An Introduction to LASIK

History of LASIK

Over the years, especially in the latter half of the 20th century, rapid advancements have been made in the field of ophthalmology. Earlier eye surgery was a complex procedure involving invasive surgery and long recovery periods. The invention of the laser changed all that. Its use in a wide variety of fields included eye surgery as well.

Though LASIK surgery was itself developed in 1990 by Dr. Ioannis Pallikaris of Greece and Dr. Lucio Buratto of Italy, the concept of LASIK itself was formulated in 1970. In that year, Dr. Jose Barraquer came out with the first official microkeratome. A microkeratome is a device used to alter the shape of the cornea, a central component of the eye, by cutting thin flaps of it. This process was called keratomileusis. Keratomileusis was a procedure to correct the refraction of the cornea. This was achieved by removing a deep corneal lamella, freezing it, altering its curvature into a new one, and then replacing it.

LASIK is the abbreviation for a surgical procedure of the cornea – Laser-assisted In Situ Keratomileusis. This procedure was jointly developed by the two doctors named above by the fusion of two techniques – keratomileusis, which I have described earlier, and keratectomy. LASIK eye surgery is very widely used nowadays because of two important reasons:

  • Improved accuracy compared to other earlier corrective procedures involving the eye or the cornea.
  • Lesser complications compared to other existing techniques of its time.

In the United States, the first LASIK surgery was performed by Dr. Stephen Brint and Dr. Stephen Blade in 1991. In Germany the first LASIK surgery was performed in 1991 itself by Dr. Tobias Neuhann and Dr. Thomas using an automated keratome.

AS a side note, there is also the LASIK hair removal procedure. This is a procedure wherein extra hair in any part of the body can be removed by destroying the root of the hair follicle.

The LASIK Procedure

LASIK eye surgery is done in two stages:

  • The pre-operative stage
  • The operation itself

During the pre-operative stage contact lens users are asked to refrain from wearing them for a period varying from between a week to 10 days. Initial examinations of the cornea of the patient are made to detect irregularities in corneal shape, such as astigmatism. The examination is done using a computer-controlled scanner that shots low-power lasers to create a map of the person’s cornea. The surgeon prepares the coordinates for the surgery – the amount of corneal tissue to be removed, the location of the tissue, etc. the patient is also advised to use a mild antibiotic to reduce the chances of the cornea getting infected post-LASIK surgery.

At the start of the operation the patient is administered localized anesthesia in the form of an eye drop. The patient is usually awake during the procedure; he may however be given a sedative. The initial incision is made using a microkeratome or a femtosecond laser and a flap of the cornea at the designated location is cut. In doing so, the flap is folded back to expose the stroma, which is the mid-section of the cornea. Next an excimer laser is used to realign the stroma.

All through the process, the position of the eye is tracked by a computer, at speeds of 4,000 times per second.

LASIK Eye Surgery Complications

While LASIK surgery has its advantages, it has a few side effects as well. LASIK eye surgeons point out that there may be complications arising out of LASIK surgery, though these are not too frequently seen.

After LASIK surgery, a patient may encounter any of the following:

  • Halo/starbursts near sources of light
  • Visual acuity fluctuation
  • Under/overcorrection
  • Double vision
  • Striae, or wrinkles in the corneal flap
  • Erosion of the epithelium
  • Induced astigmatism
  • Sensitivity to light
  • Decentered ablation

Different LASIK Procedures

The popularity of LASIK as a surgical procedure has ensured the mushrooming of LASIK centers all across the United States. You could probably have a LASIK center right around the corner! Different LASIK eye centers use different LASIK procedures. In this section we will take a look at some of the procedures on offer in different parts of the United States, and also look at some newer procedures being used nowadays.

Conventional LASIK: This is the traditional method of performing LASIK, wherein the flap of the cornea is cut using a blade, or a microkeratome. While this process has its own merits, demerits include the possibility of flap-related complications, such as a:

  • Folded flap
  • Displaced flap
  • Slipped flap
  • Diffuse lamellar keratitis
  • Epithelial ingrowth

Bladeless LASIK: This involves having the incision made using another laser, a femtosecond or IntraLase. This minimizes the risk of complications that may arise out of a LASIK usng a microkeratome.

LASEK Eye Surgery: Laser Epithelial Keratomileusis (LASEK) is a variation of the traditional LASIK surgery. It is performed by a LASIK surgeon on a patient whose cornea is too thin for LASIK to be performed. An alcohol solution is used to make the removal of the epithelium easier. The disadvantage is that it entails a longer recovery period compared to traditional LASIK surgery techniques.

Epi-LASIK: Epithelial Laser In Situ Keratomileusis (Epi-LASIK) is another type of LASIK procedure that attempts to bring together the best of LASIK, PRK and LASEK. Epi-LASEK cuts out the complications that can arise out of LASIK, and also allows the patient a faster recovery time than PRK or LASEK.

WaveFront LASIK or Custom Wavefront: Wavefront LASIK or Custom Wavefront is a LASIK procedure that provides high precision corrections to corneal defects. The degree of precision is many times sharper than that given by lenses or even conventional LASIK. This is possible because Wavefront LASIK uses three dimensional measurements of the image-processing abilities of the human eye to aid the laser rearrange the cornea to eliminate corneal defects.

With the arrival of Wavefront LASIK, one can also improve the quality of their vision, in terms of being able to see things better in different circumstances than normally possible. It enables one to enhance the contrast sensitivity of the eye. Studies show that the increase in contrast sensitivity in nearly two times that of LASIK.

While it is difficult to determine which of these is the best LASIK procedure, the sensible thing to do would be to realize that each procedure has its own advantages and is suited to individual situations and scenarios. With the different LASIK vision centers providing different kinds of LASIK procedures, one has the luxury of making comparisons between the different options in terms of usability, price, etc. and then choosing the procedure that most suits his requirements.

References


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