After performing thousands of combined LASIK, LASEK, PRK and other refractive surgeries, Dr. Sucheski has compiled a list of the most common questions that arise in the free consultation session.
Will there be any pain during or after the LASIK procedure?
Surprisingly, there is very little pain experienced during or after the procedure. During LASIK, there is mild discomfort in the lids as the lid speculum is placed. During Intralase flap creation, a mild pressure is felt around the eye for about 20 seconds as the eye is held and prohibited from moving. There is absolutely no discomfort during the second vision correcting laser. Once the surgery is complete, the topical anesthetic wears off after about 30 minutes. We suggest closing the eyes for about 4 hours after surgery to avoid a sandy, burning sensation around the eyes. After 4-6 hours, there typically is very little pain, just a bit of light sensitivity. Uncommonly, patients may have mild discomfort for a few days after surgery.
How can you tell if I’m a candidate?
The consultation usually lasts about 40-60 minutes, and all necessary testing is performed. After topography, refraction, wavefront analysis, pachymetry and slit lamp/dilated exam, Dr. Sucheski will discuss your visual needs and testing with you. If he feels that he can meet your expectations and there are no high risk conditions, then you will be told you are a candidate for vision correction. If you are not a candidate, he’ll explain thoroughly why you shouldn’t have surgery.
What are the common risks?
Most common risks include dry eye, which often lasts up to 3-6 months after surgery (progressively improving as time passes): fluctuations of vision, haloes at nighttime that improve over time, undercorrections or overcorrections, that are often treatable with an enhancement surgery. Fortunately, all of these conditions have multiple treatment options based on their severity and the judgment of your doctor during the post operative checkups. Other side effects are more uncommon and will be detailed in your consent. LASIK is a surgical procedure, so no guarantees can be made with regards to complications.
How long until LASIK heals?
Typically the vision improves quickly so the majority of LASIK patients can drive the day following surgery. In general, the quality and crispness of vision improves for 3-6 months after the surgery. Reading vision may take several weeks to months to fully recover, especially in patients over 40. The healing of the flap usually heals in a few days to weeks. Contact sports are discouraged for 3 weeks after surgery. Rubbing the eye is discouraged for a few weeks. Eye shield are recommended for a few nights after surgery.
Can I go blind? What are the most severe risks?
To our knowledge, no report of complete blindness from LASIK exists. Fortunately, severe complications such as an infection, scarring, retinal problems, or irregular astigmatism (corneal ectasia) from flap or laser complications are rare, but possible with LASIK.
How long until I can work? How long until sports? When can I wear makeup?
Most patients can work within a day to a few days after surgery. Most surgeries are done on Thursdays, and a quick post operative exam is performed Friday. Many patients return to work after the checkup. Sports that may involve having an eye injury should be avoided for 3 weeks. Opening the eyes underwater in a swimming pool or spa should be avoided for 2 weeks to avoid infection. All eye makeup should be removed prior to LASIK. Eye makeup can be used a few days after surgery, with caution used in removing and applying it. We recommend starting new mascara when reapplying just after surgery.
Can I do anything during the procedure that would mess up my result?
No. With meticulous care on our part, nothing is likely to happen in surgery. During surgery, you will be asked to look at a target (fixation) light. If your eye moves a small amount, the laser is equipped with an active tracking device which follows your eye during the laser. If there is a large eye movement, the laser will stop treating until you are realigned. Dr. Sucheski calmly discusses what to expect and what role is needed by the patients during the procedure.
What percent of people are not candidates and why aren’t they qualified?
Approximately 20% of patients are not candidates due to either eye problems (irregular topography, very thin corneas, very high prescriptions, other eye diseases) or if their expectations for surgery are too high. The only way to tell if you are a candidate is the free, no obligation consultation.
What are your enhancement policies and what percent chance will I need one?
A laser enhancement is occasionally needed to improve vision further after a first laser surgery. An enhancement involves an additional laser procedure for any residual nearsightedness, farsightedness or astigmatism remaining after the primary LASIK. It usually is known within 3-12 months if this is needed due to an overcorrection or undercorrection. Our policy is there is no charge for a retreament in the first year after vision correction. After one year, changes in the eye are likely not due to the original LASIK. We currently charge $500-770/eye for retreatments after 2 years depending on the technology recommended. About 5% of patients need enhancements, with the risk being lower in low prescriptions and higher in very nearsighted patients. Other factors such as corneal thickness, etc. go into the decision of safety of retreatments, so continued eye care is recommended every 1-2 years after LASIK.
Why do I need to remove my contact lenses prior to surgery?
The FDA tested custom LASIK in people who had contacts out for at least 2 weeks prior to surgery. The wavefront analysis finds very small imperfections on the eye and incorporates them in the laser plan. Keeping the contacts out eliminates any distortions on the cornea caused by the contacts.
Are there any medical reasons you dissuade patients from surgery?
Contraindications are conditions listed in the FDA labeling as reasons why a potential patient absolutely should not have surgery.
- Uncontrolled diabetes - This leads to fluctuations in near and farsightedness and inaccurate measurements for LASIK. It also leads to premature cataracts and eventual retinal damage. Well controlled diabetics can be done.
- Pregnancy and nursing: Pregnancy commonly causes fluctuating vision. Therefore, measurements taken during pregnancy may not lead to a stable, accurate correction, once the baby is born. The same is true for nursing. Furthermore, around the time of laser vision correction antibiotic and steroid eye drops are prescribed, both of which should be avoided by pregnant and nursing women for fear of harming the baby.
- Immune deficiency: Diseases that decrease the body's immune status, such as HIV, increase the risk of unpredictable healing and infection.
- Collagen vascular diseases: Rheumatoid arthritis, scleroderma, psoriatic arthritis, dermatomyositis, ankylosing spondylitis, Bechet's disease and systemic lupus erythematosis are on the list of disqualifying medical conditions. Nonetheless, some surgeons are willing to treat patients whose disease is "mild and well-controlled".
- Keratoconus is a progressive, degenerative disorder in which a region of the cornea thins and bulges forward, leading to a conical shape, as opposed to the normal roundness.
- A handful of medications: Accutane, an oral anti-acne drug, causes an unacceptably high risk of corneal scarring and dry-eye related complications, so patients must be off of Accutane for a minimum of six months before surgery.
- Amiodarone, a medication used to control irregular heart rhythms, forms deposits within the cornea that may affect the accuracy and healing of laser vision correction, so amiodarone users must avoid surgery.
- Migraine headache medications of the triptan family, such as Imitrex, are often listed as a contraindication to surgery.
Can you fix astigmatism?
Yes, most types of astigmatism can be corrected including farsighted astigmatism, mixed astigmatism and nearsighted astigmatism. Irregular astigmatism may not be able to be fixed.
Is LASIK permanent? Will I need glasses ever again? Can LASIK be redone later in life?
The effects of LASIK are permanent. However, as we age, our eyes may slowly change again. Patients whose eyes are not changing in prescription much prior to LASIK usually remain distance glasses independent for many years. After the age of 40, most patients lose their range of clear vision (presbyopia), so most patients will need reading glasses eventually. Monovison options will be discussed if appropriate. Monovision means the non-dominant eye is intentionally left with some nearsighted prescription to aid in reading vision. Not all patients like monovision. If the eyes do change later in life, LASIK or PRK may be able to be repeated on a case-by-case basis.
Does my insurance cover any part of my LASIK?
Most insurers do not cover LASIK. Some insurers offer a “discount” in which they offer surgeons referrals if they lower their surgical charges to members of the insurance. No quality screening of the surgeon takes place in these arrangements.
Why is PRK recommended in some cases, and what can I expect from PRK?
PRK is recommended in patients with thin corneas, a fear/contraindication to a LASIK flap, and risk adverse patients. In PRK, the same laser with the same wavefront data is lasered onto the cornea. The laser is simply done on the top surface of the eye on a layer of the cornea known as Bowman’s layer. PRK is less popular than LASIK only because of its delayed visual recovery and more discomfort. Dr. Sucheski has been able to shorten PRK’s recovery through his techniques, so that most patients see well enough to drive and work after 4-5 days. In PRK, a bandage contact lens is fit and worn through 4 days and “discomfort” aiding drops are given. Patients that have PRK can expect equivalent visual outcomes to LASIK within a few weeks of the surgery. In general, there is less dry eye in PRK from months one through three after surgery. Dr. Sucheski will discuss how he expects your PRK may heal.