorrectly placing the flap. The surgeon’s experience also lessens the risks. As for the patient, he needs to make sure that the flap is not touched, moved or displaced while it heals. The use of protective eye shield or goggles would help avoid the possibility of touching the flap whether intentional or not.

    Eye Infection

    While recovering, the eye is very susceptible to infections. Some surgeons would require patients to take antibiotics after the procedure to help lower the risk of infection. The use of eye drop solutions is another effective supplement.

    Patients also need to make sure that his environment is sanitary. Dusts and dirt can hamper the eye’s recovery. At the same time, the gears used on or around the eye including bandages or eye wears should be sterilized. The eye should not be touch directly or by bare hands.

    Over-correction and Under-correction

    The surgical procedure entails reshaping the cornea through the use of laser technology so as to fix vision problems. Inappropriately shaped cornea could result to either over-correction or under-correction.

    These cases are less common but human error could lead to incorrect shaping of the cornea. Experience and training of the surgeon helps minimize these mistakes so it is best to choose the ophthalmologist that you can truly rely on.

    The use of computer-aided equipment also helps in identifying the ideal shape of the cornea. Some equipment could map the cornea in fine details so that the surgeon could correctly plan and re-shape it. These pre-operative preparations require the patient's cooperation as it may take several sessions to ensure that the eye condition has been correctly diagnosed.

    Over- and under-correction can be corrected with a follow-up procedure depending on the status of the cornea. In certain instances when the cornea is too thin to be reshaped, follow up surgery might not be an option. Instead, the patient will be advised to use contact lenses.

    Other Factors Affecting the Risks

    People with special medical conditions and those with advanced age or are pregnant are especially susceptible to risks. To assess an individual’s condition and determine the risks that could come with it, patients are advised to see an ophthalmologist to discuss the matter with.

    While LASIK surgery comes with risks, it does not have to be something the patient has to be very worried of. With the help of technological advancement and with accurate examination, some of these risks could be fully eliminated.

    However, it is still best for the patient to prepare for the operation as well as take care of his or her eyes after the procedure to get the best result.

    Finally, always get the expert service that you can trust when choosing your surgeon. Remember that no matter how good or advanced the equipment is, it could only be as good as its user. Professional assistance is the key for patients to understand what to do and what not to before and after the surgery. You need to get the services only from an expert with good reputation if you want optimal success of the operation.

    How Refractive Eye Surgery Came to Be

    Last updated 3 months ago

    Before the contact lenses were popularized in the 1950s, people suffering from vision problems have been relying on eyeglasses for more than seven centuries. Although it is the earliest and most practical means to correct refractive vision errors, people have eventually got tired of the heavy frames and large lenses of these glasses.

    With medical advancements, more advanced procedures are offered nowadays. These procedures range from surgical insertion of artificial lenses to the ablation of the cornea through the use of laser technology. Such methods aim to provide permanent solution and eradicate the reliance on artificial lenses.

     

    The Evolution

    For more than two decades, the surgical tools, techniques and procedures used in corrective eye surgeries have rapidly evolved. The tools and techniques have been refined to achieve a more precise result. Eventually, newer procedures were developed in an attempt to compensate the limitations of a previous system.

    Radial Keratotomy

    The precursor of all corrective eye surgeries, Radial Keratotomy (RK) was widely used in the United States during the 1980s. The surgeons cut spoke-like incisions on the patient’s cornea primarily to correct conditions of nearsightedness.

    Unfortunately, long-term results were unfavorable for some individuals. It created problems like significant glare, fluctuating vision, regression and night vision problems for many patients.

    Later on, the procedure underwent various modifications and enhancements to minimize its side-effects. This paved the way to laser vision correction procedures. At present, RK is no longer widely practiced by eye surgeons.

    LASIK and Other Refractive Eye Surgery Procedures

    Photorefractive Keratectomy

    Photorefractive Keratectomy (PRK) was the first successful procedure that used laser technology to remove tissues from the eye’s surface and reshape the cornea. It received FDA approval in 1995 and is still commonly used today.

    In this process, a thin layer of the cornea’s outer layer is completely removed to expose the area that requires ablation. Using an excimer laser, the excess tissues in the cornea are removed until its desired curvature is achieved.  Since no flap is created in PRK, new epithelial cells are developed to cover the eye’s surface.

    Pros:

    PRK is ideal for patients whose cornea is too thin to undergo LASIK or those who have undergone LASIK before with thinner residual cornea. This is a better option for people with chronically dry eyes, too. There are also no risks of flap complications, like epithelial inagrowth.

    Since it does not create corneal flap, the entire underlying stroma is available during treatment. Hence, it does not compromise the corneal thickness and the laser does not reach deeper tissues.

    Cons:

    PRK has comparatively slower recovery rate. This is because the epithelial cell takes longer time to grow back. It takes longer to achieve the best vision, too. In the early stage of recovery, PRK patients experience more discomfort than those who underwent LASIK. Finally, there are higher risks of post-surgery infection, haze and inflammation.

    Laser-Assisted in situ Keratomileusis

    The result of PRK can be comparable to that of LASIK surgery. This is because the two procedures are closely similar except that LASIK creates a flap from the epithelial layer to reach the underlying tissues. After the operation, the flap is repositioned to serve as natural bandage.

    Pros:

    LASIK has shorter recuperation period because regeneration of epithelial cells is much faster than the growth of new cells. The postoperative discomfort is usually mild and short-term. In fact, many patients can see normally a few hours after their operation. Their vision gradually improves before reaching peak quality after several weeks.

    Cons:

    The removal of thin flap from the cornea’s outer layer makes LASIK not suitable for patients with thin cornea. It also has the tendency to aggravate dry eye conditions. There have been reported cases of errors in the repositioning of the epithelial flap.

    Laser Epithelial Keratomileusis

    A variant of PRK, the Laser Epithelial Keratomileusis (LASEK) also removes the outer layers of the cornea completely. It uses an alcohol solution to loosen the epithelial cells before lifting it. LASEK uses laser technology, too, in reshaping the cornea.

    After the operation, the flap is replaced. The patient will have to wear soft contact lenses in the first few days following the surgery to secure the flap in place while it heals.

    Pros:

    LASEK is a less aggressive form of PRK. It is an ideal option for people with thin corneas who cannot undergo LASIK. This is also more effective for patients with higher prescription. Since only the outer surface layers are removed, the surgeon has more corneal tissues to work with.

    Cons:

    LASEK takes longer time to recover full vision compared to LASIK. After the operation, the patient also feels more uncomfortable.

    Bladeless/All-Laser LASIK

    Instead of using mechanical cutting tool, using laser in creating the flap out of the epithelial layer is another option. This is sometimes referred to as IntraLASIK because the laser used for this purpose was originally developed by IntraLase Corp. The use of laser and computer-aided technology grants the surgeon better control over the size and thickness of the flap to be created.

    Once the outer layer was removed, another type of laser, the excimer, is used to change the shape of the cornea’s curvature.

    Pros:

    Considered a superior form of LASIK, this procedure offers a more accurate result with fewer risks. Possible long-term damage on the cornea with traditional LASIK is also underplayed because of precision. Vision can be restored in a matter of hours, so the patient may return to work in a couple of days.

    Cons:

    The sole disadvantage of this procedure is its cost. This is one of the most expensive refractive eye surgeries at present.

    Which Procedure is Right for You?

    Without a doubt, these refractive eye surgeries are all safe and effective. These also carry high patient satisfaction rate. Thanks to the continuous progressions in medical technology, major drawbacks of every operation are being improved.

    All the same, certain conditions make a candidate more suitable for a certain procedure than the others. The best person to ask for recommendations will be a trained eye doctor. You will be subjected to preoperative consultations and examinations to identify which surgery works best for you. The great news is that no matter what procedure you choose, you will most certainly be pleased with its results. 

    LASIK 101 and FDA's Role

    Last updated 4 months ago

    Are you considering Lasik to improve your vision? Are you looking forward to finally say goodbye to your corrective lenses and your embarrassing daily routine of wearing eyeglasses or contact lenses? Good. You are taking the first step to having a better vision. However, a successful Lasik eye surgery entails more than just courage. It will need your time and effort to make an informed decision to achieve desirable results that you imagine.

    Just like you, Lasik has delighted and offered promising results to millions of individuals around the globe. However, this surgical procedure isn't entirely suited for everyone who has vision problems. When you are considering Lasik eye procedure, it is very important that you do have a very clear understanding of what is all about, the surgery's advantages and potential risk and most importantly, determining if you are a good candidate for the procedure. This is main reason why organizations such as the International Society of Refractive Surgery and the American Academy of Ophthalmology are continuously developing comprehensive guide to keep every individual informed regarding the Lasik procedure. More so, the Food and Drug Administration or also known as FDA is providing objective details right from the leading experts of Lasik Surgery of the country.

     

    FDA and LASIK

    LASIK or known as  Laser in Situ Keratomileusis was first approved as outpatient refractive procedure and for medical use by FDA in the year 1998. Since then, the procedure has already been gaining wide popularity from many patients. It has also been recorded that there are approximately seven hundred thousand Americans who have undergone the procedure every year, where most of these individuals are highly satisfied and happy with the results of their Lasik procedure. However, just like all medical surgeries, there were cases of eye infections and complications which were recorded. Some of these patients, have experienced significant side effects which have also affected their eye conditions and  their daily activities.

    LASIK – Understanding the Basics

    LASIK, by definition, is an outpatient surgical process that is employ to treat vision problems such as farsightedness, nearsightedness and astigmatism. This refractive eye procedure could not be reversed and may not give you the perfect vision, precise vision could slightly diminished in the long run because of age-related vision problems. Therefore, it is very essential to take these into considerations and set realistic expectations before finally undergoing the surgical procedure. In general, LASIK will use a laser in order to reshape the eye's cornea. By doing so, it will eventually improve the way our eyes focus on the light rays that enter the eye's retina, which will allow a better vision. During the procedure, a surgical device called an Excimer laser is used to reshape the cornea. The process will start by numbing the eye through a topical anesthetic, the doctor will out few drops on the eyes. Then a device known as speculum will be placed between the eyelids of the patient in order to keep them open and avoid from blinking. Suction ring will then be placed into your eyes lifting and flattening the eye's cornea, the moment is placed into the eyes the patient's vision will go black or may appear dim. A hinged flap of the patient's corneal tissue will be created by the surgeon with the use of an automated microsurgical device. After a paper thin flap is created, it is lifted and fold back, the flap won't adhere to your eye's surface as it is of the same strength it has prior to the surgery therefore there is just a very small chance of possibly risk of the flap to be displaced after the operation. The surgery won't take long, in fact it may just take approximately less than 20 minutes for both eyes to do the LASIK surgery. Once the surgery is done, the doctor will advise the patient to avoid rubbing the eyes, prevent engaging to certain activities and using certain products in the face that may affect your recovery process or contribute to development of eye infection. Sometimes, a surgeon will put a transparent protective shield over the eyes in order to prevent you from rubbing your eyes and protect your cornea. Additionally, there may be prescribed medications and eye drops that will be given after your surgery. This is to keep your eyes moist and avoid severe dry eyes syndrome. It would be highly helpful for you to ask for any prescriptions to reduce any feeling of discomfort during the recovery period.

    The Risks and the Rewards

    The possibly risk factors which may affect you to choose LASIK surgery are dry eye syndrome, degree of refractive issue age and any health related concerns that could possibly affect the healing process. If you proceed to obtain LASIK procedure even with dry eye syndrome and it is left untreated, you will greatly be disappointed. There is a huge chance of having this condition aggravated by LASIK surgery when it isn't diagnosed prior to the surgery or adequately treated. This is the reason why initial screening of the overall condition of the eyes is highly required to determine if LASIK is the right refractive procedure for you. In addition, patients who have very high level of refractive errors may not be suited for a LASIK surgery, followup operation may be needed when a patient persists to go for the procedure.

    One thing is for sure, LASIK was able to provide great benefits to millions of people. A lot of companies and even researchers are continuously developing more advanced methods and facilities to achieve even greater results. Many surgeons today are employing scanning laser prior to the actual surgery which provide several potential advantages. Therefore it is never a surprise why LASIK has been able to continually attract patients around the world. Many of these patients claim that they are finally allowed to function on their daily activities without their contact lenses and prescription glasses. Although it has been also previously said that results cannot be guaranteed, just like all surgical procedures, many patients were able to obtain improved vision, better lifestyle and even better quality of life. 

Do you like Boston Laser - Boston Eye Group?

Have Questions for Dr. Melki?

Enter your question now by clicking on the button!



  • Hours:

  • Closed Sunday
  • 8:00 AM to 5:00 PM Monday
  • 8:00 AM to 5:00 PM Tuesday
  • 8:00 AM to 6:15 PM Wednesday
  • 8:00 AM to 5:00 PM Thursday
  • 8:00 AM to 5:00 PM Friday
  • Closed Saturday


Links

  • Recent Posts
    • Loading posts... Spinner
  • View All
  • Recent Comments
    • Loading comments... Spinner
  • Popular Tags
    • Loading tags... Spinner